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  • 246751. Östberg, Per-Olov
    et al.
    Hellander, Andreas
    Drawert, Brian
    Elmroth, Erik
    Holmgren, Sverker
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Scientific Computing. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computational Science.
    Petzold, Linda
    Reducing complexity in management of eScience computations2012In: Proc. 12th International Symposium on Cluster, Cloud and Grid Computing, Los Alamitos, CA: IEEE Computer Society, 2012, p. 845-852Conference paper (Refereed)
  • 246752.
    Östberg, Sara
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Functional Characterization of the Evolutionarily Conserved Adenoviral Proteins L4-22K and L4-33K2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Regulation of adenoviral gene expression is a complex process directed by viral proteins controlling a multitude of different activities at distinct phases of the virus life cycle. This thesis discusses adenoviral regulation of transcription and splicing by two proteins expressed at the late phase: L4-22K and L4-33K. These are closely related with a common N-terminus but unique C-terminal domains. The L4-33K protein is an alternative RNA splicing factor inducing L1-IIIa mRNA splicing, while L4-22K is stimulating transcription from the major late promoter (MLP). The L4-33K protein contains a tiny RS-repeat in its unique C-terminal end that is essential for the splicing enhancer function of the protein. Here we demonstrate that the tiny RS-repeat is required for localization of the protein to the nucleus and viral replication centers. Further, we describe an auto-regulatory loop where L4-33K enhances splicing of its own intron. The preliminary characterization of the responsive RNA-element suggests that it differs from the previously defined L4-33K-responsive element activating L1-IIIa mRNA splicing.

    L4-22K lacks the ability to enhance L1-IIIa splicing in vivo, and here we show that the protein is defective in L1-IIIa or other late pre-mRNA splicing reactions in vitro. Interestingly, we found a novel function for the L4-22K and L4-33K proteins as regulators of E1A alternative splicing. Both proteins selectively upregulated E1A-10S mRNA accumulation in transfection experiments, by a mechanism independent of the tiny RS-repeat.

    Although L4-22K is reported to be an MLP transcriptional enhancer protein, here we show that L4-22K also functions as a repressor of MLP transcription. This novel activity depends on the integrity of the major late first leader 5’ splice site. The model suggests that at low concentrations L4-22K activates MLP transcription while at high concentrations L4-22K represses transcription.

    So far, characterizations of the L4-22K and L4-33K proteins have been limited to human adenoviruses 2 or 5 (HAdV-2/5). We expanded our experiments to include HAdV-3, HAdV-4, HAdV-9, HAdV-11 and HAdV-41. The results demonstrated that the transcription- or splicing-enhancing properties of L4-22K and L4-33K, respectively, are evolutionarily conserved and non-overlapping. Thus, the sequence-based conservation is mirrored by the functions, as expected for functionally important proteins.

    List of papers
    1. Serine 192 in the tiny RS repeat of the adenoviral L4-33K splicing enhancer protein is essential for function and reorganization of the protein to the periphery of viral replication centers
    Open this publication in new window or tab >>Serine 192 in the tiny RS repeat of the adenoviral L4-33K splicing enhancer protein is essential for function and reorganization of the protein to the periphery of viral replication centers
    2012 (English)In: Virology, ISSN 0042-6822, E-ISSN 1096-0341, Vol. 433, no 2, p. 273-281Article in journal (Refereed) Published
    Abstract [en]

    The adenovirus L4-33K protein is a key regulator involved in the temporal shift from early to late pattern of mRNA expression from the adenovirus major late transcription unit. L4-33K is a virus-encoded alternative splicing factor, which enhances processing of 3’ splice sites with a weak sequence context. Here we show that L4-33K expressed from a transfected plasmid has a diffuse nuclear localization with strong enrichment in the nuclear membrane. We further show that the highly conserved part of the carboxy-terminal end of L4-33K, which functions as the splicing enhancer domain, is sufficient for nuclear localization of the protein. Interestingly, infection of the transfected cells caused a redistribution of L4-33K from the nuclear membrane into discrete ring-like structures corresponding to the viral transcription sites. We also show that serine 192 in the tiny RS repeat, which is critical for the splicing enhancer function of L4-33K, is necessary for the nuclear localization and redistribution of L4-33K protein into viral transcription sites. Collectively, our results show a good correlation between the activity of L4-33K as a splicing enhancer protein and its localization to viral transcription sites.

    Keywords
    L4-33K, L4-22K, splicing, localization, adenovirus, replication centers, transcription sites, peripheral replicative zone
    National Category
    Microbiology in the medical area
    Identifiers
    urn:nbn:se:uu:diva-159614 (URN)10.1016/j.virol.2012.08.021 (DOI)000310095700001 ()22944109 (PubMedID)
    Available from: 2011-10-05 Created: 2011-10-05 Last updated: 2018-01-12Bibliographically approved
    2. A suppressive effect of the first leader 5’ splice site on L4-­22K-­mediated activation of major late transcription
    Open this publication in new window or tab >>A suppressive effect of the first leader 5’ splice site on L4-­22K-­mediated activation of major late transcription
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-238486 (URN)
    Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2015-03-09
    3. RNA elements involved in adenovirus L4-33K regulation of alternative splicing
    Open this publication in new window or tab >>RNA elements involved in adenovirus L4-33K regulation of alternative splicing
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-237965 (URN)
    Available from: 2014-12-12 Created: 2014-12-08 Last updated: 2015-03-09
    4. Conservation of the transcriptional and post-­transcriptional activities of serotype-­specific adenovirus L4 proteins
    Open this publication in new window or tab >>Conservation of the transcriptional and post-­transcriptional activities of serotype-­specific adenovirus L4 proteins
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-238482 (URN)
    Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2015-03-09
  • 246753.
    Östberg, Sara
    et al.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Backström Winquist, Ellenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Akusjärvi, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    RNA elements involved in adenovirus L4-33K regulation of alternative splicingManuscript (preprint) (Other academic)
  • 246754.
    Östberg, Sara
    et al.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Biasiotto, Roberta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Akusjärvi, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Conservation of the transcriptional and post-­transcriptional activities of serotype-­specific adenovirus L4 proteinsManuscript (preprint) (Other academic)
  • 246755.
    Östberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Törmänen Persson, Heidi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Akusjärvi, Göran
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Serine 192 in the tiny RS repeat of the adenoviral L4-33K splicing enhancer protein is essential for function and reorganization of the protein to the periphery of viral replication centers2012In: Virology, ISSN 0042-6822, E-ISSN 1096-0341, Vol. 433, no 2, p. 273-281Article in journal (Refereed)
    Abstract [en]

    The adenovirus L4-33K protein is a key regulator involved in the temporal shift from early to late pattern of mRNA expression from the adenovirus major late transcription unit. L4-33K is a virus-encoded alternative splicing factor, which enhances processing of 3’ splice sites with a weak sequence context. Here we show that L4-33K expressed from a transfected plasmid has a diffuse nuclear localization with strong enrichment in the nuclear membrane. We further show that the highly conserved part of the carboxy-terminal end of L4-33K, which functions as the splicing enhancer domain, is sufficient for nuclear localization of the protein. Interestingly, infection of the transfected cells caused a redistribution of L4-33K from the nuclear membrane into discrete ring-like structures corresponding to the viral transcription sites. We also show that serine 192 in the tiny RS repeat, which is critical for the splicing enhancer function of L4-33K, is necessary for the nuclear localization and redistribution of L4-33K protein into viral transcription sites. Collectively, our results show a good correlation between the activity of L4-33K as a splicing enhancer protein and its localization to viral transcription sites.

  • 246756.
    Östberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Åsbrink, Tilda
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Välkomna till verkligheten: En studie om Försvarsmaktens möjligheter att minska soldaters benägenhet till att sluta2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Ijuli2010gickSverigefrånallmänvärnplikttillfrivilligmilitärutbildningochyrketsoldatblevenstatliganställningsform.Försvarsmaktenharidagsommålattsoldaternaskastannaimellansextillåttaår.Organisationenuppleverdockinulägetproblemmedenhögpersonalomsättningavsoldatersomväljerattslutaiförtid.SyftetmeddennastudieärattskapaendjupareförståelseförhurchefersomarbetarpåstrategisknivåinomFörsvarsmaktenuppleverproblematikenmeddenhögapersonalomsättningsområderidag,samtvilkamöjligheterdeharattminskasoldaternasbenägenhettillattsluta.StudienäravkvalitativkaraktärochgrundaspåfyrakvalitativaintervjuermedfyraolikachefersomarbetarpåstrategisknivåinomolikaavdelningarpåFörsvarsmakten.Istudienkommerviframtillattchefernaharbegränsademöjlighetertillattminskasoldaternasbenägenhettillattsluta.Dettaberorblandannatpåbegränsademöjligheteratterbjudasoldaternakarriär-­‐ochutvecklingsmöjligheter,skapaettvärdeianställningen,erbjudavarierandearbetsuppgifter,skickasoldaternapåutlandstjänstsamtbegränsademöjligheteriattlevaupptillsoldaternasförväntningarsomdefåttgenomdebilderavFörsvarsmaktensommålasuppimedia.

  • 246757.
    Östberg, Viveca
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Låftman Brolin, Sara
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Inequalities in subjective health complaints in Swedish adolescents: An intersectional approach2016Conference paper (Other academic)
    Abstract [en]

    Background

    Health inequality has been defined as the association between individuals’ health and their position in societal hierarchies. Such associations can be used as a starting-point in the search for social determinants of health. With regard to subjective health complaints among adolescents the evidence of socio-economic inequalities has been inconclusive. Inequalities by gender are, in contrast, clear and a female excess emerge or increase during adolescence. The aim of this study is to apply an intersectional approach and analyse differences in health complaints by parental education among girls and boys, taking age into account. Furthermore, data with information from both adolescents and their parents will be used which is ideal since adolescents seldom have correct information on parental education.

    Methods

    The data was obtained from a Swedish nationally representative survey (ULF) and its child supplement (Child-ULF) from the years 2007-2011 (n = 5280). Subjective health complaints were reported by adolescents (aged 10-18) and measures indicating psychological (e.g. feeling sad) and somatic complaints (i.e. head- and stomach ache) calculated. Information on education was obtained for one parent and five educational groups distinguished. Binary logistic regression was used and odds ratios with 95% confidence limits computed.

    Results

    Among girls, a clear gradient was found. From higher to lower level of parental education the odds ratios for psychological complaints were; 1.00 (ref); 1.07 (0.7-1.6); 1.38 (1.0-2.0); 1.73 (1.3-2.4); 2.05 (1.3-3.3); and for somatic complaints; 1.00 (ref); 1.27 (0.8-1.9); 1.55 (1.1-2.3); 1.69 (1.2-2.4); 2.82 (1.8-4.5). No association was found among boys. Gender differences per se were pervasive and, in ages where female excess is present, substantial within all educational groups.

    Conclusions

    The higher burden of subjective health complaints in adolescent girls is unequally distributed by the level of parental education.

    Key message:

    The increased reporting of girls, makes efforts to identify social determinants vital. Among Swedish girls such determinants are tied to parental education

  • 246758.
    Östberg, Erland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Pulmonary Atelectasis in General Anaesthesia: Clinical Studies on the Counteracting Effects of Positive End-Expiratory Pressure2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Partial lung collapse, i.e., pulmonary atelectasis, is common during general anaesthesia. The main causal mechanism is reduced lung volume with airway closure and subsequent gas absorption from preoxygenated alveoli. Atelectasis impairs oxygenation and forms the pathophysiological basis for postoperative pulmonary complications. Positive end-expiratory pressure (PEEP) counteracts the loss in lung volume, but its role in preventing atelectasis during anaesthesia is not clear.

    All studies included in this thesis were prospective randomized clinical trials. In the first study, oxygenation was used as a surrogate measure of atelectasis in obese patients undergoing laparoscopic gastric bypass. The subsequent studies used single-slice computed tomography (CT) to evaluate atelectasis in healthy patients undergoing non-abdominal surgery.

    Paper I: We studied the use of continuous positive airway pressure (CPAP) and PEEP during induction of anaesthesia and a reduced inspired oxygen fraction (FiO2) during emergence. Oxygenation was maintained in the group that received CPAP during induction, followed by a PEEP of 10 cmH2O. Postoperative oxygenation was impaired in the group that received a high FiO2 during emergence.

    Paper II: An early oxygen washout manoeuvre to quickly restore nitrogen levels and thus stabilize the alveoli, had no effect on atelectasis at the end of surgery. Both study groups exhibited small atelectasis after being ventilated with a moderate PEEP of 6-8 cmH2O during anaesthesia.

    Paper III: The effect of PEEP versus zero PEEP on atelectasis formation and oxygenation at the end of surgery was compared. The PEEP group maintained oxygenation better and exhibited less atelectasis than the zero-PEEP group, with atelectasis involving a median 1.8% of total lung area compared with 4.6% in the zero-PEEP group (P = 0.002).

    Paper IV: Postoperative atelectasis was compared between a group in which PEEP was maintained during emergence preoxygenation with FiO2 1.0 and a group in which PEEP was withdrawn just before the start of emergence preoxygenation with FiO2 1.0. The two groups had small atelectasis when fully awake at 30 min after extubation, with no statistically significant difference between them.  

    In conclusion, preserved end-expiratory lung volume is the key to avoiding atelectasis, in particular when an increased oxygen reserve is required during airway manipulation. PEEP is both necessary and sufficient to minimize atelectasis in healthy patients undergoing non-abdominal surgery.

    List of papers
    1. Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study
    Open this publication in new window or tab >>Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study
    Show others...
    2016 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 1, p. 26-35Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery.

    METHODS: In the intervention group (n = 20, median BMI 41.9), a CPAP of 10 cmH2 O was used during pre-oxygenation and induction of anaesthesia, but no CPAP was used in the control group (n = 20, median BMI 38.1). During anaesthesia, all patients were ventilated in volume-controlled mode with an FIO2 of 0.4 and a positive end-expiratory pressure (PEEP) of 10 cmH2 O. During emergence, before extubation, the control group was given an FIO2 of 1.0 and the intervention group was divided into two subgroups, which were given an FIO2 of 1.0 or 0.31. Oxygenation was assessed perioperatively by the estimated venous admixture (EVA).

    RESULTS: The median EVA before pre-oxygenation was about 8% in both groups. During anaesthesia after intubation, the median EVA was 8.2% in the intervention vs. 13.2% in the control group (P = 0.048). After CO2 pneumoperitoneum, the median EVA was 8.4% in the intervention vs. 9.9% in the control group (P > 0.05). One hour post-operatively, oxygenation had deteriorated in patients given an FIO2 of 1.0 during emergence but not in patients given an FIO2 of 0.31.

    CONCLUSIONS: A CPAP of 10 cmH2 O during pre-oxygenation and induction, followed by PEEP after intubation, seemed to preserve oxygenation during anaesthesia. Post-operative oxygenation depended on the FIO2 used during emergence.

    National Category
    Anesthesiology and Intensive Care
    Research subject
    Physiology; Anaesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-264212 (URN)10.1111/aas.12588 (DOI)000368139400005 ()26235391 (PubMedID)
    Available from: 2015-10-07 Created: 2015-10-07 Last updated: 2019-04-08
    2. Minimizing atelectasis formation during general anaesthesia-oxygen washout is a non-essential supplement to PEEP
    Open this publication in new window or tab >>Minimizing atelectasis formation during general anaesthesia-oxygen washout is a non-essential supplement to PEEP
    Show others...
    2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 92-98Article in journal (Refereed) Published
    Abstract [en]

    Background: Following preoxygenation and induction of anaesthesia, most patients develop atelectasis. We hypothesized that an immediate restoration to a low oxygen level in the alveoli would prevent atelectasis formation and improve oxygenation during the ensuing anaesthesia. Methods: We randomly assigned 24 patients to either a control group (n=12) or an intervention group (n=12) receiving an oxygen washout procedure directly after intubation. Both groups were, depending on body mass index, ventilated with a positive end-expiratory pressure (PEEP) of 6-8 cmH(2)O during surgery. The atelectasis area was studied by computed tomography before emergence. Oxygenation levels were evaluated by measuring blood gases and calculating estimated venous admixture (EVA). Results: The atelectasis areas expressed as percentages of the total lung area were 2.0 (1.5-2.7) (median [interquartile range]) and 1.8 (1.4-3.3) in the intervention and control groups, respectively. The difference was non-significant, and also oxygenation was similar between the two groups. Compared to oxygenation before the start of anaesthesia, oxygenation at the end of surgery was improved in the intervention group, mean (SD) EVA from 7.6% (6.6%) to 3.9% (2.9%) (P=.019) and preserved in the control group, mean (SD) EVA from 5.0% (5.3%) to 5.6% (7.1%) (P=.59). .Conclusion: Although the oxygen washout restored a low pulmonary oxygen level within minutes, it did not further reduce atelectasis size. Both study groups had small atelectasis and good oxygenation. These results suggest that a moderate PEEP alone is sufficient to minimize atelectasis and maintain oxygenation in healthy patients.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2017
    Keywords
    Atelectasis, computed tomography, general anaesthesia, oxygenation, PEEP, protective ventilation, ventilator settings
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-323496 (URN)10.1080/03009734.2017.1294635 (DOI)000401756500004 ()28434271 (PubMedID)
    Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2019-04-08Bibliographically approved
    3. Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery: A Randomized Controlled Trial
    Open this publication in new window or tab >>Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery: A Randomized Controlled Trial
    Show others...
    2018 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 128, no 6, p. 1117-1124Article in journal (Refereed) Published
    Abstract [en]

    Background: Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery. Methods: This was a randomized controlled evaluator-blinded study. Twenty-four healthy patients undergoing general anesthesia were randomized to receive either mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index (n = 12) or zero PEEP (n =12). No recruitment maneuvers were used. Hie primary outcome was atelectasis area as studied by computed tomography in a transverse scan near the diaphragm, at the end of surgery, before emergence. Oxygenation was evaluated by measuring blood gases and calculating the ratio of arterial oxygen partial pressure to inspired oxygen fraction (Pao(2)/Fio(2) ratio). Results: At the end of surgery, the median (range) atelectasis area, expressed as percentage of the total lung area, was 1.8 (0.3 to 9.9) in the PEEP group and 4.6 (1.0 to 10.2) in the zero PEEP group. Tire difference in medians was 2.8% (95% CI, 1.7 to 5.7%; A = 0.002). Oxygenation and carbon dioxide elimination were maintained in the PEEP group, but both deteriorated in the zero PEEP group. Conclusions: During nonabdominal surgery, adequate PEEP is sufficient to minimize atelectasis in healthy lungs and thereby maintain oxygenation. Titus, routine recruitment maneuvers seem unnecessary, and the authors suggest that they should only be utilized when clearly indicated.

    Place, publisher, year, edition, pages
    LIPPINCOTT WILLIAMS & WILKINS, 2018
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-363070 (URN)10.1097/ALN.0000000000002134 (DOI)000441172900012 ()29462011 (PubMedID)
    Available from: 2018-10-12 Created: 2018-10-12 Last updated: 2019-04-08Bibliographically approved
    4. Positive end-expiratory pressure and postoperative atelectasis: A randomized controlled trial
    Open this publication in new window or tab >>Positive end-expiratory pressure and postoperative atelectasis: A randomized controlled trial
    Show others...
    2019 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175Article in journal (Refereed) In press
    Abstract [en]

    Background

    Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation preparatory to extubation makes the lung susceptible to gas absorption and alveolar collapse, especially in dependent regions being kept open by PEEP. We hypothesized that withdrawing PEEP before starting emergence preoxygenation would limit postoperative atelectasis formation.

    Methods

    This was a randomized controlled evaluator-blinded trial in 30 healthy patients undergoing non-abdominal surgery under general anesthesia and mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index. A computed tomography scan at the end of surgery assessed baseline atelectasis. The study subjects were thereafter allocated to either maintained PEEP (n = 16) or zero PEEP (n = 14) during emergence preoxygenation. The primary outcome was change in atelectasis area as evaluated by a second computed tomography scan 30 min after extubation. Oxygenation was assessed by arterial blood gases.

    Results

    Baseline atelectasis was small and increased modestly during awakening, with no statistically significant difference between groups. With PEEP applied during awakening, the increase in atelectasis area was median (range) 1.6 (-1.1 to 12.3) cm2 and without PEEP 2.3 (-1.6 to 7.8) cm2. The difference was 0.7 cm2 (95% CI, -0.8 to 2.9 cm2; P = 0.400). Postoperative atelectasis for all patients was median 5.2 cm2 (95% CI, 4.3 to 5.7 cm2), corresponding to median 2.5% of the total lung area (95% CI, 2.0 to 3.0%). Postoperative oxygenation was unchanged in both groups when compared to oxygenation in the preoperative awake state.

    Conclusion

    Withdrawing PEEP before emergence preoxygenation does not reduce atelectasis formation after non-abdominal surgery. Despite using 100% O2 during awakening, postoperative atelectasis is small and does not affect oxygenation, possibly conditional on an open lung during anesthesia, as achieved by intraoperative PEEP.

    National Category
    Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-381346 (URN)
    Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-04-08
  • 246759.
    Östberg, Erland
    et al.
    Västerås & Koping Hosp, Dept Anaesthesia & Intens Care, Västerås, Sweden..
    Auner, Udo
    Vasteras Hosp, Dept Radiol, Västerås, Sweden..
    Enlund, Mats
    Clin Res Ctr, Västerås, Sweden..
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Edmark, Lennart
    Västeras & Koping Hosp, Dept Anaesthesia & Intens Care, Västerås, Sweden..
    Minimizing atelectasis formation during general anaesthesia-oxygen washout is a non-essential supplement to PEEP2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 92-98Article in journal (Refereed)
    Abstract [en]

    Background: Following preoxygenation and induction of anaesthesia, most patients develop atelectasis. We hypothesized that an immediate restoration to a low oxygen level in the alveoli would prevent atelectasis formation and improve oxygenation during the ensuing anaesthesia. Methods: We randomly assigned 24 patients to either a control group (n=12) or an intervention group (n=12) receiving an oxygen washout procedure directly after intubation. Both groups were, depending on body mass index, ventilated with a positive end-expiratory pressure (PEEP) of 6-8 cmH(2)O during surgery. The atelectasis area was studied by computed tomography before emergence. Oxygenation levels were evaluated by measuring blood gases and calculating estimated venous admixture (EVA). Results: The atelectasis areas expressed as percentages of the total lung area were 2.0 (1.5-2.7) (median [interquartile range]) and 1.8 (1.4-3.3) in the intervention and control groups, respectively. The difference was non-significant, and also oxygenation was similar between the two groups. Compared to oxygenation before the start of anaesthesia, oxygenation at the end of surgery was improved in the intervention group, mean (SD) EVA from 7.6% (6.6%) to 3.9% (2.9%) (P=.019) and preserved in the control group, mean (SD) EVA from 5.0% (5.3%) to 5.6% (7.1%) (P=.59). .Conclusion: Although the oxygen washout restored a low pulmonary oxygen level within minutes, it did not further reduce atelectasis size. Both study groups had small atelectasis and good oxygenation. These results suggest that a moderate PEEP alone is sufficient to minimize atelectasis and maintain oxygenation in healthy patients.

  • 246760.
    Östberg, Erland
    et al.
    Västerås & Köping Hosp, Dept Anesthesia & Intens Care, Västerås, Sweden.
    Thorisson, Arnar
    Västerås & Köping Hosp, Dept Radiol, Västerås, Sweden.
    Enlund, Mats
    Clin Res Ctr, Västerås, Sweden.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Edmark, Lennart
    Västerås & Köping Hosp, Dept Anesthesia & Intens Care, Västerås, Sweden.
    Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery: A Randomized Controlled Trial2018In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 128, no 6, p. 1117-1124Article in journal (Refereed)
    Abstract [en]

    Background: Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery. Methods: This was a randomized controlled evaluator-blinded study. Twenty-four healthy patients undergoing general anesthesia were randomized to receive either mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index (n = 12) or zero PEEP (n =12). No recruitment maneuvers were used. Hie primary outcome was atelectasis area as studied by computed tomography in a transverse scan near the diaphragm, at the end of surgery, before emergence. Oxygenation was evaluated by measuring blood gases and calculating the ratio of arterial oxygen partial pressure to inspired oxygen fraction (Pao(2)/Fio(2) ratio). Results: At the end of surgery, the median (range) atelectasis area, expressed as percentage of the total lung area, was 1.8 (0.3 to 9.9) in the PEEP group and 4.6 (1.0 to 10.2) in the zero PEEP group. Tire difference in medians was 2.8% (95% CI, 1.7 to 5.7%; A = 0.002). Oxygenation and carbon dioxide elimination were maintained in the PEEP group, but both deteriorated in the zero PEEP group. Conclusions: During nonabdominal surgery, adequate PEEP is sufficient to minimize atelectasis in healthy lungs and thereby maintain oxygenation. Titus, routine recruitment maneuvers seem unnecessary, and the authors suggest that they should only be utilized when clearly indicated.

  • 246761.
    Östberg, Erland
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Thorisson, Arnar
    Enlund, Mats
    Zetterström, Henrik
    Hedenstierna, Göran
    Edmark, Lennart
    Positive end-expiratory pressure and postoperative atelectasis: A randomized controlled trial2019In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175Article in journal (Refereed)
    Abstract [en]

    Background

    Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation preparatory to extubation makes the lung susceptible to gas absorption and alveolar collapse, especially in dependent regions being kept open by PEEP. We hypothesized that withdrawing PEEP before starting emergence preoxygenation would limit postoperative atelectasis formation.

    Methods

    This was a randomized controlled evaluator-blinded trial in 30 healthy patients undergoing non-abdominal surgery under general anesthesia and mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index. A computed tomography scan at the end of surgery assessed baseline atelectasis. The study subjects were thereafter allocated to either maintained PEEP (n = 16) or zero PEEP (n = 14) during emergence preoxygenation. The primary outcome was change in atelectasis area as evaluated by a second computed tomography scan 30 min after extubation. Oxygenation was assessed by arterial blood gases.

    Results

    Baseline atelectasis was small and increased modestly during awakening, with no statistically significant difference between groups. With PEEP applied during awakening, the increase in atelectasis area was median (range) 1.6 (-1.1 to 12.3) cm2 and without PEEP 2.3 (-1.6 to 7.8) cm2. The difference was 0.7 cm2 (95% CI, -0.8 to 2.9 cm2; P = 0.400). Postoperative atelectasis for all patients was median 5.2 cm2 (95% CI, 4.3 to 5.7 cm2), corresponding to median 2.5% of the total lung area (95% CI, 2.0 to 3.0%). Postoperative oxygenation was unchanged in both groups when compared to oxygenation in the preoperative awake state.

    Conclusion

    Withdrawing PEEP before emergence preoxygenation does not reduce atelectasis formation after non-abdominal surgery. Despite using 100% O2 during awakening, postoperative atelectasis is small and does not affect oxygenation, possibly conditional on an open lung during anesthesia, as achieved by intraoperative PEEP.

  • 246762.
    Östblom, Desirée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Sjölander, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Kartläggning av och skillnader i postoperativa restriktioner vid primär total höftplastik utfört med direktlateralt snitt hos utförande sjukhus i Sverige2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Total hip arthroplasty (THA) is commonly performed on patients with hip osteoarthritis when conservative treatment no longer reliefs pain sufficiently. Movement restrictions are applied to prevent hip dislocations, although those have recently been questioned since studies have shown that a liberal regimen does not increase the risk of hip dislocation.

    Purpose: To chart movement restrictions following THA performed with a direct lateral approach at Swedish hospitals and analyzes differences in those between university hospital, county hospitals, district hospitals and private hospitals. This study also aimed to chart non- standardized movement restrictions.

    Method: A cross-sectional study with a descriptive and comparative design. Data was collected from a self-made web survey, which was answered by 42 hospitals.

    Results: The appliance of restrictions regarding flexion beyond 90°, external rotation beyond 45°, internal rotation beyond 45°, adduction beyond centerline and flexion of 90° or beyond combined with adduction and rotation varied among the participating hospitals. There were no significant differences between participating hospital groups regarding mentioned movements. Non-standardized restrictions were influenced by the individual factors of the patient as well as the prosthesis type. Patients were also recommended to not perform any extreme movements.

    Conclusion: There is a variation regarding appliance of postoperative restrictions during the first six weeks postoperatively. In the light of the results of this study, together with recent evidence postoperative, restrictions should be further discussed. 

  • 246763.
    Östblom, Karin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Law, Department of Law.
    Nationell rätt anses vara överordnad internationell rätt: avseende dubbelbeskattningsavtalet mellan Sverige och Kina2013Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 246764.
    Östblom, Kristin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Kvinnlighet frihet eller förtryck?: En kvalitativ intervjustudie om ideal bland unga tjejer2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 246765.
    Östbom, Gunilla
    et al.
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Domestic Sciences. Textil.
    Svennerstedt, Bengt
    Fibre quality of hemp grown on the Swedish island Gotland2005In: Textiles for Sustainable Developments: The FAO/Escorena International Conferens, 2005, p. 632-Conference paper (Other scientific)
    Abstract [en]

    Title Hemp fibre, a textile fibre from the Swedish island Gotland in the Baltic Sea

    Keywords Hemp, Cannabis Sativa, Textile, Strength, Fineness

    Author (s) Gunilla Östbom1) & Bengt Svennerstedt2)

    Address 1) Department of Domestic Science, Trädgårdsgatan 14, Uppsala University,SE-753 09 UPPSALA, Sweden (corresponding author)2) Biofibre Technology Research Group, Department of JBT, Swedish University of Agricultural Sciences, P.O. Box 86, SE-230 53 ALNARP, Sweden

    Telephone 1) +46 18 471 23 13 (corresponding author)

    Fax 1) +46 18 471 23 21 (corresponding author)

    Mobile 1) +46 70 362 39 71 (corresponding author)

    E-mail 1) Gunilla.Ostbom@ihv.uu.se (corresponding author)2) Bengt.Svennerstedt@jbt.slu.se

    Abstract ID no.(to be assigned by conference organisers)

    Abstract:

    Hemp, Cannabis sativa L has been grown for its fibres for thousands of years. In Sweden it has been prohibited to cultivate hemp for about 40 years, but now it is possible for farmers to grow it again. Before the ban, Gotland, a limestone island in the centre of the Baltic Sea, was the last major growing area in Sweden. At that time the main crop was used for production of rope. During later years, hemp has received increased interest as a sustainable crop and for a multitude of possible uses. To use hemp as a textile fibre, knowledge of the properties of varieties and under different growing conditions is of interest. Fabric made of hemp fibres for clothing coming from China and Rumania can now be seen, but is the quality of hemp cultivated on Gotland also good enough for clothing textiles?

    To be suitable for textile purposes, a fibre should have enough strength, enough fineness, enough length and some friction on the surface of the fibres. These four aspects interact and if one factor is lacking, one or more of the others have to compensate. To be suitable for clothing and not only for coarser textiles, the fibre has to be finer than 0,04 mm and down to 0.01mm in diameter. It also has to have enough strength. There is no doubt that the friction and the length of a hemp fibre, grown almost everywhere, are enough to create a textile product. More interesting is the strength of hemp, since the stronger it is, the finer it can be, and the softer the fabric can be made. Cottonizing of hemp can make the fibres suitable for high quality fabrics.

    This paper focuses on the strength and fineness of hemp fibres from six different varieties, grown on Gotland, on different locations and handled different during the process from seed to fibre. The varieties were Beniko, Futura 75, Fedora 17, Felina 32, USO 31 and Finola. Those varieties are available on the market and not specialized for the soils and climate on Gotland. Therefore it is important to investigate the quality of the fibres. Samples from the varieties were tested according to strength and fineness. The strength varied between 247-570 MPa. Variation was also noted in fibres from different parts of the stem. “Normally” fertilized and not retted, only dried and mechanically decorticated, Futura 75 had the best value in samples from the middle of its stem. The fineness varies also a lot and it is planned to perform tests before this summer.

  • 246766.
    Östbom, Lykke
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences.
    Börjeson, Sanna
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences.
    Balance the Swedish Transmission System by Using Data Centers: A Study Whether UPS-systems Can Operate as Frequency Regulators2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The energy market is facing a switch-over where future energy systems will rely more on renewable energy sources. These intermittent energy sources will increase the demand for new regulation methods to maintain the power balance in the grid. The purpose of this report is to investigate the ability of data centers to balance the power supply and demand in the Swedish transmission system by using data centers’ UPS-systems. UPS (Uninterruptable Power Supply) systems are intended to ensure stable and reliable power at all times. The data centers are evaluated by calculating the capacity of the UPS-systems. Furthermore, the report examines the challenges and opportunities that concerned actors will come across if this new regulation method is implemented. The incentives regarding future financial revenues for data centers and business opportunities for manufacturers are also examined. 

     

    Linear regression is chosen as the method of determining the capacity. The results show that the total aggregated capacity is 82.46 MW. The revenue that data centers would earn by operating as regulators is 143 000 SEK/MW per year if they regulate a quarter per hour. Furthermore, the results inspire to a discussion whether frequency regulation is suitable for data centers. To use UPS-systems for something other than their main purpose of ensuring stable power should be well motivated and be completely risk-free. The results show that it is uncertain whether the UPS-systems are able to provide the required power without risking complete discharge, which could lead to a financial disaster if a power failure occurs. 

  • 246767.
    Östborn, Johannes
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Economic History.
    Den konkurrensreglerade marknaden: om vägtransportsektorns etableringskontroll och institutionella förhållanden.1997Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 246768.
    Östborn, Johannes
    et al.
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Economic History.
    Fredga, Henrik
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Economic History.
    Handelns första arbetsdomstol? Hall- och manufakturrätten i Stockholm under 1800-talets förra hälft.1994Independent thesis Basic level (degree of Bachelor)Student thesis
  • 246769.
    Östby, David
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Biology Education Centre.
    Tvättbjörnen (Procyon lotor) som invasiv art i Europa2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Invasiva arter är organismer som med människans hjälp spridit sig till nya områden och sedan sprider sig bortom all kontroll på bekostnad av sitt nya habitat, ekosystem eller andra arter. Detta är ett globalt problem, och kan få konsekvenser både i ekonomiska, sociala och ekologiska aspekter. Människan har ända sedan antiken fört in främmande arter i Europa, men problemet har ökat på senare år. En av de värsta invasiva arter vi har idag är tvättbjörnen, vilken normalt sätt hör hemma i Nordamerika. Den tillhör familjen halvbjörnar och utmärker sig genom sina fingerfärdiga framtassar, sin nyfikenhet och goda anpassningsförmåga. Till Europa har den kommit genom att ha rymt samt släppts ut från pälsfarmer och djurparker. Populationen är som störst i Tyskland, framförallt i städerna, och den sprider sig nu genom Europa i en alarmerande takt. Man fruktar att den kan bära på sjukdomar och parasiter samt hota delar av Europas ekosystem. Dessutom kan arten komma att ställa till med ekonomiska problem i byggnader och på odlingar på samma sätt som i Japan där den också introducerats. I Tyskland har man länge bedrivit jakt på arten, men det tycks inte stoppa tvättbjörnen då den ändå har ökat exponentiellt i antal. Det enda som verkar kunna sätta stopp för artens expansion i Europa är geografiska barriärer som till exempel hav, samt kalla vintrar eftersom tvättbjörnen begränsas av hur mycket energireserver den kan bygga upp under hösten för att klara övervintringen. I och med människans aktiviteter och klimatförändringarna är det dock möjligt för tvättbjörnen att övervinna även dessa hinder. Det ser ut som att större delen av Europa kommer tvingas att acceptera tvättbjörnen som en naturlig del av faunan, och det är därför viktigt att bedriva mer forskning kring dess ekologi i Europa för att kunna anpassa samhället och naturvården för att minimera dess negativa påverkan.

  • 246770. Östenson, C-G
    et al.
    Abdel-Halim, S M
    Andersson, A
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Cell Biology.
    Efendic, S
    Studies on the pathogenesis of NIDDM in the GK (Goto-Kakizaki) rat1996In: Lessons from Animal Diabetes IV, 1996, Vol. 17, p. 299-Chapter in book (Other scientific)
  • 246771.
    Östenson, Claes-Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine.
    Regulation of glucagon biosynthesis and secretion in isolated mammalian pancreatic islets 1979Doctoral thesis, comprehensive summary (Other academic)
  • 246772.
    Östensson, Andreas
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Arts, Department of Cultural Anthropology and Ethnology, Cultural Anthropology.
    Transsexualism i Sverige: I könsdikotomins ingenmansland2004Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 246773.
    Östensson, Jörgen
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Mathematics.
    Yafaev, Dimitri
    A trace formula for differential operators of arbitrary order2012In: Operator Theory: Advances and Applications, ISSN 1004-4469, E-ISSN 2334-2536, Vol. 218, p. 541-570Article in journal (Refereed)
  • 246774.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Return to Work and Health-related Quality of Life after Severe Burn2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A major burn is one of the most severe traumas a person can experience, and recovery can be a protracted process. The principal aim was to increase the knowledge base regarding factors related to return to work and health-related quality of life (HRQoL) after burns. Patients treated at the Uppsala Burn Center between 2000 and 2007 were included on a consecutive basis. Assessments were made at hospitalization, and thereafter and included a home visit 2 to 7 years after injury.

    The psychometric properties of the generic HRQoL instrument EQ-5D were investigated. The results support the use of EQ-5D as an adjunct to burn-specific assessments of HRQoL. Most former patients exhibited a good HRQoL at 2 to 7 years postburn. Not working at the time of injury and having PTSD at 12 months, as well as having low scores on the EQ VAS at 12 months, were related to a worse EQ VAS score at 2 to 7 years after injury.

    The majority of former patients had returned to work 2 to 7 years postburn. Time to return to work was predicted by length of hospital stay and a personality disorder diagnosis. Predictors for not returning to work were length of stay and having any anxiety or substance use disorder prior to injury. Those who were not back at work reported lower generic and burn-specific health, and exhibited more psychiatric morbidity at follow-up than those who were working. The latter group exhibited HRQoL that was comparable to that of the general population. Participants emphasized their own psychological resources and capabilities as facilitators in the process of returning to active work.

    The findings suggest that an early and systematic approach for assessing recognized risk factors enhances the possibility of discovering patients at risk of developing problems during postburn adaptation.

    List of papers
    1. Validation of the EQ-5D questionnaire in burn injured adults
    Open this publication in new window or tab >>Validation of the EQ-5D questionnaire in burn injured adults
    Show others...
    2009 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 35, no 5, p. 723-732Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQoL) is an important aspect of adaptation after burn. The EQ-5D is a standardized generic instrument for assessing HRQoL. Its psychometric properties in a group of burn injured individuals are, however, not known.

    METHODS: Seventy-eight consecutive patients admitted to a burn unit were included in a prospective longitudinal study. The participants completed the EQ-5D during acute care, and at 3, 6, and 12 months after the burn. At 6 and 12 months after the burn they also completed the Short-Form 36 Health Survey (SF-36) and the Burn Specific Health Scale-Brief (BSHS-B).

    RESULTS: High feasibility of the EQ-5D was demonstrated through a high response rate and a low proportion of missing or invalid answers. The floor and ceiling effects were small. Construct validity was demonstrated through good differentiation between health states and good discrimination of health states over time. The EQ-5D was associated with burn severity and discriminated between clinical subgroups in an expected manner. Criterion validity was demonstrated through significant correlations between the EQ-5D and subscales of the SF-36 and the BSHS-B.

    CONCLUSIONS: The EQ-5D has good psychometric properties, it is short and easy to administer and thus useful in assessment of HRQoL after burn.

    Keywords
    Psychometrics, EQ-5D, Health-related quality of life, Burn injury, Outcome assessment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-122802 (URN)10.1016/j.burns.2008.11.007 (DOI)000268065200016 ()19297100 (PubMedID)
    Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2017-12-12Bibliographically approved
    2. Health-related quality of life 2 years to 7 years after a severe burn
    Open this publication in new window or tab >>Health-related quality of life 2 years to 7 years after a severe burn
    2011 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 71, no 5, p. 1435-1441Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    Knowledge concerning the trajectory andpredictors of health-related quality of life (HRQoL) years after burninjury is fragmentary and these factors were therefore assessed usingthe EQ-5D questionnaire.

    METHODS:

    Consecutive adult burnpatients were included during hospitalization and assessed at 3 months, 6months, and 12 months. In addition, an interview was performed at 2years to 7 years postburn. Data concerning injury characteristics,sociodemographic variables, psychiatric disorders, and HRQoL wereobtained.

    RESULTS:

    The EQ-5D dimension Mobility improvedbetween hospitalization and 3 months, while Anxiety/Depression improvedbetween 12 months and 2 years to 7 years. Other dimensions improvedgradually. At 2 years to 7 years, only the dimensions Pain/Discomfortand Usual activities were lower than in the general population. Inaddition, overall HRQoL was lower than in the general population whenmeasured by EQ VAS but not by EQ-5D index. EQ-5D index at 2 years to 7years was predicted by EQ-5D index at 12 months and concurrent workstatus and pain. EQ VAS at 2 years to 7 years was predicted by previousassessments of work status, posttraumatic stress disorder and EQ VAS,and concurrent work status and substance abuse. Total amount ofexplained variance ranged between 17% and 57%.

    CONCLUSIONS:

    HRQoLafter burn is conveniently screened by EQ VAS. Impairment after 2 yearsto 7 years is mainly reflected in the EQ dimensions Pain/Discomfort andUsual activities and can be predicted in part by information availablebefore or at 12 months.

    Keywords
    Return to work, Burn injury, Health-Related Quality of Life, EQ-5D
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-132450 (URN)10.1097/TA.0b013e318208fc74 (DOI)000297118600066 ()21399545 (PubMedID)
    Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12
    3. Return to work after burn: a prospective study
    Open this publication in new window or tab >>Return to work after burn: a prospective study
    2011 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, no 7, p. 1117-1124Article in journal (Refereed) Published
    Abstract [en]

    Return to work (RTW) is one of the most important objectives to strive for in burn rehabilitation. Most individuals do return to work after burn but there is a subgroup that does not. Prospective long-time follow-up studies focusing on RTW after burn are scarce. Consecutive adult burn patients employed before injury (n = 58) were included in the present study during hospitalization and subsequently followed up for 12 months. In addition, a structured interview was performed at 2-7 years after burn. At that time; mean 4.5 years (SD 2.0) after burn; 67% of the participants had returned to their work. Predictive variables for time to RTW were length of stay (LOS) at the burn center and fulfilling criteria for Any personality disorder. No RTW was predicted by LOS and having Any anxiety disorder or Any substance use disorder prior to the burn. The non-working group reported lower generic (EQ-5D) and burn-specific (BSHS-B) HRQoL than the working group at every time point. Identification of risk factors associated with difficulties in RTW is required in order to execute individualized vocational rehabilitation.

    Keywords
    Return to work, vocational rehabilitation, Burn injury, EQ-5D, BSHS-B, HRQoL
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-132452 (URN)10.1016/j.burns.2011.05.019 (DOI)000296075600004 ()
    Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved
    4. Return to Work After Burn Injury: Burn-Injured Individuals' Perception of Barriers and Facilitators
    Open this publication in new window or tab >>Return to Work After Burn Injury: Burn-Injured Individuals' Perception of Barriers and Facilitators
    2010 (English)In: Journal of burn care & research : official publication of the American Burn Association, ISSN 1559-0488, Vol. 31, no 4, p. 540-550Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to explore burn-injured individuals' perception of factors seen as facilitators or barriers in the process of returning to work after a severe burn injury. Semistructured interviews were prospectively conducted with 39 former burn injury patients, admitted to the Uppsala Burn Center between March 2000 and March 2007. The participants were employed or studying at the time of injury and were interviewed on average 4.6 years after the burn. The interview data were analyzed with qualitative content analysis. Factors acknowledged by the participants as facilitators and barriers to return to work (RTW) were identified and sorted into five categories: the Individual, Social Life, Health Care and Rehabilitation, the Workplace, and Social Welfare Agencies. Facilitators were perceived to a great extent as individual characteristics, such as own ability to take action, setting up goals in rehabilitation, having willpower, being persistent, and learning to live with impairments. The possibility of getting modified work tasks or a change of workplace, when having physical or psychological impairments, was also seen as facilitating factors. Some barriers experienced as delaying RTW were difficulties when ceasing pain medication, limited knowledge of wound care at primary health care facilities, lack of individualized rehabilitation plans, and lack of psychological support during rehabilitation. Former burn injury patients emphasized psychological resources and capabilities as facilitators in the RTW process. The need in rehabilitation for a coordinator and for assessment of work capacity, and not solely a focus on impairments, is discussed.

    Keywords
    Return to work, burn injury, content analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-132449 (URN)10.1097/BCR.0b013e3181e4d692 (DOI)000279638400004 ()20616648 (PubMedID)
    Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2011-11-08Bibliographically approved
  • 246775.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    The Drinking Motives Questionnaire among Swedish psychiatric patients: An exploration of the four-factor structure2017In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims: Alcohol use above hazardous limits is common among persons with psychiatric disorders, and there is limited knowledge about motives for drinking. The objective of this study was to explore the adequacy of the four-factor structure of drinking motives in an adult psychiatric outpatient population in Sweden by confirming the factor structure in the Drinking Motives Questionnaire (DMQ-R) and in alternative models.

    Design and Methods: In total, 371 patients responded to the DMQ-R along with the Alcohol Use Disorders Identification Test (AUDIT). AUDIT was used to assess frequency of alcohol consumption, number of drinks consumed on a typical occasion and binge drinking frequency. Confirmatory factor analysis was used to examine the construct validity of the DMQ-R and alternative models, including the short form, DMQ-R SF.

    Results: Fit statistics suggested that the original four-factor model had questionable fit (root mean square error of approximation [RMSEA]=0.10, comparative fit index [CFI]=0.89, standardised root mean square residual [SRMR]=0.08). The model with the best fit indices was the DMQ-R SF (RMSEA=0.07, CFI=0.97, SRMR=0.04). When using DMQ-R SF in further analyses enhancement, the most strongly endorsed motives were related to quantity and AUDIT sum score. Coping motives were most strongly related to AUDIT sum score, frequency and binge drinking. Social motives were only related to binge drinking, whereas conformity motives were not statistically associated with any motives.

    Discussion and Conclusions: The study implies that the 12-item short form, DMQ-R SF, could be more appropriate than the original DMQ-R in this group.

  • 246776.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Bäckström, Susan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Lantz, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Psychiatric patients' perspectives of student involvement in their care2015In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, article id 69Article in journal (Refereed)
    Abstract [en]

    Background: In the education of professionals in psychiatry, one challenge is to provide clinical placements with opportunities for students to interact and have direct contact with patients. The aim of this study was to explore Swedish psychiatric patients' perspectives on student participation in their care. Method: In a cross-sectional survey design, 655 adult psychiatric patients at a university hospital completed questionnaires. These questionnaires included statements about student involvement, student gender, attitudes towards student participation as well as two open-ended questions. Data were analyzed quantitatively and qualitatively. Results: The majority of the patients were comfortable with student participation. There were no differences between patients in wards compared to outpatients but patients who previously had students involved in their care reported higher comfort levels and a more positive attitude. Female patients were less comfortable with male students and very young students. Patients stressed the importance of being informed about the opportunity to refuse student participation. More detailed information given before the consultation as well as the importance of the student showing a professional attitude was conditions that could enable more patients to endorse student participation. Conclusion: The psychiatric patients' overall positive attitudes are in line with previous findings from other specialties and countries. The results support both altruistic motives and experience of personal gains by student involvement. More detailed information given beforehand would enable more patients to consider student participation.

  • 246777.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Return to work after burn: a prospective study2011In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, no 7, p. 1117-1124Article in journal (Refereed)
    Abstract [en]

    Return to work (RTW) is one of the most important objectives to strive for in burn rehabilitation. Most individuals do return to work after burn but there is a subgroup that does not. Prospective long-time follow-up studies focusing on RTW after burn are scarce. Consecutive adult burn patients employed before injury (n = 58) were included in the present study during hospitalization and subsequently followed up for 12 months. In addition, a structured interview was performed at 2-7 years after burn. At that time; mean 4.5 years (SD 2.0) after burn; 67% of the participants had returned to their work. Predictive variables for time to RTW were length of stay (LOS) at the burn center and fulfilling criteria for Any personality disorder. No RTW was predicted by LOS and having Any anxiety disorder or Any substance use disorder prior to the burn. The non-working group reported lower generic (EQ-5D) and burn-specific (BSHS-B) HRQoL than the working group at every time point. Identification of risk factors associated with difficulties in RTW is required in order to execute individualized vocational rehabilitation.

  • 246778.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Hensing, Ida
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Löjdström, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sjoberg, Folke
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Parents' perceptions of adaptation and family life after burn injuries in children2014In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 29, no 6, p. 606-613Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore parents' experiences after their child's burn injury, focusing on how the burn had influenced family life and child adjustment. Six semi-structured interviews with parents of children treated at burn centers 2 to 7years previously revealed the theme, "Feeling quite alone in striving to regain family wellbeing". Identification of difficulties perceived by the parents during rehabilitation and up until the present is useful when developing pediatric burn care and support for parents of children with burns.

  • 246779.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kildal, Morten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Return to Work After Burn Injury: Burn-Injured Individuals' Perception of Barriers and Facilitators2010In: Journal of burn care & research : official publication of the American Burn Association, ISSN 1559-0488, Vol. 31, no 4, p. 540-550Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore burn-injured individuals' perception of factors seen as facilitators or barriers in the process of returning to work after a severe burn injury. Semistructured interviews were prospectively conducted with 39 former burn injury patients, admitted to the Uppsala Burn Center between March 2000 and March 2007. The participants were employed or studying at the time of injury and were interviewed on average 4.6 years after the burn. The interview data were analyzed with qualitative content analysis. Factors acknowledged by the participants as facilitators and barriers to return to work (RTW) were identified and sorted into five categories: the Individual, Social Life, Health Care and Rehabilitation, the Workplace, and Social Welfare Agencies. Facilitators were perceived to a great extent as individual characteristics, such as own ability to take action, setting up goals in rehabilitation, having willpower, being persistent, and learning to live with impairments. The possibility of getting modified work tasks or a change of workplace, when having physical or psychological impairments, was also seen as facilitating factors. Some barriers experienced as delaying RTW were difficulties when ceasing pain medication, limited knowledge of wound care at primary health care facilities, lack of individualized rehabilitation plans, and lack of psychological support during rehabilitation. Former burn injury patients emphasized psychological resources and capabilities as facilitators in the RTW process. The need in rehabilitation for a coordinator and for assessment of work capacity, and not solely a focus on impairments, is discussed.

  • 246780.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kildal, Morten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Dyster-Aas, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Validation of the EQ-5D questionnaire in burn injured adults2009In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 35, no 5, p. 723-732Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQoL) is an important aspect of adaptation after burn. The EQ-5D is a standardized generic instrument for assessing HRQoL. Its psychometric properties in a group of burn injured individuals are, however, not known.

    METHODS: Seventy-eight consecutive patients admitted to a burn unit were included in a prospective longitudinal study. The participants completed the EQ-5D during acute care, and at 3, 6, and 12 months after the burn. At 6 and 12 months after the burn they also completed the Short-Form 36 Health Survey (SF-36) and the Burn Specific Health Scale-Brief (BSHS-B).

    RESULTS: High feasibility of the EQ-5D was demonstrated through a high response rate and a low proportion of missing or invalid answers. The floor and ceiling effects were small. Construct validity was demonstrated through good differentiation between health states and good discrimination of health states over time. The EQ-5D was associated with burn severity and discriminated between clinical subgroups in an expected manner. Criterion validity was demonstrated through significant correlations between the EQ-5D and subscales of the SF-36 and the BSHS-B.

    CONCLUSIONS: The EQ-5D has good psychometric properties, it is short and easy to administer and thus useful in assessment of HRQoL after burn.

  • 246781.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sveen, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Is sexuality a problem?: A follow-up of patients with severe burns 6 months to 7 years after injury2015In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 41, no 7, p. 1572-1578Article in journal (Refereed)
    Abstract [en]

    PURPOSE AND AIMS:

    This is the first study investigating sexuality from 6 months up to 7 years after burn. The aim was to examine sexuality in females and males by using the BSHS-B sexuality subscale and to examine possible contributing factors with regard to sociodemographics, burn characteristics, personality traits, and previous psychiatric disorders.

    METHODS:

    A cohort of 107 patients consecutively admitted to a Swedish national burn center was followed up at 6, 12, and 24 months after burn, and 67 individuals were followed up at 2-7 years after burn. The present study utilized the BSHS-B sexuality subscale, and multiple regression analyses were used to examine possible contributing factors.

    RESULTS:

    Women were less satisfied than men, and sexuality mean scores improved over time, even up to 7 years after-burn, in both men and women. The strongest contributing factors for worse outcome regarding sexuality were a history of psychiatric morbidity, neuroticism and burn severity.

    CONCLUSIONS:

    As some patients experience sexual problems after burns, even many years later, it is important to identify these individuals. The BSHS-B sexuality subscale may be used as a screening tool, but more in-depth assessment might be needed to address all aspects of sexuality.

  • 246782.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sveen, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    The psychiatric sequelae of burn injury2014In: General Hospital Psychiatry, ISSN 0163-8343, E-ISSN 1873-7714, Vol. 36, no 5, p. 516-522Article in journal (Refereed)
    Abstract [en]

    Objective: To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury. Methods: A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, as well as 94 patients at 1 year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7 years postinjury. The predictive effects of psychiatric history, personality and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses. Results: The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full posttraumatic stress disorder. At 2 to 7 years, 31% fulfilled the criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism. Conclusions: Two-thirds of the patients had a lifetime psychiatric disorder, and one-third had a psychiatric diagnosis 2 to 7 years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus, identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.

  • 246783.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Burn-specific health 2 to 7 years after burn injury2013In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, Vol. 74, no 4, p. 1119-1124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge concerning the pattern of recovery and predictors of burn-specific health years after burn injury is limited, and these factors were therefore assessed with a disease-specific instrument, the Burn Specific Health Scale-Brief. METHODS: Consecutive adult burn patients were prospectively included during hospitalization and assessed at 3, 6, and 12 months as well as at 2 years to 7 years (4.6 years on average) after burn. Data concerning injury characteristics, sociodemographic variables, psychiatric disorders, and burn-specific health were obtained. RESULTS: Burn-specific health improved over time, from 6 months to the final assessment after burn. At 2 years to 7 years after burn, most problems were reported in the subscales heat sensitivity, body image, and work. The regression analyses revealed that length of stay, any preburn psychiatric disorder, major depression, and posttraumatic stress disorder 12 months after burn were predictors of long-term burn-specific health in the affect and relations domain, whereas time since injury, length of stay, and major depression 12 months after burn predicted outcome in the skin involvement domain. Predictors for the subscale work were length of stay, working at the time of injury, and posttraumatic stress disorder at 12 months. CONCLUSION: This study underscores that significant improvement in postburn health can be expected even later than 2 years after injury. Furthermore, the results imply that both preburn factors and factors identified 1 year after burn have impact on burn-specific health after several years.

  • 246784.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Health-related quality of life 2 years to 7 years after a severe burn2011In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 71, no 5, p. 1435-1441Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Knowledge concerning the trajectory andpredictors of health-related quality of life (HRQoL) years after burninjury is fragmentary and these factors were therefore assessed usingthe EQ-5D questionnaire.

    METHODS:

    Consecutive adult burnpatients were included during hospitalization and assessed at 3 months, 6months, and 12 months. In addition, an interview was performed at 2years to 7 years postburn. Data concerning injury characteristics,sociodemographic variables, psychiatric disorders, and HRQoL wereobtained.

    RESULTS:

    The EQ-5D dimension Mobility improvedbetween hospitalization and 3 months, while Anxiety/Depression improvedbetween 12 months and 2 years to 7 years. Other dimensions improvedgradually. At 2 years to 7 years, only the dimensions Pain/Discomfortand Usual activities were lower than in the general population. Inaddition, overall HRQoL was lower than in the general population whenmeasured by EQ VAS but not by EQ-5D index. EQ-5D index at 2 years to 7years was predicted by EQ-5D index at 12 months and concurrent workstatus and pain. EQ VAS at 2 years to 7 years was predicted by previousassessments of work status, posttraumatic stress disorder and EQ VAS,and concurrent work status and substance abuse. Total amount ofexplained variance ranged between 17% and 57%.

    CONCLUSIONS:

    HRQoLafter burn is conveniently screened by EQ VAS. Impairment after 2 yearsto 7 years is mainly reflected in the EQ dimensions Pain/Discomfort andUsual activities and can be predicted in part by information availablebefore or at 12 months.

  • 246785.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kildal, Morten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Dyster-Aas, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Health-related quality of life after a severe burn: a prospective study2009In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 35, no Suppl 1, p. S27-S27Article in journal (Refereed)
    Abstract [en]

    Rationale:

    Health related quality of life (HRQoL) is defined as the impact an injury or illness has on quality of life, including the individual's perception of his or her injury or illness. The aim of this study was to investigate changes over time in HRQoL in burn-injured adults using the EQ-5D instrument.

    Methods:

    Participants were 88 consecutively included burn patients treated at the Uppsala University Hospital Burn Center. Their mean age was 43.3 (SD 15.5), total body surface area burned 24.4 (SD 19.8) and full-thickness burn 10.7 (SD 14.5). The participants completed the EQ-5D during hospitalisation, and at 3, 6, 12 and 24 months after injury. The EQ-5D includes five dimensions: Mobility, Self-care, Usual activities, Pain/Discomfort and Anxiety/Depression. Within each dimension there are three severity levels: no problems, moderate problems or severe problems. In addition the participants rate their health state on a VAS scale from 0 to 100. In a follow-up study the participants completed the EQ-5D in average 4.5 years after burn, with a range of 2–7 years. Pre- and post-burn psychiatric morbidity were assessed as well as burn characteristics.

    Results:

    The mean EQ utility index score improved on a group level from 0.15 at baseline to 0.72 at 24 months after the burn. In average 4.5 years after the burn the index score was 0.79. All scores were below the population norm. The VAS score improved from 48.3 at baseline to 72.5 at 24 months after burn. In spite of the fact that utility scores and VAS scores have improved more than half of the participants reported problems in the dimension Pain/Discomfort and one fifth reported problems in Usual Activities, in average 4.5 years after burn. Psychiatric morbidity pre- and post-burn as well as burn characteristics will be discussed.

    Conclusion:

    Burn injured adults have evident impairments in HRQoL even many years after burn. Most pronounced are problems in Pain/Discomfort and Usual Activities.

  • 246786.
    Öster, Ella Erika
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Sjögren, Emilie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Percy Barnevik’s 200 Advice- Corporate Bullshit or Scientifically Proven Praxis: A picture of how well Guru Theory in general and Percy Barnevik specifically is connected to management research and practice2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Percy Barnevik is one example of a renowned leader publishing a book, “Leadership- 200 advice”, on his experiences as a manager. The overall quantity of this so called Guru Literature on the market demonstrate that it exist a great interest in advice from business leaders but further raise a question of soundness of the advice. The aim with the thesis is to generate a picture of how well Guru Theory in general and Percy Barnevik specifically is connected to management research and practice. What constitute evidence is often debated within the management research field and scholars mean that one cannot assume a fact without any evidence created from research. This leads to a discussion about rigor and relevance and how management research should be designed to create a rigorous study, without overshadowing its practical relevance to the operating business. To answer the research question, interviews were executed with complementary questionnaires. In order to create a picture of what kind of anchoring Barnevik’s advice have in management theory a literature review was conducted. It is possible to see that the majority of the practitioners compared to research have a different level of cohesiveness with Barnevik regarding the studied advice. Practitioners, tend to a high level agree with Barnevik although management research stand for a more hesitant approach. Our conclusions are that management researchers should consider Guru Theory to a greater extent rather than discard it. This we believe could generate relevant research contributions to practitioners and add rigor to an unscientific field of theories 

  • 246787.
    Öster, Hedvig
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Jonze, Johanna
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Employer Branding in Human Resource Management: The Importance of Recruiting and Retaining Employees2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Problem: Companies are facing problems concerning the attraction and retention of talented employees, due to the shortage of individuals with competence. Employer Branding is a relatively new concept that can function as an instrument for firms to position themselves as an employer, in order to attract and retain wanted employees.

    Purpose: The purpose of this thesis is to examine the field of Employer Branding in the context of recruitment and retaining. The study examines the questions of how and why Employer Branding is implemented in firms and what role such implementation plays in Human Resource Management, in the context of recruitment and retaining processes.

    Methodology: This study has been made with a qualitative approach, with a descriptive and exploratory purpose a case study approach. Data has primarily been collected through interviews at five different companies with knowledge within the area of Employer Branding.

    Findings: Employer Branding can be utilized both externally to attract potential employees, and internally to increase commitment and loyalty among current employees. In the context of recruitment, Employer Branding can make the process more effective. For the Employer Brand to be trustworthy and successful the consistency between the internal values and the external image is vital.

  • 246788.
    Öster, Hedvig
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Winberg, Jessica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Organization and Management of Coopetition: Trust the Competition, Not the Competitor2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In the search for innovation, high technology firms in the same industries turn to each other for R&D collaborations. The collaboration form where competitors cooperate have been defined as “coopetition” and the term builds on the interplay between competitive and cooperative forces. While coopetition brings benefits such as shared risks and costs, it implies organizational and managerial challenges as two opposing logics merge. This complexity calls for a deeper understanding of how firms organize and manage coopetition and why they organization and manage coopetition in the way they do. This thesis is set to answer these questions by empirically investigate coopetition at a case firm active in a high technology context with a long experience of collaborating with competitors. By acknowledging coopetition as a phenomenon carried out in the shape of projects, the internal organization and management could been thoroughly understood as project management allows a more detailed view of coopetition. Key findings concludes that in this empirical context, finance is the prior reason for engaging in coopetition, competitive forces are superior to cooperative forces in coopetition projects and that coopetition influence innovation more through contributing with funding than by an exchange of knowledge between competitors. All these aspects are further stated to impact organization and management of coopetition. 

  • 246789.
    Öster, Johan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Department of Literature.
    Fjäder Ur Den Dödas Dräkt: En undersökning av Per Bäckströms Öijerska poetik i SVART SOM SILVER2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 246790.
    Öster, Jonas
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Physics, Department of Physics and Astronomy.
    Collier, B
    Hughes, W
    Blomberg, G
    Lichtenberger, J
    Spatial correlation between lightning strikes and whistler observations from Tihany, Hungary2009In: South African Journal of Science, ISSN 0038-2353, E-ISSN 1996-7489, Vol. 105, no 5-6, p. 234-237Article in journal (Refereed)
    Abstract [en]

    A whistler is a very low frequency (VLF) phenomenon that acquires its characteristics from dispersive propagation in the magnetosphere. Whistlers are derived from the intense VLF radiation produced in lightning strikes, which can travel great distances within the Earth-ionosphere waveguide (EIWG) before penetrating the ionosphere, and exciting a duct. Field-aligned ducts of enhanced plasma density guide the propagation from one hemisphere to the other. The location of the duct, relative to the strike that causes the whistler, is unknown. Whistler time series from Tihany, Hungary, have been cross-correlated with lightning data obtained from the World Wide Lightning Location Network (WWLLN). The results show that whistlers observed at Tihany originate mainly from lightning strikes in an area with a radius of approximately 1 000 km surrounding the magnetic conjugate point in the Indian Ocean just east of East London, South Africa. A clear diurnal distinction was seen in that the correlation is maximised when the whistler station and the source region are in darkness. This is believed to relate to the diurnal variation of the ionosphere, which becomes more transparent to VLF waves at night.

  • 246791.
    Öster, Jonas
    et al.
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Business Studies.
    Hammarström, Ester
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Business Studies.
    The Swedish PR Consulting Industry - Development, Structure, and Professionalism2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    There has been a rapid expansion of the PR and information industry during the last few years. An expansion like this might lead to structural changes in an industry. The aim of this thesis is to describe a part of this industry, namely the Swedish PR consulting industry, in terms of its development, structure and professionalism. Web sites of the consultancies in the industry has been analyzed. Furthermore, interviews have been conducted with three leading individuals in the industry. Structural changes can be seen since there is a trend towards further specialization among the consultancies. Some of the most common criteria for an industry to be characterized by professionalism are not achieved, but the industry is characterized by an aim towards increased professionalism.

  • 246792.
    Österberg, A
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Edebol Eeg-Olofsson, K
    Halldén, M
    Graf, W
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence.2004In: Br J Surg, ISSN 0007-1323, Vol. 91, no 9, p. 1131-7Article in journal (Refereed)
  • 246793.
    Österberg, Anna
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Delaktighet för utvecklingsstörda i en institutionsliknande gruppbostad2006Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
  • 246794.
    Österberg, Annika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kvist, Joanna
    Dahlgren, Madeleine Abrandt
    Ways of experiencing participation and factors affecting the activity level after nonreconstructed anterior cruciate ligament injury: a qualitative study2013In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 43, no 3, p. 172-183Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:

    Phenomenographic, cross-sectional.

    OBJECTIVES:

    To describe ways of experiencing participation in activities of individuals with a nonreconstructed anterior cruciate ligament injury and to describe the emotional aspects related to participation. Further, the objective was to explore factors affecting the activity level.

    BACKGROUND:

    The importance of assessing different factors (knee status, muscle performance, psychological factors, performance-based tests, and subjective rating of knee function) after an anterior cruciate ligament injury has been emphasized. However, the results of these assessments do not answer the question of how the individuals themselves experience their participation in activities.

    METHODS:

    Semi-structured interviews were conducted with 19 strategically selected informants (age range, 18-43 years) who had sustained an anterior cruciate ligament injury 18 to 67 months previously. A phenomenographic approach, which describes individuals' ways of experiencing a phenomenon, was used.

    RESULTS:

    Five qualitatively different categories were identified: (A) unconditioned participation, (B) participation as conditioned by risk appraisal, (C) participation as conditioned by experienced control of the knee, (D) participation as conditioned by experienced knee impairment, and (E) participation as conditioned by neglecting the knee injury. Within each category, 5 interrelated aspects were discerned: focus, level of performance, activities, strategies, and feelings. Categories A, C, and E reflected experiences of full participation, whereas categories B and D reflected experiences of modified participation. There were mostly positive feelings regarding participation. Negative feelings were expressed in category D. Factors affecting the activity level were grouped according to the framework of the International Classification of Functioning, Disability and Health and described as facilitating or hindering the activity level. Facilitating factors included regaining and maintaining physical function, regaining confidence in knee function, and learning/relearning movement patterns. Hindering factors included fear of injury/reinjury, uncontrollable giving way, and loss of motivation.

    CONCLUSION:

    With different strategies, most of the informants achieved a satisfactory activity level, despite impairments and decreased activity level. Both physical and psychological factors were described to affect the activity level, as well as time since injury.

  • 246795.
    Österberg, Asbjörn
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Faecal incontinence: Aspects of diagnosis and treatment1999Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Rectal reservoir function and anal pressures were investigated using anorectal manovolumetry in 48 patients with faecal incontinence and in 25 control subjects. Resting and squeeze pressures were lower in patients (p<0.001), but no significant difference was seen concerning rectal sensibility or compliance. The primary defect in incontinent patients seems to be a sphincter dysfunction. Any reduction in rectal compliance is likely to be a secondary phenomenon.

    The longitudinal high pressure zone profile was evaluated in 156 patients and 25 healthy controls using anorectal manometry with a station pull-through technique, 1 to 6 cm from the anal verge. Resting and squeeze pressures were lower in patients (P<0.01-0.001) apart from the proximal half of the measured length during rest. The high pressure zone was shorter in patients (P<0.05). There was a more proximal pressure accumulation in patients at rest (P<0.05). The main difference between incontinent patients and controls was a greater magnitude of the pressure profile in the latter group.

    Results of neurophysiological investigation (pudendal nerve terminal motor latency (PNTML) and fibre density (FD)) were studied prospectively in 72 patients with faecal incontinence. Prolonged PNTML was found in 46% and increased FD in 82% of the patients. FD but not PNTML was correlated to clinical and manometric variables.

    A questionnaire used in the assessment of patients with faecal incontinence and constipation was evaluated prospectively for 36 patients with incontinence and 38 with constipation. Reliability and validity were judged acceptable. Faecal incontinence per se was reproducible, as was the need to wear a pad. Several items distinguished both patient groups from healthy controls (P<0.05-0.001).

    Effects of electrostimulation of the pelvic floor were studied in 24 patients with idiopathic (neurogenic) incontinence. The results were evaluated at 3 and 12 months with a questionnaire and anorectal manometry. Eleven patients (46%) reported improvement after 3 months, and 9 (38%) after one year. Variables reflecting sphincter competence did not improve.

    Functional results of anterior levatorplasty (n=31) and sphincteroplasty (n=20) for idiopathic incontinence or sphincter injury were evaluated at 3 and 12 months. Eighteen patients (58%) in the levatorplasty group reported continence to solid and loose stools after one year, as compared with two patients (6%) before surgery (P<0.01). The corresponding figures in the sphincteroplasty group were 50% and 11% (P<0.05). Improvements were also observed concerning social and physical handicap in both groups.

    In a randomised trial, the results of levatorplasty (n=33) were compared with electrostimulation (n=29) for idiopathic (neurogenic) faecal incontinence. Improved incontinence scores after 3 months were seen in 29 patients (88%) after levatorplasty compared with 19 patients (66%) after electrostimulation (P<0.05). Improvements concerning deferring time for stool and social and physical handicap were more pronounced after levatorplasty.

  • 246796. Österberg, Björn
    Evaluation of a Bisphosphonate-linked hyaluronic acid hydrogelas a fracture healing application2013Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 246797.
    Österberg, David
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Electricity.
    Multi-Body Unsteady Aerodynamics in 2D Applied to aVertical-Axis Wind Turbine Using a Vortex Method2010Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Vertical axis wind turbines (VAWT) have many advantages over traditional Horizontalaxis wind turbines (HAWT).One of the more severe problem of VAWTs are the complicated aerodynamicbehavior inherent in the concept. Incontrast to HAWTs the blades experience varying angle of attack during its orbitalmotion. The unsteady flowleads to unsteady loads, and hence, to increased risk for problems with fatigue.A tool for aerodynamic analysis of vertical axis wind turbines has been developed.The model, a Discrete vortex method, relies on conformal maps to simplify the taskto finding the flowaround cylinders. After the simplified problem has been solved with Kutta condition,using the Fast Fouriertransform, the solution is transformed back to the original geometry yielding the flowabout the turbine.The program can be used for quick predictions of the aerodynamic blade loads fordifferent turbines allowing the method to be validated by comparing the predictionsto experimental data from realvertical axis wind turbines. The agreement with experiment is good.

  • 246798.
    Österberg, Emelie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    The Trend, the Cycle and the Output Gap: A Decomposition of Swedish GDP2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The first aim of this thesis is to decompose real GDP for Swedeninto a trend and a cyclical component. By identifying a state spacerepresentation and using a Kalman filter I find the latent stochastic trendand the stationary cycle. The relationship between the two componentsis studied to find whether it is the stochastic trend or the cycle thataccounts for most of the unexpected variation in real GDP. The secondaim is to compare the extracted cycle to two commonly used indicatorsof the output gap: capacity utilization and unemployment. I find thatthe cycle is quite closely related to both variables, indicating that thecycle reflects the output gap to a large extent.

  • 246799.
    Österberg, Erik
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology.
    Profiling memory accesses on the ODROID-XU42017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Decoupled Access-Execute(DAE) is an innovative approach to optimize energy consumption of computer programs by splitting the program into two tasks; the first task is to access data, this is profoundly memory-bound and can be done with energy efficient cores. The second task is to execute and compute the data, which iscompute-bound and can be done with powerful cores. This thesis work aims todevelop a profiling tool that can measure the efficiency of DAE by investigating thecache misses in the original code and the DAE code (in the access and executephases). This was achieved by measuring the cache loads and memory accesses forthe DAE transformation for the benchmarks done by a previous study that targets DAE on Arm's HMP architecture, big.LITTLE. The data obtained from this study showt hat DAE on big.LITTLE has a potential for energy savings, especially with applications that feature indirection in memory accesses. Arm DynamIQ opens up new possibilities for DAE code transformation. New levels of energy efficiency can be reached with a finer-grained Dynamic Voltage Frequency Scaling(DVFS), a more rapid power, state transition mechanism and a shared cache for 'big' and 'LITTLE' CPUs.

  • 246800. Österberg, Eva
    et al.
    Lindström, Dag
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts.
    Crime and social control in medieval and early modern Swedish towns1988Book (Other academic)
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