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  • 65651.
    Åkerblom, Axel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Wojdyla, Daniel M.
    Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA.
    Wallentin, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Brito, Flavio de Souza
    Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA.
    Steg, Philippe Gabriel
    Hop Bichat Claude Bernard, AP HP, Dept Hosp Univ FIRE, Paris, France;Paris Diderot Univ, Sorbonne Paris Cite, Paris, France;NHLI Imperial Coll, ICMS, Royal Brampton Hosp, London, England;FACT, FCRIN Network, INSERM U1148, Paris, France.
    Cannon, Christopher P.
    Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA.
    Katus, Hugo A.
    Univ Klinikum, Med Klin, Heidelberg, Germany.
    Himmelmann, Anders
    AstraZenca Res & Dev, Gothenburg, Sweden.
    Storey, Robert F.
    Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England.
    Becker, Richard C.
    Acad Hlth Ctr, Div Cardiovasc Hlth & Dis, Heart Lung & Vasc Inst, Cincinnati, OH USA.
    Lopes, Renato D.
    Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA.
    Ticagrelor in patients with heart failure after acute coronary syndromes - Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial2019Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 213, s. 57-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Heart failure (HF) following acute coronary syndromes (ACS) is associated with worse prognosis; however, the efficacy and safety of ticagrelor in patients with HF and if ticagrelor influences the risk of new-onset HF are unknown.

    Methods: We examined the efficacy and safety of ticagrelor compared to clopidogrel in patients with ACS in the randomized PLATelet inhibition and patient Outcomes (PLATO) trial subdivided by strata: (1) previous HF and/or clinical signs of HF on admission or (2) no HF on admission. The primary outcome was the combination of cardiovascular death, myocardial infarction, or stroke evaluated by multivariable Cox regression models. The safety outcome was major bleeding. New-onset HF was defined as an HF event after discharge in patients without previous HF.

    Results: Data were available in 18,556 patients, whom 2,862 (15.4%) patients had HF, including 1,584 (8.5%) patients with previous HF. Patients randomized to ticagrelor had lower risk of the composite end point regardless of HF status: hazard ratio (HR) 0.87 (95% CI: 0.73-1.03) in patients with HF and HR 0.84 (95% CI: 0.75-0.93) in patients with no HF (P = .76). Corresponding HR for major bleeding were HR 1.08 (95% CI: 0.87-1.34) and HR 1.03 (95% CI: 0.94-1.14) (P = .71). There was no difference in new-onset HF at 12 months between patients randomized to ticagrelor (4.1%, n = 278) or clopidogrel (4.0%, n = 276).

    Conclusions: In patients with ACS, ticagrelor is more efficacious in protecting against new ischemic events and mortality than clopidogrel irrespective of the presence of HF. There is no difference between ticagrelor or clopidogrel treatment in new-onset HF post-ACS.

  • 65652.
    Åkerblom, Axel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27708 USA;Uppsala Clin Res Ctr, Hammarskjolds Vag 38, S-75185 Uppsala, Sweden.
    Wojdyla, Daniel
    Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27708 USA.
    Steg, Philippe Gabriel
    INSERM, U1148, Paris, France;Hop Bichat Claude Bernard, AP HP, Dept Hosp Univ FIRE, Paris, France;Univ Paris Diderot, Sorbonne Paris Cite, Paris, France;Imperial Coll, NHLI, ICMS, Royal Brompton Hosp, London, England.
    Wallentin, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Budaj, Andrzej
    Grochowski Hosp, Postgrad Med Sch, Warsaw, Poland.
    Katus, Hugo A.
    Univ Klinikum Heidelberg, Med Klin, Heidelberg, Germany.
    Himmelmann, Anders
    AstraZeneca Res & Dev, Molndal, Sweden.
    Huber, Kurt
    Wilhelminen Hosp, Dept Cardiol & Intens Care Med, Vienna, Austria;Sigmund Freud Univ, Sch Med, Vienna, Austria.
    Siegbahn, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Storey, Robert F.
    Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England.
    Becker, Richard C.
    Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27708 USA;Acad Hlth Ctr, Div Cardiovasc Hlth & Dis, Heart Lung & Vasc Inst, Cincinnati, OH USA.
    Prevalence and relevance of abnormal glucose metabolism in acute coronary syndromes: insights from the PLATelet inhibition and patient Outcomes (PLATO) trial2019Ingår i: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 48, nr 4, s. 563-569Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Diabetes mellitus (DM) and abnormal glucose metabolism are associated with cardiovascular (CV) disease. We investigated the prevalence and prognostic importance of dysglycaemia in patients with acute coronary syndromes (ACS) in the PLATelet inhibition and patient Outcomes (PLATO) trial. Diabetes was defined as known diabetes or HbA1c >= 6.5% or non-fasting glucose >= 11.1 mmol/L on admission, prediabetes as HbA1c >= 5.7% but < 6.5%, and no diabetes as HbA1c < 5.7%. The primary endpoint was the composite of CV death, spontaneous myocardial infarction type 1 (sMI) or stroke at 12 months. Multivariable Cox regression models, adjusting for baseline characteristics, and biomarkers NT-proBNP and troponin I, were used to explore the association between glycaemia and outcome. On admission, 16,007 (86.1%) patients had HbA1c and/or glucose levels available and were subdivided into DM 38.5% (6160) (1501 patients had no previous DM diagnosis), prediabetes 38.8% (6210), and no DM 22.7% (3637). Kaplan Meier event rates at 12 months for CV death, sMI or stroke per subgroups were 14.5% (832), 9.0% (522), and 8.5% (293), respectively with multivariable adjusted HRs, versus no diabetes, for diabetes: 1.71 (1.50-1.95) and for prediabetes 1.03 (0.90-1.19). Corresponding event rates for CV death were 6.9% (391), 3.4% (195) and 3.0% (102), respectively, with adjusted HRs for patients with DM of: 1.92 (1.42-2.60) and for prediabetes 1.02 (0.79-1.32). Abnormal glucose metabolism is common in ACS patients, but only patients with definite DM have an increased CV risk, indicating that prediabetes is not immediately associated with worse CV outcomes.

  • 65653.
    Åkerblom, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Frk/Shb Signalling in Pancreatic Beta-cells: Roles in Islet Function, Beta-cell Development and Survival as Implicated in Mouse Knockout Models2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The adaptor protein Shb and the non-receptor tyrosine kinase Frk have been implicated in intracellular signalling in insulin-producing beta cells. In this thesis, knockout mice are used to further elucidate the role of Shb and Frk for beta cell number, cytokine-induced cell death, and glucose homeostasis. In addition, the effect of Shb deficiency upon tumour growth is studied in a mouse model of endogenous tumourigenesis.

    Previously, overexpression of Frk has been associated with increased beta cell replication, and increased susceptibility to cytokine induced beta cell destruction. To test whether Frk has a non-redundant role in regulating beta cell mass, beta cell number in Frk-/- mice was assessed at different stages of life. The results showed that Frk is involved in regulating beta cell number during embryonal and early postnatal life, but is probably redundant in the adult.

    An earlier study had suggested that Shb participates in cytokine-induced beta cell death, a model of autoimmune diabetes. To test this further, Shb-/- islets were exposed to cytokines, or to an ER-stress inducing agent. Shb knockout islets exhibited decreased cell death, and this effect appeared to be independent of NO, JNK, p38 MAP kinase, FAK and c-Abl, but may involve an augmented induction of Hsp70.

    Furthermore, glucose homeostasis in Shb-/- mice was impaired, with elevated basal blood sugar concentration and reduced glucose-induced insulin secretion.

    Previously Shb deficient mice had showed an impaired ability to sustain growth of implanted tumour cells, due to reduced angiogenesis. Tumour growth and angiogenesis were here assessed in an inheritable tumour model. Shb deficient mice exhibited fewer tumours, and reduced vessel density in small tumours, indicating impaired angiogenesis. However, a few large tumours developed in Shb-/- mice, suggesting that tumours can escape the angiogenic restriction caused by the absence of Shb.

    Delarbeten
    1. A role of FRK in regulation of embryonal pancreatic beta cell formation
    Öppna denna publikation i ny flik eller fönster >>A role of FRK in regulation of embryonal pancreatic beta cell formation
    2007 (Engelska)Ingår i: Molecular and Cellular Endocrinology, ISSN 0303-7207, E-ISSN 1872-8057, Vol. 270, nr 1-2, s. 73-78Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The fyn-related-kinase (FRK) is a non-receptor tyrosine kinase expressed in various tissues, and among them, is the islets of Langerhans. The role of FRK in pancreatic beta cells has been addressed by studies of knockout or FRK transgenic mice. These experiments have shown that FRK overexpression in beta cells leads to an increased susceptibility to the beta cell toxin streptozotocin and to cytotoxic cytokines, suggesting that FRK may participate in events leading to beta cell destruction. However, these mice also exhibit an increased relative beta cell volume and increased beta cell replication following partial pancreatectomy, suggesting a positive role for FRK in the regulation of beta cell number as well. To further assess the significance of FRK for beta cell replication, we studied the beta cell area and islet cell replication in FRK null mice. We currently observed that the FRK knockout mouse showed no difference in the insulin positive cell area or in the percentage of Ki67-stained proliferating islet cells at adulthood, when compared to wild-type control. In addition, adult FRK(-/-) mice performed normally when subjected to an intravenous glucose tolerance test. To elucidate whether FRK affects pancreatic beta cell number during embryogenesis and shortly after birth, pancreata were collected from FRK(-/-) mice at these stages. Histological analysis of insulin stained pancreatic sections showed that the insulin positive cell area in FRK(-/-) mice was reduced at embryonal day 15 and at birth to 31 and 70% of that of wild-type mice, respectively. FRK(-/-) pancreas weight on day 1 neonatally was similar to that of the control, indicating that the obtained results were not due to altered pancreatic growth. Taken together, these results show that FRK affects beta cell number during embryogenesis and early in life, but is probably redundant for beta cell number and function in adult animals under normal conditions.

    Nyckelord
    Animals, Animals, Newborn, Embryo, Mammalian/*cytology/*enzymology, Insulin-Secreting Cells/*cytology/*enzymology, Mice, src-Family Kinases/deficiency/*metabolism FRK; beta cell; development; replication; neogenesis; tyrosine kinase
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-13082 (URN)10.1016/j.mce.2007.02.009 (DOI)000246920500010 ()17416457 (PubMedID)
    Tillgänglig från: 2008-01-21 Skapad: 2008-01-21 Senast uppdaterad: 2017-12-11
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  • 65654.
    Åkerblom, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Annerén, Cecilia
    Welsh, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    A role of FRK in regulation of embryonal pancreatic beta cell formation2007Ingår i: Molecular and Cellular Endocrinology, ISSN 0303-7207, E-ISSN 1872-8057, Vol. 270, nr 1-2, s. 73-78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The fyn-related-kinase (FRK) is a non-receptor tyrosine kinase expressed in various tissues, and among them, is the islets of Langerhans. The role of FRK in pancreatic beta cells has been addressed by studies of knockout or FRK transgenic mice. These experiments have shown that FRK overexpression in beta cells leads to an increased susceptibility to the beta cell toxin streptozotocin and to cytotoxic cytokines, suggesting that FRK may participate in events leading to beta cell destruction. However, these mice also exhibit an increased relative beta cell volume and increased beta cell replication following partial pancreatectomy, suggesting a positive role for FRK in the regulation of beta cell number as well. To further assess the significance of FRK for beta cell replication, we studied the beta cell area and islet cell replication in FRK null mice. We currently observed that the FRK knockout mouse showed no difference in the insulin positive cell area or in the percentage of Ki67-stained proliferating islet cells at adulthood, when compared to wild-type control. In addition, adult FRK(-/-) mice performed normally when subjected to an intravenous glucose tolerance test. To elucidate whether FRK affects pancreatic beta cell number during embryogenesis and shortly after birth, pancreata were collected from FRK(-/-) mice at these stages. Histological analysis of insulin stained pancreatic sections showed that the insulin positive cell area in FRK(-/-) mice was reduced at embryonal day 15 and at birth to 31 and 70% of that of wild-type mice, respectively. FRK(-/-) pancreas weight on day 1 neonatally was similar to that of the control, indicating that the obtained results were not due to altered pancreatic growth. Taken together, these results show that FRK affects beta cell number during embryogenesis and early in life, but is probably redundant for beta cell number and function in adult animals under normal conditions.

  • 65655.
    Åkerblom, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Barg, Sebastian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Calounova, Gabriela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Mokhtari, Dariush
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Jansson, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Welsh, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Impaired glucose homeostasis in Shb-/- mice2009Ingår i: Journal of Endocrinology, ISSN 0022-0795, E-ISSN 1479-6805, Vol. 203, nr 2, s. 271-279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Src homology 2 domain-containing protein B (SHB) is an adapter protein involved in the regulation of beta-cell and endothelial cell function. We have recently obtained the Shb knockout mouse, and consequently, the aim of this study was to assess the effect of Shb deletion upon beta-cell function and blood glucose homeostasis. Shb-/- mice display an elevated basal blood glucose concentration, and this increase is maintained during insulin challenge in insulin sensitivity tests. To assess glucose-induced insulin secretion, pancreata were perfused, and it was observed that Shb-/- first phase insulin secretion was blunted during glucose stimulation. Gene expression of Shb-/- islets shortly after isolation was altered, with increased pancreatic and duodenal homeobox gene-1 (Pdx1) gene expression and reduced expression of Vegf-A. Islet culture normalized Pdx1 gene expression. The microvascular density of the Shb-/- islets was reduced, and islet capillary endothelial cell morphology was changed suggesting an altered microvascular function as a contributing cause to the impaired secretory activity. Capacitance measurements of depolarization-induced exocytosis indicate a direct effect on the exocytotic machinery, in particular a dramatic reduction in readily releasable granules, as responsible for the insulin-secretory defect operating in Shb-/- islets. Shb-/- mice exhibited no alteration of islet volume or beta-cell area. In conclusion, loss of Shb impairs insulin secretion, alters islet microvascular morphology, and increases the basal blood glucose concentration. The impaired insulin secretory response is a plausible underlying cause of the metabolic impairment observed in this mutant mouse.

  • 65656.
    Åkerblom, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Zang, Guangxiang
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Zhuang, Zhen W.
    Calounova, Gabriela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Simons, Michael
    Welsh, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Heterogeneity among RIP-Tag2 insulinomas allows vascular endothelial growth factor-A independent tumor expansion as revealed by studies in Shb mutant mice: implications for tumor angiogenesis2012Ingår i: Molecular Oncology, ISSN 1574-7891, E-ISSN 1878-0261, Vol. 6, nr 3, s. 333-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Shb adapter protein is a signaling intermediate that operates downstream of vascular endothelial growth factor receptor-2 (VEGFR-2) in endothelial cells. The Shb knockout mouse displays a dysfunctional microvasculature and impaired growth of subcutaneously implanted tumor cells. We decided to investigate tumor growth and angiogenesis in the absence of Shb in an inheritable tumor model, the RIP-Tag2 mouse, which produces insulinomas in a manner highly dependent on de novo angiogenesis. We observed a reduced tumor incidence and burden in both RIP-Tag2 Shb-/- and RIP-Tag2 Shb+/- mice. This correlated with a reduced microvascular density, measured as percentage of insulinoma area positive for CD31 staining, and altered vascular morphology. However, treatment with a VEGF-A blocking antibody was without effect on the Shb mutant tumor volume whereas it significantly inhibited tumor volume in the wild-type mice, suggesting that in mice with reduced Shb expression tumor angiogenesis was primarily sustained by VEGF-A independent pathway(s). This notion was further substantiated by gene expression analysis of angiogenic markers showing reduced VEGF-A expression in Shb deficient tumors. Considerable heterogeneity with respect to the gene expression profiles of other angiogenic markers and the signal-transduction characteristics was observed between different tumors, suggesting that multiple “rescue” pathways could be operating. The numbers of invasive tumors or metastases were unchanged in the Shb mutant. It is concluded that the Shb mutant background reduces tumor frequency by chronically suppressing VEGF-A dependent angiogenesis. However, VEGF-A independent angiogenesis supports a significant degree of tumor expansion in Shbdeficient mice, indicating heterogeneity in the mechanisms by which tumor expansion is promoted. Interference with Shb signaling may provide novel means for future cancer therapy.

  • 65657.
    Åkerblom, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Åkerblom, Jessica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Upplevelser av bemötande inom hälso- och sjukvård hos personer med ADHD2017Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Personer med ADHD har ofta nedsatta exekutiva funktioner, vilket kan försvåra social interaktion. Även vid autismspektrumtillstånd förekommer exekutiv dysfunktion, och där har tidigare studier visat ett behov av att ta hänsyn till detta vid vårdrelaterat bemötande. Det finns begränsad kunskap om hur personer med ADHD upplever bemötande inom hälso- och sjukvården. 

    Syfte: Syftet var att utforska hur personer med ADHD upplever bemötande inom hälso- och sjukvården.

    Metod: I studien tillämpas en kvalitativ design med deskriptiv ansats. Semistrukturerade intervjuer genomfördes med åtta personer med ADHD-diagnos.

    Resultat: Tre huvudkategorier kunde formuleras utifrån intervjumaterialet: Brist på tydlighet, bristande respekt för individ och autonomi samt begränsad kunskap om ADHD hos vårdpersonal. Informanter upplevde otydlighet i kommunikation och struktur och en känsla av att vårdpersonalen inte hade respekterat deras person eller autonomi. De beskriver också hur tidsaspekten blir ett problem: att behöva vänta på olika moment och inte veta hur länge de behöver vänta. Okunskapen om ADHD kändes besvärande. Informanter upplevde att vårdpersonalen hade låst sig vid en begränsad kunskap om ADHD istället för att se personen de hade framför sig. Studiens teoretiska referensram, Joyce Travelbees interaktionsteori, understryker betydelsen av kommunikation och interaktion i omvårdnadssituationen för att adekvat vård ska kunna ges till den unika patienten, och att en förutsättning är att sjuksköterskan vill hjälpa men också har förmågan att göra det. 

    Slutsats: Informanter i studien upplevde brister inom i huvudsak tre områden: tydlighet i kommunikation och struktur, respekt för deras person och autonomi samt vårdpersonalens kunskapsnivå gällande ADHD. Det är viktigt att patienter bemöts efter sina särskilda förutsättningar. Patienter med ADHD är inte en homogen grupp: graden och omfattningen av svårigheter kan skilja mycket, även mellan individer som uppfyller samma subdiagnos. Sjuksköterskan kan använda dessa kunskaper för att förbättra individanpassningen av bemötande och omvårdnad av personer med ADHD.

  • 65658.
    Åkerblom, Hanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Retinal morphology and function in prematurely-born children at school age2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Preterm birth may lead to complications during the neonatal period that can cause visual dysfunctions. Retinopathy of prematurity (ROP) and neurological complications are well known reasons for visual dysfunctions, but preterm children with no or only mild ROP and no evident neurological problems may also be affected visually when they grow up. Retinal development starts early after gestation and continues long after birth. Major processes are underway during the second half of pregnancy when preterm children are born, and a preterm birth could possibly have a negative effect on normal retinal development.

    The aims of the studies were to evaluate retinal morphology and function in former preterm children and compare the results with children born at term.

    Former preterm children aged 5 to 17 years and born in a gestational age (GA) of 32 weeks or less were included in the different study groups. Children of similar ages who were born at term and with normal visual acuity (VA) acted as controls. Best corrected VA and refraction in cycloplegia were assessed in all children. Macular thickness and retinal nerve fiber layer (RNFL) thickness were measured with optical coherent tomography (OCT). Total retinal function was assessed with fullfield electroretinography (ffERG) and central macular function was assessed with multifocal electroretinography (mfERG).

    Preterm children had thicker central maculae than controls. There was a positive correlation between central macular thickness and GA at birth. RNFL thickness was reduced in the preterm children with severe ROP and treated ROP, but children with mild or no ROP did not differ from the fullterm children. The photoreceptor function measured with ffERG and the macular function measured with mfERG were reduced in the preterm group compared to controls.

    Preterm birth affects the retina both morphologically and functionally, and ROP has been suggested to be a reason for retinal changes. However, the results of this thesis indicate that children with no ROP also have retinal changes, suggesting an effect of prematurity itself. There were no correlations between any retinal changes and VA, but it is possible that larger studies using improved techniques may elucidate this further.

    Delarbeten
    1. Central macular thickness is correlated with gestational age at birth in prematurely born children
    Öppna denna publikation i ny flik eller fönster >>Central macular thickness is correlated with gestational age at birth in prematurely born children
    2011 (Engelska)Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 95, nr 6, s. 799-803Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background/aim Previous studies have revealed various subnormal visual functions in prematurely born children. The present study aimed to determine the retinal macular thickness in prematurely born children and compare with children born at term. Methods The eyes of 65 prematurely born children aged 5-16 years were examined with Stratus optical coherence tomography (OCT) 3, and the results were compared with those of 55 children born at term. The retinal macular thickness in the nine EDTRS macular areas (A1-A9), the foveal minimum and the total macular volume were determined. Results The central macular thickness (A1 and foveal minimum) was significantly thicker in the prematurely born children than in those born at term. There was no correlation between macular thickness and visual acuity or refraction. Children with previous retinopathy of prematurity (ROP) had significantly thicker central maculae than those without it. Prematurely born children without previous ROP had significantly thicker central maculae than the control group. Multiple regression analyses showed that gestational age at birth was the only risk factor for a thick central macula. Conclusion Prematurely born children had thicker central maculae than those born at term. Regardless of ROP, the degree of prematurity was the most important risk factor for abnormal foveal development.

    Nationell ämneskategori
    Neurovetenskaper
    Identifikatorer
    urn:nbn:se:uu:diva-154617 (URN)10.1136/bjo.2010.184747 (DOI)000290793600011 ()20974631 (PubMedID)
    Tillgänglig från: 2011-06-08 Skapad: 2011-06-08 Senast uppdaterad: 2018-01-12Bibliografiskt granskad
    2. Retinal nerve fibre layer thickness in school-aged prematurely-born children compared to children born at term
    Öppna denna publikation i ny flik eller fönster >>Retinal nerve fibre layer thickness in school-aged prematurely-born children compared to children born at term
    2012 (Engelska)Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 96, nr 7, s. 956-960Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim To investigate the retinal nerve fibre layer (RNFL) with optical coherent tomography (OCT) in prematurely-born children. Methods 62 children born with a gestational age of <= 32 weeks, and a control group of 54 children born at term with normal birth weight (BW) were included in the study. 28 of the preterm children had retinopathy of prematurity (ROP) in the neonatal period; eight of them had severe ROP (stages 3-4). RNFL thickness was measured with Stratus OCT 3. Mean age at examination was 8.6 years in the preterm children and 10.1 years in the control group. Results There was a significant difference between the children born preterm and those born at term, regarding RNFL thickness in the superior (right eye (RE), p=0.043; left eye (LE), p=0.048) and the nasal quadrants (RE, p=0.006; LE, p<0.001), as well as average RNFL thickness (RE, p=0.016; LE, p=0.029). This difference was caused by the thinner RNFL in children with previous severe ROP (stages 3 and 4). Within the preterm group, the average RNFL thickness increased with larger BW (RE, p=0.050; LE, p=0.028), but there was no correlation with gestational age at birth. Conclusion The RNFL was reduced in prematurely-born children with severe ROP when compared to children born at term. It is hypothesised that severe retinopathy as well as ablation of the retina with laser treatment or cryotherapy may affect the axons of the ganglion cells and thus reduce RNFL thickness. Prematurely-born children with low BW had a thinner RNFL, suggesting a negative effect of low birth weight on neural development.

    Nationell ämneskategori
    Neurovetenskaper
    Identifikatorer
    urn:nbn:se:uu:diva-177561 (URN)10.1136/bjophthalmol-2011-301010 (DOI)000305579000008 ()
    Tillgänglig från: 2012-07-16 Skapad: 2012-07-16 Senast uppdaterad: 2018-01-12Bibliografiskt granskad
    3. Photoreceptor Function in School-Aged Children is Affected by Preterm Birth
    Öppna denna publikation i ny flik eller fönster >>Photoreceptor Function in School-Aged Children is Affected by Preterm Birth
    2014 (Engelska)Ingår i: Translational vision science & technology, ISSN 2164-2591, Vol. 3, nr 6, artikel-id 7Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    PURPOSE: Prematurely born children have affected visual functions at school age. Optical coherent tomography (OCT) has shown morphological changes in the retina, suggesting a disturbance in normal retinal development in these children. The aim of this study was to examine retinal function with fullfield electroretinogram (ffERG) in school-aged children born prematurely and compare with children born at term. A second aim was to correlate retinal function with visual acuity (VA), gestational age (GA), birth weight, and retinopathy of prematurity (ROP).

    METHODS: The study group consisted of 35 former preterm children born before GA of 32 weeks. A group of 42 children born at term acted as controls. All children were between 5- and 18-years old. FfERG was performed in both eyes. Best-corrected VA and refraction in cycloplegia was determined.

    RESULTS: The a-wave of the combined rod/cone responses was significantly reduced in the prematurely-born children compared with children born at term. There was a correlation between reduced a-wave amplitude in the combined rod/cone response and ROP and GA at birth.

    CONCLUSION: Function of photoreceptors was affected in prematurely born children, possibly also in children without previous ROP. Whether immaturity per se affects the retinal function remains to be elucidated.

    Nationell ämneskategori
    Oftalmologi
    Forskningsämne
    Oftalmiatrik
    Identifikatorer
    urn:nbn:se:uu:diva-247881 (URN)10.1167/tvst.3.6.7 (DOI)25674356 (PubMedID)
    Tillgänglig från: 2015-03-24 Skapad: 2015-03-24 Senast uppdaterad: 2015-07-07Bibliografiskt granskad
    4. Macular function in preterm children at school age.
    Öppna denna publikation i ny flik eller fönster >>Macular function in preterm children at school age.
    2014 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Oftalmologi
    Forskningsämne
    Oftalmiatrik
    Identifikatorer
    urn:nbn:se:uu:diva-240845 (URN)000345328000028 ()
    Konferens
    Nordic Congress of Ophthalmology, 20–23 August 2014, Stockholm, Sweden
    Tillgänglig från: 2015-01-08 Skapad: 2015-01-08 Senast uppdaterad: 2015-07-07
  • 65659.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Andreasson, Sten
    Lund Univ, Ophthalmol, Lund, Sweden..
    Function of the visual pathway in preterm children at school age2016Ingår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 57, nr 12Artikel i tidskrift (Refereegranskat)
  • 65660.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Andreasson, Sten
    Univ Lund Hosp, Dept Ophthalmol, S-22185 Lund, Sweden..
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Macular function in preterm children at school age2016Ingår i: Documenta Ophthalmologica, ISSN 0012-4486, E-ISSN 1573-2622, Vol. 133, nr 3, s. 151-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Macular development is a complex process that starts by mid-gestation and continues several years after birth. A preterm birth could affect this development, causing increased thickness in the central macula, but the effect of the macular function remains uncertain. The aim of this study was to investigate the macular function measured with multifocal electroretinography (mfERG), in former preterm children and compare with healthy controls. A second aim was to correlate central macular function with central macular thickness measured with optical coherent tomography (OCT), in the preterm group. Fifteen former preterm children born before 32 weeks of gestation were included in the study. MfERG results from 12 children acted as controls. Visual acuity, refraction in cycloplegia and mfERG were carried out in all children, and optical coherent tomography (OCT) was performed in the preterm children. Main outcomes were P1 amplitudes and implicit times for Rings 1-5 and "sum of groups" of the mfERG, and central macula thickness in area A1 measured with OCT. The P1 amplitudes were reduced in Rings 1-5 and "Sum of groups" in the preterm children compared to controls. There were no significant correlation between P1 amplitude or implicit times in Ring 1 and central macular thickness in the preterm group. Macular function is reduced in former preterm children compared to children born at term. This suggests that the structural changes with a thicker central retina can have an effect on function and may be one, of probably several, explanations for visual dysfunction in preterm children at school age.

  • 65661.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Andreasson, Sten
    Lunds universitet.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Macular function in preterm children at school age.2014Manuskript (preprint) (Övrigt vetenskapligt)
  • 65662.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Andreasson, Sten
    Lunds universitet.
    Larsson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Photoreceptor Function in School-Aged Children is Affected by Preterm Birth2014Ingår i: Translational vision science & technology, ISSN 2164-2591, Vol. 3, nr 6, artikel-id 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Prematurely born children have affected visual functions at school age. Optical coherent tomography (OCT) has shown morphological changes in the retina, suggesting a disturbance in normal retinal development in these children. The aim of this study was to examine retinal function with fullfield electroretinogram (ffERG) in school-aged children born prematurely and compare with children born at term. A second aim was to correlate retinal function with visual acuity (VA), gestational age (GA), birth weight, and retinopathy of prematurity (ROP).

    METHODS: The study group consisted of 35 former preterm children born before GA of 32 weeks. A group of 42 children born at term acted as controls. All children were between 5- and 18-years old. FfERG was performed in both eyes. Best-corrected VA and refraction in cycloplegia was determined.

    RESULTS: The a-wave of the combined rod/cone responses was significantly reduced in the prematurely-born children compared with children born at term. There was a correlation between reduced a-wave amplitude in the combined rod/cone response and ROP and GA at birth.

    CONCLUSION: Function of photoreceptors was affected in prematurely born children, possibly also in children without previous ROP. Whether immaturity per se affects the retinal function remains to be elucidated.

  • 65663.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Eriksson, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Larsson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Retinal nerve fibre layer thickness in school-aged prematurely-born children compared to children born at term2012Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 96, nr 7, s. 956-960Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim To investigate the retinal nerve fibre layer (RNFL) with optical coherent tomography (OCT) in prematurely-born children. Methods 62 children born with a gestational age of <= 32 weeks, and a control group of 54 children born at term with normal birth weight (BW) were included in the study. 28 of the preterm children had retinopathy of prematurity (ROP) in the neonatal period; eight of them had severe ROP (stages 3-4). RNFL thickness was measured with Stratus OCT 3. Mean age at examination was 8.6 years in the preterm children and 10.1 years in the control group. Results There was a significant difference between the children born preterm and those born at term, regarding RNFL thickness in the superior (right eye (RE), p=0.043; left eye (LE), p=0.048) and the nasal quadrants (RE, p=0.006; LE, p<0.001), as well as average RNFL thickness (RE, p=0.016; LE, p=0.029). This difference was caused by the thinner RNFL in children with previous severe ROP (stages 3 and 4). Within the preterm group, the average RNFL thickness increased with larger BW (RE, p=0.050; LE, p=0.028), but there was no correlation with gestational age at birth. Conclusion The RNFL was reduced in prematurely-born children with severe ROP when compared to children born at term. It is hypothesised that severe retinopathy as well as ablation of the retina with laser treatment or cryotherapy may affect the axons of the ganglion cells and thus reduce RNFL thickness. Prematurely-born children with low BW had a thinner RNFL, suggesting a negative effect of low birth weight on neural development.

  • 65664.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Larsson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    The rim area of the optic nerve head, assessed with Heidelberg retina tomography, is smaller in prematurely born children than in children born at term2018Ingår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 96, nr 7, s. 699-704Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To examine the optic nerve head with Heidelberg tomography (HRT) in prematurely born school-age children and compare them to children born at term.

    METHODS: Sixty-three 5-16-year-old children born with a gestational age (GA) of ≤32 weeks were included in the study and compared to 54 children of the same age, born at term. In the preterm group, 29 children had had retinopathy of prematurity (ROP) and nine children had neurological complications. The optic nerve head was assessed with HRT. Three measurements were performed, and the different topographic parameters were noted.

    RESULTS: Rim area of the optic nerve was significantly smaller in prematurely born children than in children born at term. The mean difference was 0.146 mm2 (p = 0.02). No difference between the groups was found regarding disc area or cup area. In the preterm group, both disc and rim areas were reduced with increasing GA. No correlations with birthweight, ROP or neurological complications were found.

    CONCLUSION: Reduced rim area of the optic nerve head was found in preterm children of school age. Previous ROP or neurological complication did not influence the result, suggesting the preterm birth per se was the reason for the reduction. Establishing whether this finding was caused by disturbed maturation of the optic nerve or by injury of the axons, or a combination of the two, will require further research.

  • 65665.
    Åkerblom, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Larsson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Eriksson, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Central macular thickness is correlated with gestational age at birth in prematurely born children2011Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 95, nr 6, s. 799-803Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/aim Previous studies have revealed various subnormal visual functions in prematurely born children. The present study aimed to determine the retinal macular thickness in prematurely born children and compare with children born at term. Methods The eyes of 65 prematurely born children aged 5-16 years were examined with Stratus optical coherence tomography (OCT) 3, and the results were compared with those of 55 children born at term. The retinal macular thickness in the nine EDTRS macular areas (A1-A9), the foveal minimum and the total macular volume were determined. Results The central macular thickness (A1 and foveal minimum) was significantly thicker in the prematurely born children than in those born at term. There was no correlation between macular thickness and visual acuity or refraction. Children with previous retinopathy of prematurity (ROP) had significantly thicker central maculae than those without it. Prematurely born children without previous ROP had significantly thicker central maculae than the control group. Multiple regression analyses showed that gestational age at birth was the only risk factor for a thick central macula. Conclusion Prematurely born children had thicker central maculae than those born at term. Regardless of ROP, the degree of prematurity was the most important risk factor for abnormal foveal development.

  • 65666.
    Åkerblom, Olof
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten.
    Optimization methods for erythrocyte preservation 1974Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
  • 65667.
    Åkerblom, Ylva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Experiences of pain and associations between pain, disease severity and individual quality of life in people with motor neuron diseases2019Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Many people with the incurable and often times fatal motor neuron diseases have pain, but there is lack of knowledge about people’s experiences of living with pain. Further, the correlation between pain and their quality of life is not well understood, and previous studies have not used individual quality of life, namely that people with their own words express what quality of life is.   The aim of these studies was to explore the experiences of pain and the association between pain and quality of life in people with MND.

    Methods: Study I was explorative about the individual experience of pain, while study II was correlational between pain, pain severity, disease severity and IQOL. Study I was qualitative, whereas study II used both qualitative and quantitative analysis.

    Results and conclusions: People with motor neuron diseases experienced pain to have multiple characteristics and impact. However, the results emphasise that the individual experienced some pain characteristics as difficult and that pain could worsen functions that were already affected by the disease. The experience was also that it could be challenging to manage pain. However, the symptom of pain could pass unnoticed in contacts with healthcare professionals (study I). The three most important areas for individual quality of life in both participants with and without pain were: Social relations, followed by Activities for amusement and relaxations, and Being in the outdoor environment. Individual quality of life was noticed to be good regardless of pain. Pain and pain severity were not found to be associated with satisfaction of individual quality of life in patients with motor neuron diseases, neither was disease severity. The results support previous findings, that strong associations between symptoms of MND and IQoL are not obvious. However, this does not infer that pain in people with MNDs should be neglected and undertreated. On the contrary, it seems to be important for healthcare to pay more attention to pain in people with motor neuron diseases and that pain continuously is measured, individually treated and followed. Regardless of whether persons with MND have pain or not, the results point to the importance of healthcare professionals providing support to not only the patient but also the patient’s family and friends, as well as assisting in various forms of relaxing activities and possibility of being in the outdoor environment.

    Delarbeten
    1. The multiple faces of pain in motor neuron disease: a qualitative study to inform pain assessment and pain management
    Öppna denna publikation i ny flik eller fönster >>The multiple faces of pain in motor neuron disease: a qualitative study to inform pain assessment and pain management
    (Engelska)Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Artikel i tidskrift (Refereegranskat) Accepted
    Nationell ämneskategori
    Hälsovetenskaper
    Forskningsämne
    Sjukgymnastik/fysioterapi
    Identifikatorer
    urn:nbn:se:uu:diva-372239 (URN)
    Tillgänglig från: 2019-01-07 Skapad: 2019-01-07 Senast uppdaterad: 2019-10-29
    2. Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases
    Öppna denna publikation i ny flik eller fönster >>Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background Up to 85% of people with motor neuron diseases (MNDs) report pain, but whether pain is correlated to quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQoL) in patients with MND.

     

    Methods Sixty-one patients were recruited from four multidisciplinary teams in the middle of Sweden, whereof 55 responded to The Brief Pain Inventory – Short form. Disease severity were measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version. Individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting. The data was collected once and qualitative analysis and non-parametric statistical analyses were applied. 

    Results Forty-one of 55 participants (74 %) reported pain. The participants nominated in total 19 areas important for their IQoL. The three most important areas nominated by both participants with and without pain were Social relations n = 35/12 (participants with pain/without pain), amusement and relaxation (23/4)and being in the outdoor environment (12/7). The satisfaction of IQoL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQoL between those with pain/without pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U=249, p=0.452).  There was neither any correlation between pain severity and IQoL (rs=-0.007, p=0.961), nor between the separate functions representing disease severity and IQoL (bulbar functions and IQOL rs = .087, p =.505, fine motor functions and IQoL rs = .101, p= .44, gross motor functions and IQOL rs = .181, p= .163, and respiratory functions and IQoL rs = .069, p = .598).

     

    Conclusions

    Pain was not associated with satisfaction of IQoL in patients with MNDs, neither were disease severity. The results support previous findings, that strong associations between symptoms of MND and IQoL are not obvious. However, this does not infer that pain in people with MNDs should be neglected and undertreated.

    Nyckelord
    Amyotrophic lateral sclerosis (ALS), Motor neuron disease (MND), palliative diseases, quality of life, individual quality of life, pain, disease severity, qualitative analysis
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Neurologi
    Identifikatorer
    urn:nbn:se:uu:diva-396032 (URN)
    Tillgänglig från: 2019-10-29 Skapad: 2019-10-29 Senast uppdaterad: 2019-10-29
  • 65668.
    Åkerblom, Ylva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Jakobsson Larsson, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Zetterberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    The multiple faces of pain in motor neuron disease: a qualitative study to inform pain assessment and pain managementIngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Artikel i tidskrift (Refereegranskat)
  • 65669.
    Åkerblom, Ylva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Zetterberg, Lena
    Jakobsson Larsson, Birgitta
    Nyholm, Dag
    Nygren, Ingela
    Åsenlöf, Pernilla
    Pain, disease severity and associations with individual quality of life in patients with motor neuron diseasesManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background Up to 85% of people with motor neuron diseases (MNDs) report pain, but whether pain is correlated to quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQoL) in patients with MND.

     

    Methods Sixty-one patients were recruited from four multidisciplinary teams in the middle of Sweden, whereof 55 responded to The Brief Pain Inventory – Short form. Disease severity were measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version. Individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting. The data was collected once and qualitative analysis and non-parametric statistical analyses were applied. 

    Results Forty-one of 55 participants (74 %) reported pain. The participants nominated in total 19 areas important for their IQoL. The three most important areas nominated by both participants with and without pain were Social relations n = 35/12 (participants with pain/without pain), amusement and relaxation (23/4)and being in the outdoor environment (12/7). The satisfaction of IQoL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQoL between those with pain/without pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U=249, p=0.452).  There was neither any correlation between pain severity and IQoL (rs=-0.007, p=0.961), nor between the separate functions representing disease severity and IQoL (bulbar functions and IQOL rs = .087, p =.505, fine motor functions and IQoL rs = .101, p= .44, gross motor functions and IQOL rs = .181, p= .163, and respiratory functions and IQoL rs = .069, p = .598).

     

    Conclusions

    Pain was not associated with satisfaction of IQoL in patients with MNDs, neither were disease severity. The results support previous findings, that strong associations between symptoms of MND and IQoL are not obvious. However, this does not infer that pain in people with MNDs should be neglected and undertreated.

  • 65670.
    Åkerfeldt, Nazanin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Personal och patientens kunskap om hygienåtgärder avsedda att förebygga MRSA- spridning, samt deras upplevelse av dessa åtgärder2018Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 65671.
    Åkerfeldt, Torbjörn
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Proteinbehovet vid styrketräning2001Ingår i: Svensk Idrottsforskning, Vol. nr 3, s. 50-Artikel i tidskrift (Övrigt vetenskapligt)
  • 65672.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Leo Swenne, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Ronquist, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels2014Ingår i: European Journal of Medical Research, ISSN 0949-2321, E-ISSN 2047-783X, Vol. 19, s. 61-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels.

    Methods: Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA.

    Results: Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group.

    Conclusion: Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.

  • 65673.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Helmersson, Johanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Postsurgical inflammatory response is not associated with increased serum cystatin C values2010Ingår i: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 43, nr 13-14, s. 1138-1140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Cystatin C is used both as a glomerular filtration (GFR) marker and a cardiovascular risk marker. There are several studies showing an association between cystatin C and inflammatory markers and it has been suggested that the inflammatory response in itself could result in elevated cystatin C levels. The aim of this study was to evaluate if an induced inflammatory response has an effect on cystatin C levels in humans. MATERIALS AND METHODS: CRP and cystatin C were analyzed in serum samples from orthopedic surgery patients (n=29). The patients were sampled prior to surgery and four and thirty days after surgery. RESULTS: The surgery induced a pronounced CRP elevation on day four, median 137.3 (interquartile range 104.1-178.2) mg/L compared to 1.94 (1.20-8.70) mg/L before surgery, P<0.001, but no significant difference in cystatin C levels before and four and thirty days after surgery could be seen. CONCLUSIONS: The orthopedic surgery-induced inflammatory response does not cause changes in cystatin C levels.

  • 65674.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Helmersson-Karlqvist, Johanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Circulating Human Fractalkine is Decreased Post-operatively After Orthopedic and Coronary Bypass Surgery2014Ingår i: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 28, nr 2, s. 185-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fractalkine is an important chemokine involved in resolving normal inflammatory processes such as wound healing. Soluble fractalkine acts as a chemoattractant bringing cytotoxic and cytokine-producing cells to areas of inflammation. The aim of the present study was to investigate circulating fractalkine during inflammatory response induced by surgery.

    MATERIALS AND METHODS: Fractalkine was analyzed in serum samples from orthopedic surgery patients (n=29) and coronary bypass patients (n=21). The samples were collected prior to surgery and 4 and 30 days after surgery, respectively.

    RESULTS: Fractalkine concentrations decreased from pre-operative levels of 1,764 (1,330-2,434) pg/mL to 1,520 (1,330-2,434) pg/mL at 4 days after surgery, and to 1,285 (1,099-1,462) pg/mL 30 days after surgery in patients undergoing orthopedic procedures (p<0.01, 30 days post-operatively versus pre-operatively). Furthermore, fractalkine concentrations decreased significantly from pre-operative levels of 1,856 (1,520-2,434) pg/mL to 1,338 (964-1,650) pg/mL 4 days post-operatively and to 1,266 (1,080-1,338) pg/mL 30 days post-operatively in patients undergoing coronary bypass surgery (p<0.01, 30 days post-operative versus pre-operative values).

    CONCLUSION: A significant and persistent decrease in circulating fractalkine was observed after orthopedic and coronary bypass surgery despite a marked inflammatory response.

  • 65675.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Helmersson-Karlqvist, Johanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Swenne, Christine Leo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Postsurgical Acute Phase Reaction is Associated with Decreased Levels of Circulating Myostatin2015Ingår i: Inflammation, ISSN 0360-3997, E-ISSN 1573-2576, Vol. 38, nr 4, s. 1727-1730Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Muscle strength is of importance for postsurgical rehabilitation. Myostatin is a growth factor that regulates the size of muscles and could thus influence muscle mass and function in the postsurgical period. The aim of the present study was to study the changes in myostatin levels during the postsurgical inflammatory period. Myostatin was analysed in serum samples from two elective surgery groups, orthopaedic surgery (n = 24) and coronary bypass patients (n = 21). The samples were collected prior to surgery and 4 and 30 days after surgery. In the orthopaedic group, the median myostatin levels decreased from 3582 ng/L prior to surgery to 774 ng/L at day 4 (p < 0.001) and to 2016 ng/L at day 30 (p < 0.001). Median CRP increased from 2.35 mg/L preoperatively to 117 mg/L at day 4 and decreased to 5.5 mg/L at day 30 in the same group. The coronary bypass group showed a similar pattern with a decrease in myostatin from 4212 ng/L to 2574 ng/L at day 4 (p < 0.001) and to 2808 ng/L at day 30 (p = 0.002). Median CRP increased from 1.80 mg/L preoperatively to 136 mg/L at day 4 and returned to 6.12 mg/L at day 30 in the coronary bypass group. There was a significant decrease in myostatin concentrations both in the early and late postsurgical period. The lowest myostatin concentration time point coincided with the highest CRP concentration time point.

  • 65676.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Inflammatory response is associated with increased cathepsin B and decreased cathepsin S concentrations in the circulation2011Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 71, nr 3, s. 203-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Objective. Extracellular matrix remodeling by cathepsins play an important role in many conditions associated with inflammation. The aim of this study was to study the effect of inflammation on circulating levels of human cathepsin B and S. Materials and methods. Blood sampling was carried out prior to surgery and 4 and 30 days after surgery, respectively. Two patient groups were included: (1) patients undergoing orthopedic surgery (n = 29) and coronary bypass patients (n = 21). Serum cathepsin B and S levels were measured using sandwich ELISAs. C-reactive protein (CRP) was analysed by turbidimetry. Results. Serum cathepsin B showed significantly higher values 4 days after surgery in comparison with samples collected prior to surgery. Serum cathepsin S instead showed significantly lower values 4 days after surgery. Similar results were found in both patient groups. Conclusions. Inflammation has different effects on circulating levels of cathepsin B and S.

  • 65677.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Pentraxin 3 Increase is Much Less Pronounced Than C-Reactive Protein Increase After Surgical Procedures2011Ingår i: Inflammation, ISSN 0360-3997, E-ISSN 1573-2576, Vol. 34, nr 5, s. 367-370Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pentraxin 3 is an acute phase marker that belongs to the same protein family as C-reactive protein (CRP). The aim of this study was to compare the acute phase reactions of pentraxin 3 and CRP in humans. High sensitivity CRP and pentraxin 3 were analyzed in blood samples from orthopedic surgery (n = 29) and coronary bypass patients (n = 21). The samples were collected prior to surgery and 4 and 30 days after surgery, respectively. Both CRP and pentraxin 3 were significantly increased at day 4. Median pentraxin 3 values increased from 4,021 to 7,459 pg/mL in the orthopedic group and from 4,637 pg/mL to 10,419 pg/mL in the coronary bypass group while CRP increased from 6.3 mg/L to 151.6 mg/L and from 5.7 mg/L to 176.3 mg/L in the same groups. Pentraxin 3 shows a much smaller increment in humans in comparison with CRP.

  • 65678.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lipcsey, Miklos
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Swenne, Christine, Leo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Serum leptin is decreased thirty days after surgery2014Ingår i: Journal of Diabetes and Metabolism, ISSN 2155-6156, Vol. 5, nr 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Leptin plays an important role for the regulation of food intake, energy expenditure and glucose control. The aim of this study was to study the effect of surgery on circulating levels of human leptin in a human elective surgery model. Methods: A prospective observational study was conducted. Blood sampling was carried out prior to surgery and four and thirty days after elective surgery, respectively. Patients undergoing orthopedic surgery (n=29) and coronary bypass patients (n=21) were included in the study. Serum leptin levels were measured using sandwich ELISA. C-reactive protein (CRP) was analyzed by turbidimetry. Results: Leptin values was significantly decreased thirty days after surgery in both orthopedic (p=0.002) and coronary bypass patients (p=0.003) in comparison with presurgical values. Conclusion: Elective surgery is associated with decreased leptin levels in the late postsurgical phase.

  • 65679.
    Åkerlind, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Nattfotboll i socialt utsatta områden: Beskrivning av verksamheten utifrån programteori och förutsättningar för uppskalning2018Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Andelen barn och ungdomar som befinner sig ett socialt utanförskap halkar efter alltmer i samhället. Att befinna sig ett socialt utanförskap kan medföra en rad negativa konsekvenser för såväl den enskilde individen som för samhället. Det finns ett stort behov av att belysa framgångsrika exempel på sociala innovationer, inriktade på unga i socialt utsatta områden, som kan förbättra deras välfärd och framtidsutsikter.

    Syftet med examensarbetet var att beskriva verksamheten ”Nattfotboll” utifrån programteori och undersöka dess förutsättningar för att skalas upp utifrån teorier om spridning av interventioner. Studien genomfördes med en kvalitativ studiedesign bestående av en fokusgruppsintervju med initiativtagare och projektledare, semistrukturerade intervjuer med 10 ledare och 21 ungdomar samt tre strukturerade observationer i samband med idrottsaktiviteter i Sandviken och i Örebro.

    Resultatet visade att konceptet Nattfotboll kännetecknades av flera viktiga kärnkomponenter och nyckelidéer. De komponenter som tillskrevs mycket stor betydelse för utfallet var de unga, utvalda ledare som drev idrottsverksamheten, men även den lokala projektledaren. Verksamheten visade sig främja ett relationsbygge mellan ungdomarna och ledarna som var betydelsefullt: ungdomarna fick tillgång till unga förebilder, medan de unga ledarna kunde växa som individer. Verksamheten erbjuder en träffpunkt som bidrar till att ungdomar breddar sitt kontaktnät, blir mer fysiskt aktiva och erbjuds en väg in i föreningslivet, då många av ledarna själva är idrottsaktiva. Studien visar att Nattfotbollskonceptet innehåller de fem kategorier som är nödvändiga för en framgångsrik uppskalning; Kärnkomponenter & Nyckelidéer, Upplägg, Kommunikation, Resultatmätning & Feedback samt Ledarskap. Ytterligare forskning skulle kunna bidra till att fördjupa förståelsen för vad interventionen har för betydelse för ledarna som individer.

  • 65680.
    Åkerman, Carl Rudolph
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten.
    Glas, Olof
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten.
    Om angina pectoris :, Del 2: akademisk afhandling, med vidterfarna Medicinska Facultetens i Upsala tillstånd, under inseende af doct. Olof Glas1851Dissertation (äldre avhandling) (Övrigt vetenskapligt)
  • 65681.
    Åkerman, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi. Uppsala University.
    Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden.

    Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care.

    Delarbeten
    1. A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden
    Öppna denna publikation i ny flik eller fönster >>A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden
    2019 (Engelska)Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 19, s. 64-70Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access,or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual andreproductive healthcare services among immigrant women in Sweden

    Method: A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed amongimmigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants.Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests,and logistic regressions were used for the analysis.

    Results: About one-third of the immigrant women reported lack of knowledge of where to go for contraceptivecounselling. Experiencing lack of emotional social support and not having had children was associated with thislack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and thiswas associated with not having participated in a health examination. Almost 25% stated that their culture keptthem back from using contraception.

    Conclusion: Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrantwomen participating in Swedish language schools for immigrants could be considered as a missed opportunity,as all citizens in Sweden have free access to these services. New health policies and strategies should aim toincrease knowledge of SRH services among immigrants. Swedish language schools could play an important rolein increasing knowledge of SRH-related information as many new immigrants become students during their firstyears in Sweden.

    Nyckelord
    Health services accessibility, Sexual and reproductive health, Contraceptive counselling, Immigrant, Social capital, Sweden
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Forskningsämne
    Socialmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-376260 (URN)10.1016/j.srhc.2018.12.005 (DOI)000465365500011 ()30928137 (PubMedID)
    Forskningsfinansiär
    Folkhälsomyndigheten
    Tillgänglig från: 2019-02-03 Skapad: 2019-02-03 Senast uppdaterad: 2019-05-29Bibliografiskt granskad
    2. Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden
    Öppna denna publikation i ny flik eller fönster >>Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden
    Visa övriga...
    2016 (Engelska)Ingår i: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, artikel-id 25Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.

    METHODS: This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.

    RESULTS: The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR = 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).

    CONCLUSIONS: The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.

    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-305856 (URN)10.1186/s12914-016-0100-4 (DOI)000384947700001 ()27724904 (PubMedID)
    Forskningsfinansiär
    Folkhälsomyndigheten
    Tillgänglig från: 2016-10-23 Skapad: 2016-10-23 Senast uppdaterad: 2019-02-05Bibliografiskt granskad
    3. Healthcare-seeking behaviour in relation to sexual and reproductive health among Thai-born women in Sweden: a qualitative study
    Öppna denna publikation i ny flik eller fönster >>Healthcare-seeking behaviour in relation to sexual and reproductive health among Thai-born women in Sweden: a qualitative study
    2017 (Engelska)Ingår i: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 19, nr 2, s. 194-207Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Thailand is one of the most common countries of origin among immigrants in Sweden and Thai immigrants comprise the immigrant group most frequently diagnosed with HIV. Little is known about their healthcare-seeking behaviour and views on HIV prevention. This study explored Thai women's healthcare-seeking behaviour in relation to sexual and reproductive health and their views on HIV prevention. Nineteen in-depth interviews were conducted with Thai-born women in the Stockholm area. Three themes were identified: (1) poor access to healthcare in Sweden, preferring to seek care in Thailand; (2) partners playing a key role in women's access to healthcare; (3) no perceived risk of HIV, but a positive attitude towards prevention. Despite expressing sexual and reproductive healthcare needs, most women had not sought this type of care, except for the cervical cancer screening programme to which they had been invited. Identified barriers for poor access to healthcare were lack of knowledge about the healthcare system and language difficulties. To achieve 'healthcare on equal terms', programmes and interventions must meet Thai women's healthcare needs and consider what factors influence their care-seeking behaviour. Integrating HIV prevention and contraceptive counselling into the cervical screening programme might be one way to improve access.

    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-312021 (URN)10.1080/13691058.2016.1214746 (DOI)000393781500004 ()27684388 (PubMedID)