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  • 51.
    Libungan, Berglind
    et al.
    Sahlgrens university hospital, Sweden.
    Lindqvist, Jonny
    Sahlgrens university hospital, Sweden.
    Strömsöe, Anneli
    Univ Dalarna, Sweden.
    Nordberg, Per
    Karolinska institutet, Sweden.
    Hollenberg, Jacob
    Karolinska institutet, Sweden.
    Albertsson, Per
    Sahlgrens university hospital, Sweden.
    Karlsson, Thomas
    Univ Gothenburg, Sweden.
    Herlitz, Johan
    Western Sweden Univ Boras, Sweden.
    Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Background: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA). Aim: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    Methods: OHCA patients >= 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and >= 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    Results: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    Conclusions: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age. 

  • 52.
    Lindblad, Katarina
    et al.
    Västmanland County Hospital, Västerås, Sweden.
    Bergkvist, Leif
    Västmanland County Hospital, Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Västmanland County Hospital, Västerås, Sweden.
    Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: a randomisezed controlled trial2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 6, p. 2523-2531Article in journal (Refereed)
    Abstract [en]

    Purpose. The purpose was to investigate the effects of long-wave diathermy in combination with interferential currents (interferential therapy and long-wave diathermy at high power (ITH)) in comparison with long-wave diathermy at a power below the active treatment dose (long-wave diathermy at low power (LDL), control group) on sensory and motor symptoms in patients with chronic chemotherapy-induced peripheral neuropathy (CIPN) in the lower extremities.

    Methods. Sixty-seven patients with chronic CIPN were randomized to 12 weeks of either ITH or LDL. Follow-up assessments were performed after the treatment period and at 37 weeks after randomization. The primary outcome was pain (Numeric Rating Scale (NRS)), and the secondary outcomes were discomfort, nerve symptoms, subjective measurement of dizziness (Dizziness Handicap Inventory), and balance. Differences within and between groups were analyzed.

    Results. Pain intensity decreased significantly only in the LDL group directly after the treatment period from NRS median 25 to median 12.5 (P = 0.017). At the 37-week follow-up, no changes were detected, irrespective of group (NRS 13 vs. 20, P = 0.885). Discomfort decreased significantly in both groups at both 12 and 37 weeks after the baseline (P < 0.05). Balance disability showed significant declines in both groups at 12 and 37 weeks (P = 0.001/0.025 in the ITH group vs P = 0.001/<0.001 in the LDL group). Balance ability (tightened Romberg test) increased significantly at both 12 and 37 weeks in both groups (P = 0.004/<0.040 in the ITH group) but did not improve in the LDL group at any of the follow-up time points (P = 0.203 vs P = 0.383). The one-legged stance test was unchanged in the ITH group after 12 weeks but improved 37 weeks after baseline (P = 0.03). No significant changes were observed in the LDL group at any of the follow-up time points.

    Conclusion. This study provides no support for the use of a combination of long-wave diathermy and ITH as a treatment option for patients with chronic CIPN. However, the chronic CIPN symptoms decreased with time irrespective of the treatment.

  • 53.
    Lindgren, Gunilla
    et al.
    Stockholm Institute of Education, Sweden.
    CERNERUD, LARS
    The Nordic School of Public Health, Göteborg, Sweden.
    Physical Growth and Socioeconomic Background of Stockholm Schoolchildren born in 1933-631992In: Annals of Human Biology, ISSN 0301-4460, Vol. 19, no 1, p. 1-16Article in journal (Refereed)
    Abstract [en]

    Height, weight and body mass index (BMI) at aged 7, 10 and 13 years for samples of Stockholm schoolchildren born in 1933, 1943, 1953 and 1963 were analysed in relation to their socioeconomic background. In height there were significant socioeconomic differences for boys and girls born in 1933 and 1943 at the ages of 7 and 10 years; children from the lowest socioeconomic group were smaller. For the cohort born in 1953 there were, however, no socioeconomic differences in height - either for boys or for girls. For children born in 1963, socioeconomic differences in height appeared again, but mainly for the boys; boys in the lowest socioeconomic group were smaller. Significant weight differences between socioeconomic groups were for the boys found only in cohorts born in 1943 and in 1963 and for the girls born in 1933, 1943 and 1953. Socioeconomic differences in BMI were found for boys born in 1943, when the middle socioeconomic group had the lowest index, and for boys born in 1963 when the highest socioeconomic group had the highest index. For girls socioeconomic differences in BMI were only found for girls born in 1953 when the lowest group had the highest BMI. The main conclusions from the study were: socioeconomic differences in height formerly present in Stockholm schoolchildren born in 1933 and 1943 were levelled out for the children born in 1953, but reappeared again for children born in 1963 - mainly for the boys; these socioeconomic height differences for the 1963 cohort were of about the same magnitudes as those for the cohort born in 1943 during the Second World War. The influence of socioeconomic background on the BMI of Stockholm schoolchildren born 1933-63 was not so marked.

  • 54.
    Lostelius, Hanna
    Mälardalen University, School of Health, Care and Social Welfare.
    Kartläggning av kvinnors amningsupplevelser på BB: -en enkätundersökning2009Independent thesis Advanced level (degree of Master (One Year)), 15 credits / 22,5 HE creditsStudent thesis
  • 55.
    Lugina, Helen I
    et al.
    School of Nursing, Muhimbili Univ. Coll. of Hlth. Sci., Dar es Salaam, Tanzania .
    Nyström, Lennarth
    Umeå University, Umeå, Sweden .
    Christensson, Kyllike
    Karolinska Institute, Stockholm, Sweden.
    Lindmark, Gunilla
    Uppsala University, Uppsala, Sweden.
    Assessing mothers' concerns in the postpartum period: methodological issues.2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 48, no 3, p. 279-290Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study evaluating the sensitivity of a semi-structured interview schedule and card sort methods in assessing postpartum concerns of women. BACKGROUND: Several methods have been used to assess postpartum maternal concerns and the process of becoming a mother, but few studies have evaluated the methods with respect to their sensitivity for obtaining information. METHOD: A cohort of mothers was followed-up at one (n = 110) and 6 weeks (n = 83) after childbirth in Dar es Salaam, Tanzania. Women with a minimum of 7 years of primary education were interviewed and they also sorted cards. Those with less fewer than 7 years of primary education were interviewed only. The methods were used in alternate order to assess method interaction. RESULTS: In the interviews at 1 week, mothers more often expressed worry and interest related to the baby or themselves when they had sorted cards first. The extent to which women expressed worry and interest about specific baby- and mother-related topics was generally higher for women who had sorted cards before the interview at both 1 and 6 weeks. Independent of whether they were interviewed only, interviewed after sorting cards or before, mothers more often expressed a higher degree of interest than of worry about the baby and self at both 1 and 6 weeks. The order of the data collection methods did not influence the way women sorted cards as being worries and interests. CONCLUSION: Compared to interview using a semi-structured interview schedule, our findings suggest that the card sort is more sensitive in obtaining information about women's concerns. Although the interview method has the advantage of reaching less educated people, the card sort is a technique that is associated with fewer barriers and is a more participatory method for those who can use it.

  • 56.
    Malmberg, Jennie
    Mälardalen University, School of Sustainable Development of Society and Technology.
    The neuroanatomical  expression profile of novel  membrane proteins.: The effect of macronutrients on gene expression.2008Independent thesis Advanced level (degree of Magister), 20 points / 30 hpStudent thesis
    Abstract [en]

    Worldwide obesity is an increasing problem. Apart from the fact that obesity greatly  impairs the health, quality and length of life for the affected individuals, it is also has the  potential to become a major socioeconomic problem in a near future. However preventive  actions require an understanding of the cause. Before the psychological influence on  eating can be evaluated a profound understanding of the biological regulatory system and  how this interacts with the food consumed is required. On the assumption that food  consumption is regulated by interplay between food and genes, the food itself may  influence the genes that regulate consumption, hence change the expression levels of the  genes regulating food intake.     To evaluate the interplay between food and gene expression, the project contained several  parts, reflecting different aspects of the area of research. The feeding studies had in  common that they were initial trials in a larger project. The results of these will be  evaluated and used in combination with further studies.     The mice typed for food preference illustrate the complexity of the feeding regulatory  system by pointing out the differences between individuals even in a relatively small  group of animals. Mice in general like food high in fat and here the animals that showed a  preference for sugar also showed a significant increase in their intake of chow. Since  chow consists mainly of carbohydrates the results might indicate a preference not for  sucrose in particular but for carbohydrates in general. The effect this may have on other  studies is still unclear as further studies are needed to determine whether the difference  may be the result of an innate genetic difference.      Leucine has been previously shown to reduce the total caloric intake. When given in  combination with palatable food the addition of Leucine primarily reduced the intake of  chow. From a dietary perspective this would translate to a preference to sweets and fast  food at the expense of food with more nutritious content.     The RT-PCR analysis’s gives clues to how the energy regulatory circuitry responds to the  intake of selected macronutrients. When it comes to gene expression there is a significant  effect of macronutrients on the gene expression levels. The common theme for many of  the genes tested seems to be down regulation of satiety signals, as if to support over  feeding on palatable diets and in many cases sucrose in particular.     The intake of macronutrients such as sugar or fat has been showed to have an effect on  the feeding regulatory circuitry, demonstrated by the change in gene expression levels.   The response to said macronutrients is site specific which is clearly shown both by RTPCR analysis of samples from different parts of the brain, such as the brainstem or  hypothalamus, and by immunohistochemistry of selected areas. The  immunohistochemistry also confirms that the novel Oxytocin receptor-antagonist, who is  injected IP, actually passes over the blood-brain barrier and has an actual affect on the  regions of interest. The areas affected by the antagonist can be visualized and identified  through the staining of active sites.

  • 57.
    Malmer, L
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Martin, Lene
    Karolinska Institutet, Stockholm, Sweden.
    Microdot test of foveal function. A comparison with visual acuity at high and low contrast2005In: Ophthalmic & physiological optics, ISSN 0275-5408, E-ISSN 1475-1313, Vol. 25, no 2, p. 81-86Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To define normal values across age from novel computerized tests of foveal vision and to compare the findings with visual acuity (VA) at high and low contrast. SUBJECTS AND METHODS: Sixty-one healthy volunteers, aged 22-87, with subjectively normal vision participated in the study. The right eye from each subject was tested with Snellen letter VA at high contrast, at 10% contrast using the Tri-VA test and with the Rarebit Microdot Fovea Test (RMFT), in addition to biomicroscopy and fundus examination. RESULTS: The median letter VA was 0.77 minimum angle of resolution (MAR; range 0.63-1.54) with a significant decline in letter VA with increasing age (r = 0.7, p < 0.001). The median Tri-VA resolution threshold at 10% contrast was 1.8 MAR (range 0.9-4.1) and a significant age effect (r = 0.7) was observed, most pronounced above 65 years. The median RMFT hit rate was 100% (range 97-100) in the age group below 65 years and 87.5% (range 34-98) in subjects older than 65 years. CONCLUSION: The study shows a decline in foveal function with age with all three methods, reflecting the loss of neural detectors with increasing age. The hit rate to microdot stimuli appears to be a sensitive measure, which can be used for fine-graded evaluation of foveal function.

  • 58.
    Marqvardt, Clary
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Hagelroth, Sara
    Mälardalen University, School of Health, Care and Social Welfare.
    Kampen måste gå vidare: Upplevelser av att återinsjukna i cancer2010Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Cancer is often perceived as a threatful and dangerous disease. A lot of people with a history of cancer also suffer a relapse later in their life. Nursing staff’s knowledge of experiences of being affected by a relapse is insufficient, resulting in that people in these situations do not receive adequate support and assistance. The aim of this Bachelor thesis was to illuminate people’s experiences of a cancer relapse. Four autobiographies were analyzed from a qualitative manifest content analysis with an inductive approach. The analysis resulted in three categories: the will to live, the experience of suffering and the experience of the desire to give up. The main findings were that they experienced a fear of death, a mental pain and an experience of chaos, which were expressed through an experience of suffering. Hopelessness, incomprehension and despair were also prominent experiences. A number of experiences were permeated by a strong will to live, vitality and a positive attitude which showed that they wanted to continue the struggle to survive. It is important that nurses take patients who relapse seriously, because these patients should not have to suffer in silence. These people require more attention and the nursing care must be improved so their needs are satisfied and the quality of life is strengthened.

  • 59.
    Martin, L M
    Karolinska Institute, Stockholm, Sweden.
    Working with glaucoma patients - prospects for "shared care".1999In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 77, no 1, p. 103-106Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the prospects for "shared care" by evaluating to what extent ophthalmic nurses are involved in ophthalmic care decision tasks in the management of glaucoma patients, how well prepared the nurses feel they are for these tasks and their level of satisfaction in those tasks they actually are performing. METHODS: A questionnaire was sent to the ophthalmic nurses at 13 eye clinics in Sweden. The clinics were selected to represent different parts of Sweden as well as university clinics and smaller rural clinics. RESULTS: A difference was found between clinics regarding the number of tasks independently performed by the ophthalmic nurses and a significant correlation was found between level of participation and satisfaction (p=0.008). The nurses felt prepared for (61/62) and satisfied (58/62) when performing the glaucoma management tasks, and a high and very significant correlation (r=0.96, p= 0.0001) was found between the mean preparedness and satisfaction scores for each of the 14 tasks. CONCLUSIONS: The findings in the study show that the ophthalmic nurses feel prepared for their tasks and regard their involvement in glaucoma care as subjectively satisfactory. These observations support the idea of "shared care" in glaucoma management.

  • 60.
    Martin, L M
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lindblom, B
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Gedda, U K
    St. Erik Eye Hospital, Stockholm, Sweden.
    Concordance between results of optic disc tomography and high-pass resolution perimetry in glaucoma2000In: Journal of glaucoma, ISSN 1057-0829, E-ISSN 1536-481X, Vol. 9, no 1, p. 28-33Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate concordance between results obtained with the Heidelberg Retina Tomograph (HRT) (Heidelberg Engineering GmbH, Heidelberg, Germany) and those obtained with the high-pass resolution perimeter (HRP) in glaucoma diagnosis. METHODS: A total of 217 patients from the glaucoma services at St. Erik Eye Hospital, Stockholm, Sweden (n = 107) and Sahlgrenska University Hospital, Göteborg, Sweden (n = 110) were included in the study. All patients were examined because of known or suspected glaucoma in at least one eye. The conventional indices presented by the instruments were used, i.e., glaucoma index from the HRT (negative values = abnormal, positive = normal) and combined deviation (upper normal limit 2.1 dB) from the HRP. RESULTS: The concordance regarding the classification of normal or glaucomatous by the two instruments was 71% (153/217 eyes). The HRT indicated glaucoma but HRP findings were normal in 47 patients, and the reverse occurred in 17 patients. There was a significant difference in optic disc area between patients with abnormal HRT findings and normal HRP findings and in patients with normal HRT findings and abnormal HRP findings. The concordance could not be improved by adjusting for disc size. The correlation between combined deviation on HRP and the HRT glaucoma index was r = -0.53. CONCLUSION: A significant correlation was found between the combined index given by HRP and the HRT glaucoma index in 217 patients examined for known or suspected glaucoma. Discordant findings were observed in 64 patients; in 22 this discordance was explained by the influence of disc size. No other reasons for differences in examination results could be detected.

  • 61.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.
    Clinical experience with Latanoprost: a retrospective study of 153 patients1999In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 77, no 3, p. 336-339Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the pressure-reducing effect of latanoprost in a clinical setting. Patients and methods: Data from 153 consecutive patients with open angle glaucoma receiving latanoprost were recorded at baseline (=153), 2 weeks (n=151) and 8 to 12 months (n=89) after starting latanoprost treatment, In 82 patients (54%) latanoprost was added to ongoing treatment, Two patients terminated treatment because of side effects before the first follow-up examination, Results: 56% (84/151) of the patients showed an intraocular pressure reduction of 20% or more after 2 weeks, regardless of baseline therapy. The difference between intraocular pressure before (24.4+/-5.8 mm Hg) and after 2 weeks of latanoprost treatment (19.9+/-6.9 mm Hg) in the total group (n=151) was highly significant (p<0.0001). The pressure reduction was significantly correlated,vith the pretreatment intraocular pressure level (r=0.48, p<0.0001). In the 89 patients who could be followed for 8 to 12 months no significant upward drift in mean intraocular pressure was observed, but in fourteen patients intraocular pressure increased with 5 mm Hg or more. Thirteen patients reported side effects, five of these discontinued the treatment. Conclusion: Latanoprost is obviously an efficient pressure reducing drug which can be used in glaucoma patients as an adjunct to any ongoing therapy with the expectation of clinically relevant intraocular pressure reduction in 45-71% of the patients.

  • 62.
    Martin, Lene
    Stockholm University, Sweden.
    Computer-assisted management of primary open-angle glaucoma. Knowledge acquisition and prototype testing1996In: Computers in Nursing, ISSN 0736-8593, Vol. 14, no 5, p. 267-271Article in journal (Refereed)
    Abstract [en]

    Primary open-angle glaucoma is a common disease afflicting 1% to 2% of people older than 50 years of age. The care of patients with glaucoma is a subject of debate because the disease is incompletely understood. The diagnosis relies on a number of examinations, many of them performed by ophthalmic nurses, and the care of patients with glaucoma has become one of the main tasks for ophthalmic nurses in Sweden. This study describes a knowledge-based system for decision support in glaucoma management, which uses seven data elements about the patient to arrive at one of 25 different recommendations for appropriate action. In 267 patient visits to five different eye clinics, the program recommendations were compared with the actual decisions made by the responsible physician. The concordance was 92% to 100% when policy differences among the clinics were taken into account. The program appears to provide substantial decision support in the management of primary open-angle glaucoma. The program's ability to support the ophthalmic nurses in the care of patients with open-angle glaucoma is being evaluated.

  • 63.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.
    Computerized method to measure glare and contrast sensitivity in cataract patients1999In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 25, no 3, p. 411-415Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate computerized methods for measuring glare sensitivity and visual acuity at 3 contrast levels in cataract patients. Setting: St. Erik's Eye Hospital, Stockholm, Sweden. Methods: In a prospective study, 25 consecutive cataract patients meeting the inclusion criteria were examined before and 12 weeks after cataract surgery. Measured were glare sensitivity and visual acuity at 3 contrast levels using the Ophthimus Y-VA Contrast Sensitivity lest and Glare Test. Results: Preoperatively, ail patients had impaired values compared with those in a group of age-matched normal volunteers (control group). Postoperatively, median values were similar to those in the age-matched control group in all parameters except glare sensitivity, which was significantly higher in the pseudophakic group (P = .03). Correlation coefficients between preoperative visual acuity and contrast sensitivity at 90%, 25%, and 10% were 0.50 (P = .01), 0.53 (P = .006), and 0.45 (P = .02), respectively, and between preoperative visual acuity and preoperative glare difference, 0.45 (P = .02). A significant correlation was found between age and visual acuity in the control group at all contrast levels: 90% (r = 0.61, P = .0018 ), 25% (r = 0.52, P = .01), and 10% (r = 0.42, P = .04). Median differences between Y-VA examinations (repeatability) were 0 LogMAR except between examinations 1 and 2 at the 25% contrast level, where it was 0.3 LogMAR. Conclusion: The Ophthimus Y-VA Test and Glare Test were useful in the preoperative evaluation of patients with cataract and mild to moderate visual impairment.

  • 64.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare.
    Dense cataracts lead to amblyopia and visual field impairment in children2008In: Ocular Surgery NewsArticle, review/survey (Other academic)
  • 65.
    Martin, Lene
    Karolinska Institutet, Stockholm, Sweden.
    Intraocular pressure before and after visual field examination2007In: Eye (London. 1987), ISSN 0950-222X, E-ISSN 1476-5454, Vol. 21, no 12, p. 1479-1481Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the influence of visual field (VF) examinations using modern techniques with short examination times on the intraocular pressure (IOP). METHODS: Sixty-one consecutive patients, aged 28-90 years, 40 women and 21 men, were examined. Forty patients were treated for glaucoma and 21 were untreated patients with ocular hypertension or suspected glaucoma. Twenty-one subjects were examined using the Humphrey Field Analyzer, using SITA programs, and 40 with high-pass resolution perimetry (HRP). Goldmann applanation tonometry was performed immediately before and after the VF examinations. RESULTS: A difference in IOP of more than 2 mm Hg before and after the VF examination was observed in 14 of the 61 patients (23%). The maximum change in each direction was 4 mm Hg. The mean differences were not significant. All eight subjects with increasing IOP after VF examinations were examined using the HRP technique (P=0.04). CONCLUSION: Modern VF techniques with short examination time do not seem to significantly influence IOP.

  • 66.
    Martin, Lene
    Karolinska Institutet, Sweden.
    Knowledge acquisition and evaluation of an expert system for managing disorders of the outer eye2001In: Computers in Nursing, ISSN 0736-8593, Vol. 19, no 3, p. 114-117Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to develop and evaluate an expert system for diagnosing outer eye disorders, intended to support family physicians and nurse practitioners in the management of patients with minor eye complaints. The knowledge in the program was gathered from the scientific literature and from 6 experienced ophthalmologists and 6 ophthalmic nurses. Fourteen diagnoses must be considered, and the differential diagnosis is dependent upon 32 signs and symptoms. The program calculates the most likely diagnosis, presents photographs of the typical ocular findings, and provides information regarding management and treatment. The program's output was compared with the diagnosis made by 8 other ophthalmologists at a Swedish university clinic, based on data from 157 patients with disorders of the outer eye, who visited the emergency ward during a one-week period. The concordance between the diagnosis made by the ophthalmologists and the program was 96%. In conclusion, the expert system for disorders of the outer eye provided essentially the same diagnostic information as an examination by an ophthalmologist. Support from the program would make it possible for family physicians and nurse practitioners to manage most of these patients.

  • 67.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare.
    Medical treatment after argon laser trabeculoplasty in glaucoma1989In: Chibret International Journal of Ophthalmology, ISSN 0748-9501, Vol. 6, no 1, p. 18-21Article in journal (Refereed)
    Abstract [en]

    Medical therapy was reduced or withdrawn in 80 of 160 glaucoma patients with normalized intraocular pressure (IOP) after argon lasertrabeculoplasty (ALT). In the 80 patients with unchanged medical therapy, mean IOP was stable during the six-month follow-up period. Timolol could be withdrawn in a significantly smaller proportion of patients [14 of 28 (50%)] compared to pilocarpine [26 of 32 (81%)]. Acetazolamide could be withdrawn in 14 of 20 patients (70%). The mean IOP increase one month after discontinuance of timolol was 6.6 ± 5.7 mm Hg; after pilocarpine, 4.4 ± 4.7 mm Hg; and after acetazolamide, 4.8 ± 6.3 mm Hg. After six months, IOP remained normal in 13 of the 14 patients (93%) from whom timolol had been withdrawn. Corresponding values were 20 of 26 (77%) for pilocarpine and nine of 14 (64%) for acetazolamide. Thus, medicaltherapy could be discontinued in 54% of patients with normalized IOP after ALT without IOP increase to pathological levels for at least six months.

  • 68.
    Martin, Lene
    Karolinska Institute, Sweden.
    Rarebit and frequency-doubling technology perimetry in children and young adults2005In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 83, no 6, p. 670-677Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe the outcome of visual field examinations performed with rarebit (RB) and frequency-doubling technology perimetry (FDT) in children and young adults. METHODS: Twenty-one children (aged 6.5-12 years) and 30 teenagers and young adults (aged 14-20 years), participated in the study. RESULTS: Reliable RB examinations were carried out in 76% of the younger group and 90% of the older group. Corresponding values for FDT were 57% and 90-95%, respectively. The RB results were very similar to those previously obtained in adult subjects, while some subjects showed borderline values in FDT, depending on the criteria used. The RB perimetry was preferred by 88% of the examined subjects. CONCLUSIONS: Rarebit perimetry seems useful for visual field examination in children aged 7 years and over, if age-corrected normative data are established; this test was also preferred by the tested subjects. No adaptation or special instructions were needed and the children found it rather amusing.

  • 69.
    Martin, Lene
    Stockholm University, Sweden.
    'Shared care' and computer assistance in glaucoma management1997In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 46, p. 288-290Article in journal (Refereed)
    Abstract [en]

    Primary open angle glaucoma afflicts 1-2% of people over 50 years of age. The diagnosis relies on a number of examinations, many of them performed by ophthalmic nurses, and the care of glaucoma patients has become one of their main tasks. A knowledge-based system for decision support in glaucoma management has been developed and validated. The aim of the current study is to evaluate the influence of computerised decision support on a 'shared care' organisation for the management of glaucoma patients.

  • 70.
    Martin, Lene
    Karolinska Institute, Stockholm, Sweden.
    Working with glaucoma patients. Prospects for ‘shared care’1999In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 77, no 1, p. 103-106Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the prospects for "shared care" by evaluating to what extent ophthalmic nurses are involved in ophthalmic care decision tasks in the management of glaucoma patients, how well prepared the nurses feel they are for these tasks and their level of satisfaction in those tasks they actually are performing. Methods: A questionnaire was sent to the ophthalmic nurses at 13 eye clinics in Sweden. The clinics were selected to represent different parts of Sweden as well as university clinics and smaller rural clinics. Results: A difference was found between clinics regarding the number of tasks independently performed by the ophthalmic nurses and a significant correlation was found between level of participation and satisfaction (p = 0.008), The nurses felt prepared for (61/62) and satisfied (58/62) when performing the glaucoma management tasks, and a high and very significant correlation (r = 0.96, p = 0.0001) was found between the mean preparedness and satisfaction scores for each of the 14 tasks. Conclusions: The findings in the study show that the ophthalmic nurses feel prepared for their tasks and regard their involvement in glaucoma care as subjectively satisfactory. These observations support the idea of "shared care" in glaucoma management.

  • 71.
    Martin, Lene
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ley, David
    Karolinska Institutet, Stockholm, Sweden.
    Marsal, Karel
    Karolinska Institutet, Stockholm, Sweden.
    Hellström, Ann
    Sahlgrenska University Hospital/East, Gothenburg, Sweden.
    Visual function in young adults following intrauterine growth retardation2004In: Journal of pediatric ophthalmology and strabismus, ISSN 0191-3913, E-ISSN 1938-2405, Vol. 41, no 4, p. 212-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intrauterine growth retardation (IUGR) resulting in infants born small for gestational age is a known risk factor for neurologic deficits and may predispose to poor cognitive development later in life. We recently found an association between IUGR and a reduced neuroretinal rim area at 18 years of age. We evaluated the possible association between IUGR and visual function. SUBJECTS AND METHODS: We studied 26 subjects who had been born small for gestational age and 20 subjects whose birth weights were appropriate for gestational age (controls) using letter acuity thresholds, color vision testing, full-threshold frequency doubling technology perimetry, and rarebit perimetry at 18 years of age. gestational age had a rarebit hit rate below the normal range as compared with none of the controls (P = .006). These 8 subjects had a significantly smaller rim-disc ratio compared with the subjects who were small for gestational age who had a normal rarebit hit rate (P = .047). The frequency doubling technology indices did not differ significantly between the control group and the group that was small for gestational age, nor did the visual acuity, refraction, and color vision test results. CONCLUSION: These data indicate that IUGR is associated with an increased rate of impaired visual function, which can be detected by using rarebit perimetry but not frequency doubling technology perimetry, visual acuity, or color vision tests.

  • 72.
    Martin, Lene M
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Anna Lundvall
    St. Erik's Eye Hospital, Stockholm, Sweden.
    Rarebit perimetry and optic disk topography in pediatric glaucoma2007In: Journal of pediatric ophthalmology and strabismus, ISSN 0191-3913, E-ISSN 1938-2405, Vol. 44, no 4, p. 223-231Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To determine the relationship between visual field and optic nerve topography findings in a cohort of children with pediatric glaucoma and an age-matched and sex-matched control SUBJECTS AND METHODS: Fifteen children, aged 6 to 15 years, with pediatric glaucoma in at least one eye and 15 age-matched and sex-matched healthy children were examined with best-corrected visual acuity and perimetry. When possible, scanning laser topography of the optic disk (ie, Heidelberg retinal tomography) was performed. RESULTS: Of 27 eyes in 15 children with pediatric glaucoma examined with Goldmann perimetry, 15 eyes (55%) had a normal visual field. Of 24 eyes examined with Rarebit perimetry, 8 eyes (33%) showed normal results and 16 eyes (67%) showed an abnormally low hit rate (ie, the fraction of seen targets vs presented targets). Nine of the 15 eyes showing normal Goldmann visual fields had a subnormal Rarebit hit rate. All children in the control group had normal Rarebit visual fields. Heidelberg retinal tomography could be performed in all healthy children and in 22 eyes of 13 children with pediatric glaucoma. The concordance between the Heidelberg retinal tomography classification (ie, normal or glaucoma) and the Rarebit results was high (Cohen's kappa = 0.79). A statistically significant correlation (r = 0.66, P = .006) between Rarebit hit rate and Heidelberg retinal tomography glaucoma index was found in the glaucoma group. CONCLUSIONS: Rarebit perimetry detected glaucomatous damage in various types of pediatric glaucoma, and can be assumed to be of value in both diagnosis and follow-up. In 13 children with glaucoma, Heidelberg retinal tomography could be performed. The results conformed well to Rarebit findings.

  • 73.
    Martin, Lene
    et al.
    Stockholm University, Sweden.
    Wanger, P
    St. Erik Eye Hospital, Stockholm, Sweden.
    Five-year follow-up of treated patients with glaucoma using resolution perimetry1998In: Journal of glaucoma, ISSN 1057-0829, E-ISSN 1536-481X, Vol. 7, no 1, p. 22-6Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The authors describe high-pass resolution perimetry findings during the first five years of antiglaucoma treatment. PATIENTS AND METHODS: Thirty-seven patients were examined six times, once a year for five years, with best corrected visual acuity, applanation tonometry, slitlamp examination, funduscopy, and high-pass resolution perimetry. Twenty-nine of these were treated for glaucoma and eight followed for ocular hypertension without treatment. RESULTS: The resolution thresholds in the treated group improved during the first two years and deteriorated after that back to baseline level. Regarding individual patients, the visual fields were improved in 4, unchanged in 16, and deteriorated in 13 of the 29 treated glaucoma patients at the end of the study period. CONCLUSIONS: Resolution visual fields showed initial improvement and subsequent deterioration in treated patients with early glaucoma. The conventional therapy, aiming at reducing intraocular pressure, appeared to postpone visual field decay for at least five years in about 50% of the patients.

  • 74.
    Martin, Lene
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Wanger, Peter
    St. Erik's Eye Hospital, Sweden.
    New perimetric techniques: a comparison between rarebit and frequency doubling technology perimetry in normal subjects and glaucoma patients2004In: Journal of glaucoma, ISSN 1057-0829, E-ISSN 1536-481X, Vol. 13, no 4, p. 268-72Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare rarebit microdot perimetry (RB) with frequency doubling technology (FDT) perimetry in normal subjects and a group of patients with ocular hypertension or glaucoma, with age-matched controls. MATERIALS AND METHODS:: Eighty-one subjects (age 17-88 years) were examined. Twenty-seven of these were patients, aged 50 to 88 years, with ocular hypertension or suspected/manifest glaucoma in at least one eye. All subjects were examined with the RB and FDT perimetry, using the standard procedures, recommended by the respective manufacturer. RESULTS: All patients were able to perform the RB perimetry, but three patients could not perceive the strongest FDT stimulus. The concordance in RB and FDT classifications as normal/outside normal limits was 96% (Cohen's kappa = 0.90). A curvilinear (quadratic) relationship (Rsq = 0.75) was found between RB hit rate and FDT MD. All patients, who could perform both examinations, preferred the RB perimetry. CONCLUSION: In the current study, the information from the RB and FDT perimetry was almost completely equivalent. However, RB perimetry was preferred by the patients and seemed to have a larger dynamic range than FDT. The RB hit rate is apparently a straightforward and efficient measure of visual field function.

  • 75.
    Martin, Lene
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Wanger, Peter
    Karolinska Institutet, Stockholm, Sweden.
    Vancea, Lucian
    Sundsvall Hospital, Sundsvall, Sweden.
    Göthlin, Birgitta
    St Eriks Eye Hospital.
    Concordance of high-pass resolution perimetry and frequency-doubling technology perimetry results in glaucoma: no support for selective ganglion cell damage.2003In: Journal of glaucoma, ISSN 1057-0829, E-ISSN 1536-481X, Vol. 12, no 1, p. 40-44Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare the results of frequency-doubling technology perimetry (FDT), assumed to test the magnocellular visual pathway, and high-pass resolution perimetry (HRP), assumed to test the parvocellular visual pathway, in patients with ocular hypertension or glaucoma. PATIENTS AND METHODS: Forty-eight consecutive patients with glaucoma or ocular hypertension, covering the entire range of optic nerve function from normal to severely damaged, were examined on the same day using FDT and HRP. RESULTS: There was a linear correlation between both global and local indices in FDT and HRP (r = -0.84 P<0.0001 and r = 0.8 P<0.001, respectively). The HRP and FDT classifications agreed in 32 of the 48 (67%) eyes (Cohen kappa = 0.5). There was no significant difference between the ability of the different techniques to detect abnormality. CONCLUSION: The observations in the present study indicate either that both cell populations are similarly affected by glaucomatous damage or that both methods measure activity in the same cell populations.

  • 76. Martin-Boglind, Lene
    Computer-assisted interpretation of resolution visual fields from patients with chiasmal and retrochiasmal lesions1993In: Ophthalmologica, ISSN 0030-3755, E-ISSN 1423-0267, Vol. 207, no 3, p. 148-154Article in journal (Refereed)
    Abstract [en]

    Computer-assisted interpretation of resolution visual fields was performed in 147 normal subjects and 174 consecutive patients with known chiasmal or retrochiasmal lesion. The program identified 99% of normal subjects, and provided support for the correct diagnosis in 64% of patients with chiasmal and 83% of patients with retrochiasmal lesions. In conclusion, computer-assisted interpretation of resolution visual fields can provide considerable support to the final diagnostic decision in patients with lesions of the visual pathways.

  • 77.
    Martin-Boglind, Lene
    Mälardalen University, School of Health, Care and Social Welfare. Sabbatsberg Hospital, Sweden.
    High-pass resolution perimetry in uncomplicated myopia1991In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 69, no 4, p. 516-520Article in journal (Refereed)
    Abstract [en]

    Fifteen subjects (28 eyes) with uncomplicated myopia (3-9 D) were examined using high-pass resolution and Goldmann perimetry. In the central 30 degree field a slight increase was observed in mean resolution threshold significantly correlated to the degree of myopia. In the Goldmann visual fields threshold increase was observed in the area around the blind spot in eight subjects (10 eyes). In the resolution fields only one subject (one eye) showed a corresponding abnormality.

  • 78.
    Martin-Boglind, Lene
    Mälardalen University, School of Health, Care and Social Welfare.
    The effect of treatment on the results of high-pass resolution perimetry in glaucoma1994In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 72, p. 423-428Article in journal (Refereed)
    Abstract [en]

    In order to find out to which extent high-pass resolution perimetry would detect any changes in patients treated for glaucoma, resolution perimetry resultswere evaluated from 56 glaucoma patients and 15 untreated ocular hypertensive patients followed for 2 to 3 years. Fifty-nine of the 71 examined patients showed lower resolution thresholds, i.e. increased sensitivity after 2 years, compared to initial values. The threshold decrease was significantly larger inthe treated glaucoma patients (median 1.22 dB) than in the untreated ocular hypertensive patients (0.48 dB). The threshold decrease in the untreated ocular hypertensive group corresponds to the previously described learning effect. In 35 of the 56 treated glaucoma patients the thresholds improved more than 0.84 dB, the upper confidence limit in the untreated group, which may indicate a beneficial effect of antiglaucoma therapy in these patients.The threshold change was unrelated to initial resolution threshold and cannot be explained by a 'sorting' effect. The observations in the current study using resolution perimetry indicate that improved visual function can be demonstrated in many patients treated for early glaucoma, at least during thefirst 2 years of treatment.

  • 79.
    Martin-Boglind, Lene
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Sabbatsberg Hospital, Sweden.
    Graves, Adrienne
    Sabbatsberg Hospital, Sweden.
    Wanger, Peter
    Sabbatsberg Hospital, Sweden.
    The effect of topical antiglaucoma drugs on the results of high-pass resolution perimetry1991In: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 11, no 6, p. 711-714Article in journal (Refereed)
    Abstract [en]

    We conducted a randomly assigned, double-masked, crossover study of the effects of betaxolol, epinephrine, pilocarpine, and timolol on the high-passresolution perimetry results in normal subjects. The influence of topical administration of these intraocular pressure reducing drugs was negligible, which confirmed the reliability of high-pass resolution perimetry results. The method seems appropriate for the diagnosis of glaucoma and the follow-up ofpatients with glaucoma.

  • 80.
    Mastersong, Siobhan
    et al.
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    McNally, Bryan
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Cullinan, John
    Natl Univ Ireland, JE Cairnes Sch Business & Econ, Galway H91 WN80, Ireland..
    Vellano, Kimberly
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Escutnaire, Josephine
    Univ Lille Law & Hlth, Fac Engn & Hlth Management ILLS, Lille, France..
    Fitzpatrick, David
    Stirling Univ, Scottish Ambulance Serv, NMAHP Res Unit, Unit 13 Scion House, Stirling FK9 4NF, Scotland..
    Perkins, Gavin D.
    Univ Warwick, WMS Warwick Clin Trials Unit, Out Hosp Cardiac Arrest Outcomes OHCAO Trial, Coventry CV4 7AL, W Midlands, England..
    Koster, Rudolph W.
    Acad Med Ctr, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands..
    Nakajima, Yuko
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Pemberton, Katherine
    Queensland Ambulance Serv, GPO Box 1425, Brisbane, Qld 4001, Australia..
    Quinn, Martin
    Natl Univ Ireland Galway, Natl Out Hosp Cardiac Arrest Register OHCAR Steer, Dept Publ Hlth Med, HSE, Letterkenny F92 XK84, Co Donegal, Ireland..
    Smith, Karen
    Ambulance Victoria Ctr Res & Evaluat, POB 2000, Doncaster, Vic 3108, Australia..
    Jonsson, Bergpor Steinn
    Akureyri Hosp, Eyrarlandsvegur 600, Akureyri, Iceland..
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tandan, Meera
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    Vellinga, Akke
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    Out-of-hospital cardiac arrest survival in international airports2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 127, p. 58-62Article in journal (Refereed)
    Abstract [en]

    Background: The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment. Methods: This retrospective cohort study included all cases of out-of-hospital cardiac arrest at international airports with resuscitation attempted between January 1st, 2013 and December 31st, 2015. Crude incidence, patient, event characteristics and survival to hospital discharge/survival to 30 days (survival) were calculated. Mixed effect logistic regression analyses were performed to identify predictors of survival. Variability in survival between airports/countries was quantified using the median odds ratio. Results: There were 800 cases identified, with an average of 40 per airport. Incidence was 0.024/100,000 passengers per year. Percentage survival for all patients was 32%, and 58% for patients with an initial shockable heart rhythm. In adjusted analyses, initial shockable heart rhythm was the strongest predictor of survival (odds ratio, 36.7; 95% confidence interval [CI], 15.5-87.0). In the bystander-witnessed subgroup, delivery of a defibrillation shock by a bystander was a strong predictor of survival (odds ratio 4.8; 95% CI, 3.0-7.8). Grouping of cases was significant at country level and survival varied between countries. Conclusions: In international airports, 32% of patients survived an out-of-hospital cardiac arrest, substantially more than in the general population. Our analysis suggested similarity between airports within countries, but differences between countries. Systematic data collection and reporting are essential to ensure international airports continually maximise activities to increase survival.

  • 81.
    Müllersdorf, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. University of Uppsala, Uppsala, Sweden.
    Söderback, Ingrid
    Mälardalen University, School of Health, Care and Social Welfare. University of Uppsala, Uppsala, Sweden.
    The actual state of the effects, treatment and incidence of disabling pain in a gender perspective-- a Swedish study.2000In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 22, no 18, p. 840-54Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of the study was to elicit the actual state of self-perceived experience of long-term and/or recurrent pain and its effects as reported by women and men with disabilities due to pain, in order to determine criteria for assessing the need for measures in rehabilitation/occupational therapy. METHODS: The study used a comparative design with a sample randomized from the Swedish population aged 18-58 years (n = 10,000). The inclusion criterion was that the respondents had or had had pain causing activity limitation or restricting participation in daily life. A special questionnaire including items concerning demography, pain, coping, occupations in daily life, work, treatments, care institutions and hospital/care staff visited, was posted to 1,849 persons and was answered by 1,448 respondents (study group n = 1,305, control group n= 117). Results: Gender differences were found in the overall prevalence of pain, women reporting more frequent episodes of pain than men did. Differences were also found in pain variables, in daily occupations, days of sick-leave and work variables. Women completed more varied treatment than men. The incidence rate of long-term/recurrent pain in the population studied was 0.07. Conclusions: As a conclusion from this study, three essential components are suggested for use when assessing the need for rehabilitation/occupational therapy: (1) shoulder/arm or lower back pain of aching, tensed and/or searing character, particularly among women; (2) emotional/affective pain effects causing restlessness and depression, particularly among women; and (3) limitations in daily occupations assessed by FSQ and the demand/control/support model with results falling within the warning zones plus long sick-leave periods.

  • 82.
    Nahlen Bose, Catarina
    et al.
    Röda Korsets Högskola, Sweden.
    Björling, Gunilla
    Röda Korsets Högskola, Sweden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson, Hans
    Karolinska Institutet, Sweden.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Sweden.
    Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured2015In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, p. 239-248Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

    Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

    Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

    Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

  • 83.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Stockholm, Sweden.
    Persson, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Björling, Gunilla
    The Swedish Red Cross University College, Stockholm, Sweden.
    Ljunggren, Gunnar
    Karolinska Institutet, Stockholm, Sweden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Stockholm, Sweden.
    Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 537-548, article id S1-S1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).

    AIMS:

    To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

    METHODS:

    Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

    RESULTS:

    No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

    CONCLUSION:

    CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

  • 84.
    Nicklasson, Mercedes
    et al.
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Olofson, J
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Bergman, Bengt
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: A randomized study2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 1, p. 87-95Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aims of this study were to investigate the impact of individual health-related quality of life (HRQL) evaluation on the attention towards symptom control and psychosocial function in advanced cancer patients.

    Methods

    Patients with advanced lung cancer or mesothelioma who attended a pulmonary oncology outpatient clinic were randomized to either of two strategies for HRQL assessment. The experimental group (EG) answered the EORTC QLQ-C30 + LC13 questionnaire using a digital table interface, with outprint of aggregated scale scores presented to the consulting physician as a support for evaluation. The control group (CG) answered a paper version of the same questionnaire, which was stored for later analysis. Consultations were audio-recorded. Outcome measures were a quantitative content analysis of audio-recorded consultations and medical and psychosocial interventions abstracted from clinical records.

    Results

    One hundred seventy-one patients were randomized and participated in the study. Issues regarding emotional function were more frequently discussed during consultations in the EG (p < 0.05). Similarly, interventions directed to emotional and social concerns were more frequent in the EG (p = 0.013 and p = 0.0036, respectively). HRQL measures over time were similar across the groups.

    Conclusion

    Individual HRQL assessment increased the attention to psychosocial functioning in patients with chest malignancies.

  • 85.
    Nilsson, K,
    et al.
    Uppsala University Hospital, Uppsala, Sweden .
    Lukinius, A,
    Uppsala University Hospital, Uppsala, Sweden .
    Påhlson, Carl
    Uppsala University Hospital, Uppsala, Sweden .
    Moron, C,
    University of Texas Medical Branch, Galveston, TX, United States.
    Hajem, N,
    Mälardalen University, Department of Biology and Chemical Engineering.
    Olsson, B
    Mälardalen University, Department of Biology and Chemical Engineering.
    Lindquist, O
    Uppsala University Hospital, Uppsala, Sweden .
    Evidence of Rickettsia spp. infection in Sweden: a clinical, ultrastructural and serological study2005In: APMIS., Vol. 113, no 2, p. 126-134Article in journal (Refereed)
    Abstract [en]

    Sweden is an area potentially endemic for spotted fever rickettsioses. Rickettsia helvetica has been isolated from its tick vector Ixodes ricinus, and in a handful of cases linked to human disease. This study demonstrates for the first time in Sweden the transmission of rickettsial infection after a tick bite and the attack rate in an endemic area. We present three cases of documented rickettsial infection and a prospective serological study of Swedish recruits who were trained in the area where the patients lived and showed seroconversion to spotted fever rickettsiae. All patients showed a four-fold increase in antibody titer to the spotted fever rickettsia, R. helvetical and immunohistochemical examination revealed rickettsia-like organisms in the walls of skin capillaries and veins. Electron microscopy showed organisms resembling R. helvetica and immunogold labeling with two anti-rickettsial antibodies demonstrated specific labeling of the rickettsial organisms in the skin biopsy specimens. Eight of the thirty-five recruits showed a four-fold increase in IgG titer reflecting a high rate of exposure. The results of this study demonstrate that spotted fever rickettsioses should be taken into consideration in the diagnosis of tick-transmitted infections in Sweden.

  • 86.
    Nilsson,, Kenneth
    et al.
    Section of Infectious Diseases, Department of Medical Sciences, Uppsala.
    Påhlson,, Carl
    Mälardalen University, Department of Biology and Chemical Engineering. Section of Infectious Diseases, Department of Medical Sciences, Uppsala.
    Eriksson, Lars
    Uppsala University Hospital, Uppsala, Swedn.
    Nilsson,, Lennart
    Karolinska Institute, Stockholm.
    Lindquist., Olle
    Uppsala University, Uppsala, Sweden.
    Presence of Rickettsia helvetica in granulomatous tissue from three patients with sarcoidosis2002In: The Journal of Infectious Diseases, Vol. 185, no 8, p. 1128-1138Article in journal (Refereed)
    Abstract [en]

    In samples obtained during the autopsies of 2 patients with sarcoidosis, genetic material from Rickettsia helvetica was detected by polymerase chain reaction, and histologic and immunohistochemical examination (using 3 different antibodies) of the polymerase chain reaction-positive tissues showed different degrees of granuloma formation and presence of rickettsia-like organisms predominantly located in the endothelium and macrophages. Electron microscopic examination clearly identified and demonstrated rickettsia-like organisms within the granuloma, with findings suggestive of ongoing infection. Immunogold labeling withProteus OX-19 antiserum showed that the gold markers were localized to the rickettsia-like organisms. Paraffin-embedded biopsy specimens from 30 patients with confirmed sarcoidosis were also reexamined, and 26 specimens were judged to be positive for rickettsia-like organisms by histologic and immunohistochemical examination. In a specimen from 1 patient, rickettsia-like organisms also were demonstrated and identified by transmission electron microscopy. These results support the hypothesis that rickettsiae may contribute to a granulomatous process, as is seen in sarcoidosis.

  • 87.
    Nilsson, M
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    von Wendt, G
    St. Erik Eye Hospital, Stockholm, Sweden.
    Wanger, P
    Karolinska Institutet, Stockholm, Sweden .
    Martin, Lene
    Karolinska Institutet, Stockholm, Sweden .
    Early detection of macular changes in patients with diabetes using Rarebit Fovea Test and optical coherence tomography2007In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 91, no 12, p. 1596-1598Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate central retinal thickness and foveal function using optical coherence tomography (OCT) and the Rarebit Fovea Test (RFT) in patients with diabetes without previously known retinopathy or maculopathy. METHOD: Forty-two patients with diabetes mellitus (DM) were selected from the screening records at St Erik Eye Hospital. Inclusion criteria were absence of macular or other retinal changes at previous screening examination and best corrected visual acuity >/=1.0. These patients and 42 healthy controls were examined with the recently developed RFT, and retinal thickness was measured using OCT. Lens thickness and light scatter were evaluated by Scheimpflug photography. RESULTS: Significantly more DM subjects (12/42) had a subnormal RFT result compared with the controls (2/42) (p = 0.007). None of the 12 DM subjects had maculopathy, one had mild non proliferative diabetic retinopathy, and five had minimal non-proliferative diabetic retinopathy. The retinal thickness in the pericentral zone was significantly (p<0.05) thinner in DM patients with subnormal RFT compared with the controls. CONCLUSION: Decreased RT and subnormal RFT results were found in a subgroup of diabetes patients, despite normal screening results. Prospective studies are under way to evaluate the prognostic implications.

  • 88.
    Nilsson, M
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Wanger, P
    Karolinska Institutet, Stockholm, Sweden.
    Martin, Lene
    Karolinska Institutet, Stockholm, Sweden.
    Perception of very small visual stimuli in the fovea: normative data for the Rarebit Foveal Test.2006In: Clinical and experimental optometry, ISSN 0816-4622, E-ISSN 1444-0938, Vol. 89, no 2, p. 81-85Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Conventional visual tests are not sensitive enough to detect low degree neural damage, as 6/6 (1.0) visual acuity can be upheld with less than two-thirds of the normal number of optic nerve axons. The aim of the current study was to evaluate the physiologic properties of a new computerised test, the Rarebit Fovea Test (RFT), using very small stimuli, by quantifying the effect of age and binocular summation in relation to stimulus luminance. METHODS: The RFT relies on the perception of very small (less than 0.5 minutes of arc) bright stimuli. Two different experiments were performed. 1. Thirty-five subjects (age 19 to 63 years) were tested with five different stimulus luminances, 158, 64, 53, 41 and 33 cd/m(2). 2. Nineteen subjects (age 19 to 63 years) were tested using binocular stimulation to define the binocular summation. RESULTS: Significantly reduced median hit rates were observed at luminances of 53 cd/m(2) or below. Age and mean hit rate correlated negatively at all luminance levels below 158 cd/m(2). The mean hit rate from binocular stimulation, compared to the highest value from monocular stimulation in the same subject, was increased by a factor of 1.54 +/- 0.45 (SD). No age effect was found regarding binocular summation. CONCLUSIONS: The results in the current study indicate that RFT can identify some of the well-known features of the visual system, that is, the effects of age and binocular summation, provided that the stimulus luminance is adequately selected.

  • 89.
    Nisell, Margret
    et al.
    Karolinska Institutet.
    Igl, Wilmar
    Karolinska Institutet.
    Öjmyr-Joelsson, Maria
    Karolinska Institutet.
    Frenckner, Björn
    Rydelius, Per-Anders
    Christensson, Kyllike
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet.
    Social issues among children with high or intermediate imperforate anus: a proxy perspective.2009In: Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, ISSN 1744-6171, Vol. 22, no 3, p. 132-142Article in journal (Refereed)
    Abstract [en]

    PROBLEM: Children with imperforate anus (IA) may be psychosocially affected. METHODS: Parents of children with IA and parents in two comparison groups rated their children using a study-specific questionnaire and the Competence Scales in the Child Behavior Checklist (CBCL). Teachers rated Academic and Adaptive Functioning Scales in the Teacher's Report Form (TRF). FINDINGS: School items were rated favorably by the fathers of children with IA, and mothers reported less expression of their children's will. Children with IA were socially competent according to CBCL, although they received lower ratings on the TRF. CONCLUSIONS: Psychosocial issues seem to be challenging for children with IA, and this needs attention in care management.

  • 90.
    Nisell, Margret
    et al.
    Karolinska Institutet, Sweden.
    Öjmyr-Joelsson, Maria
    Karolinska Institutet, Sweden.
    Frenckner, Björn
    Karolinska Institutet, Sweden.
    Rydelius, Per-Anders
    Karolinska Institutet, Sweden.
    Christensson, Kyllike
    Karolinska Institutet, Sweden.
    Views on psychosocial functioning: responses from children with imperforate anus and their parents.2008In: Journal of Pediatric Health Care, ISSN 0891-5245, E-ISSN 1532-656X, Vol. 22, no 3, p. 166-174Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: High and intermediate imperforate anus (IA) is a congenital malformation that may entail psychosocial consequences. The objective was to examine disagreement on psychosocial functioning in reports between children with high and intermediate IA and their mothers. METHOD: Twenty-five children with IA and their mothers participated, including two groups for comparison. The responses on 15 psychosocial variables were compared on pair-level, between the mothers and their child, within each group. RESULTS: Statistically significant differences were found on the psychological variables in all groups, for example, feelings of sadness. For responses related to the social variables, few statistical discrepancies were found, except for the items "bullied" and "teased." Two specific discrepancies emerged in responses from children with IA and their mothers, the child's self-confidence and the mothers' thinking about their child's disability. DISCUSSION: It is vital to gather information from both the child and the parents in order to obtain a complete assessment of the child. The course of disagreement can give valuable information for future care, including where to exert extra effort.

  • 91. Nishiyama, Chika
    et al.
    Brown, Siobhan P.
    May, Susanne
    Iwami, Taku
    Koster, Rudolph W.
    Beesems, Stefanie G.
    Kuisma, Markku
    Salo, Ari
    Jacobs, Ian
    Finn, Judith
    Sterz, Fritz
    Nuernberger, Alexander
    Smith, Karen
    Morrison, Laurie
    Olasveengen, Theresa M.
    Callaway, Clifton W.
    Do Shin, Sang
    Graesner, Jan-Thorsten
    Daya, Mohamud
    Ma, Matthew Huei-Ming
    Herlitz, Johan
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Aufderheide, Tom P.
    Masterson, Siobhan
    Wang, Henry
    Christenson, Jim
    Stiell, Ian
    Davis, Dan
    Huszti, Ella
    Nichol, Graham
    Apples to apples or apples to oranges?: International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 11, p. 1599-1609Article in journal (Refereed)
    Abstract [en]

    Objectives: Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. Study design: Retrospective study.

    Setting: This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee.

    Measurements and main results: Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9 +/- 2.2%. The proportion of unknown was mean 4.8 +/- 6.4%. Among time variables, missingness was mean 9.0 +/- 6.3%.

    Conclusions: International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.

  • 92.
    Nymark, Alexander
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Lundh, Johan
    Mälardalen University, School of Health, Care and Social Welfare.
    Postoperativ uppföljning - Anestesisjuksköterskans uppfattning2018Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 93.
    Nyqvist, K H
    et al.
    Uppsala University, Sweden.
    Rubertsson, C
    Uppsala University, Sweden.
    Ewald, U
    Uppsala University, Sweden.
    Sjödén, P O
    Uppsala University, Sweden.
    Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement1996In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 12, no 3, p. 207-219Article in journal (Refereed)
    Abstract [en]

    Research on the development of preterm infant feeding behavior has focused mainly on bottlefeeding, using invasive methods or observations by professionals. In this study, a clinical method for observing breastfeeding was developed in collaboration between observers and mothers for the purpose of enabling neonatal personnel and mothers to describe developmental stages in preterm infant breastfeeding behavior. Tests of interobserver reliability resulted in acceptable agreement between observers, but a somewhat lower level of agreement between observers and mothers. The scale showed a good capacity to discriminate between infant gestational ages and can be used for helping mothers to identify their infants' emerging competence.

  • 94.
    Pavlik, Lina
    Mälardalen University, School of Health, Care and Social Welfare.
    Hur behandlar jag mig själv i svåra stunder?: Uppfattning av självmedkänsla och Self-Compassion Scale bland vuxna med adhd.2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Research has shown correlation between high self-compassion and wellbeing as well as low self-compassion has been correlated with psychopathology. Little research of Self-compassion in nursing science has been done and the concept is still relative unknown. Aim: To describe how adults with adhd percived the concept of self-compassion and conversation  with Self-Compassion Scale as starting point. How did adults with adhd perceive self-compassion and it´s meaning? Which challanges and profits did they describe in the use of Self-Compassion Scale? How was their self-compassion? Method: The study had a QUAL + quan, mixed method design. Four participants performed cognitive interviews in the qualitative part and in the quantitative part 23 participants performed Self-Compassion Scale. The interviews underwent content analysis and the assessment tools has been numerically analyzed. Result: The interviews present three categories; Self-compassion contains wellbeing and the relationship to oneself and others, Conversation leeds to self-awareness and To explore problems and solutions is rewarding and challenging. Persons rate a medium-level self-compassion of 2,6 in total (medium level = 2,6-3,5). Highest scores for the categories isolation and over-identified. Conclusion: To converse about self-compassion can be challenging and important for persons with adhd. For the nurse within psychiatric care to have knowledge of self-compassion can be valuable to patient’s health and recovery.   

  • 95.
    Philip, Ragnartz
    et al.
    Mälardalen University, School of Innovation, Design and Engineering.
    Staffanson, Axel
    Mälardalen University, School of Innovation, Design and Engineering.
    Produktutveckling av medicinteknisk produkt, Suture passer2016Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The following report has been prepared based upon an assignment given by the company, Ortopedic Care Scandinavia AB. The paper is an exam on basic level, 15 credit points at higher level education within product development.

    Ortopedic Care Scandinavia AB is working with product development of medical technology products. What makes the corporate unique is the fact that the development is based upon problems encountered by surgeons in their daily work. Suggestions for improvement in technology are given directly by the end users. This paper is based upon such problems.

    Product development was made on the medical instrument called, suture passer. The instrument is used in endoscopic surgery of the rotator cuff. The cuff is a group of four muscles (and their respective tendons) that stabilize the shoulder. In case of an accident, mostly sport related, these muscles can loosen from the bone. In surgery a suture passer is then used to penetrate the injured tendon with a needle with an attached suture. The passer creates a loop of suture that can be used to attach the damaged tendon.

    The report is based upon the following problem formulations:

    • The needle has an inconvenient edge that can damage the muscle.
    • The strength of the suture thread is deteriorated by the design of the needle.
    • The suture thread has been known to snap when the surgeon apply to much pressure when tying.
    • If the patient is suffering from subacromial impingement the jaw of the instrument can appear to be clumsy and hard to open.
    • The jaw has sharp teeth which have been known to get stuck in the tendon. The surgeon must then perform an uncontrolled movement which might damage the tendon.
    • The jaw limits the surgeons’ choice of thickness of the suture thread.
    • The thickness of the needle used in the suture passer is limited to one size. 

    The purpose of the project is to develop a new concept that minimizes the risk for the patient and at the same time the concept should facilitate the work of the surgeon. The concept should meet the set requirements and be presented in the form of renderings of CAD-models and drawings.

    To achieve this process the instrument uses four different components. The needle, the jaw, the handle and an attachment between the needle and the handle.  Under heading 5, the generating process, each component presents to together with arguments of its design. The instrument consist of 25 components that are all developed from the ground up.

    The result should be viewed as a thorough concept that can be used for further development. It is recommended that the next step should be an investigation about material choice. When the material is specified a prototype should be manufacture and then used for testing. 

  • 96.
    Prenler, Johanna
    Mälardalen University, School of Innovation, Design and Engineering.
    Om astma för barn: Hur man förenklar komplex information med hjälp av bilder2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    This report presents the process of creating an information material for children

    around the age of seven that have just gotten the diagnosis asthma. With the help of

    literature, an interview with an expert in the field, and tests together with the target

    audience a material has been produced. A material that presents the information of

    how the everyday life with asthma will be like, in a simple and relaxed way. By

    explaining asthma with simple images, it makes the information more relaxed, and

    makes it easier for the children to process. This report accounts for the different

    theories, methods, and processes that has been utilised to create this material.

    Denna rapport syftar till att presentera den process jag genomfört för att skapa ett

    informationsmaterial för barn runt sju år som precis fått diagnosen astma. Med

    hjälp av litteratur, intervju med sakkunnig, samt tester ihop med målgruppen har ett

    material tagits fram. Ett material som presenterar information om hur vardagen

    med astma ser ut, på ett enkelt och avdramatiserat vis. Genom att förklara astma

    med enkla bilder gör det informationen avdramatiserad och gör den mer

    lättillgänglig för barnen att ta till sig. Denna rapport innehåller redogörelser för de

    olika teorier, metoder och processer som jag har använt för att skapa detta material.

  • 97.
    Ragnar, Inga
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences.
    Altman, D
    Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Tydén, T
    University of Uppsala, Uppsala, Sweden .
    Olsson, S-E
    Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Comparison of the maternal experience and duration of labour in two upright delivery positions - a randomised controlled trial.2006In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, Vol. 113, no 2, p. 165-170Article in journal (Refereed)
    Abstract [en]

    Objective: To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience. Design: A randomised controlled trial. Setting: A county hospital delivery ward. Sample: Primiparous subjects (n = 271) were randomly allocated to a kneeling (n = 138) or a sitting (n = 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial. Methods: Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis. Main outcome measure: Duration of the second stage of labour. Results: A comparison of the duration of the second stage of labour (kneeling 48.5 minutes +/- 27.6 SD, sitting 41 minutes +/- 23.4 SD) revealed no significant difference between the groups. A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P = 0.002), less comfort for giving birth (P = 0.03) and more frequent feelings of vulnerability (P = 0.05) and exposure (P = 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) (Table 3). Conclusion: Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.

  • 98.
    Ragnar, Maria Ekstrand
    et al.
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Grandahl, Maria
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Stern, Jenny
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Mattebo, Magdalena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health2018In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, no 4, p. 265-273Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group. Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis. Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given. Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

  • 99.
    Rahme, Hans
    et al.
    University Hospital, Uppsala, Sweden.
    Vikerfors, Ola
    Central Hospital, Västerås, Sweden.
    Ludvigsson, Lena
    Central Hospital, Västerås, Sweden.
    Elvén, Maria
    Central Hospital, Västerås, Sweden.
    Michaëlsson, K
    University Hospital, Uppsala, Sweden.
    Loss of external rotation after opern Bankart repair: an important prognostic factor for patient satisfaction2010In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, p. 404-408Article in journal (Refereed)
    Abstract [en]

    The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0° of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10° of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

  • 100.
    Rasjö Wrååk, G.
    et al.
    Storvretens Primary Health Care Centre, Stockholm County, Sweden.
    Törnkvist, L.
    Karolinska Institutet, Stockholm, Sweden .
    Hasselström, J.
    Karolinska Institutet, Stockholm, Sweden .
    Wändell, P. E.
    Karolinska Institutet, Stockholm, Sweden .
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nurse-led empowerment strategies for patients with hypertension: A questionnaire survey2015In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 62, no 2, p. 187-195Article in journal (Refereed)
    Abstract [en]

    Background: Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim: This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods: A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results: Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations: Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion: Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. Implications for nursing and health policy: This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.

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