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  • 1. Abarca-Goméz, Leandra
    et al.
    Abdeen, Ziad A
    Abdul Hamid, Zargar
    Abu-Rmeileh, Niveen M
    Acosta-Cazares, Benjamin
    Acuin, Cecilia
    Adams, Robert J
    Aekplakorn, Wichai
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ezzati, Majid
    Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10113, p. 2627-2642Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

    METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

    FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.

    INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

    FUNDING: Wellcome Trust, AstraZeneca Young Health Programme.

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  • 2. Abrahamsson, Kajsa
    et al.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Hakeberg, Magnus
    Dental beliefs: factor structure of the revised dental beliefs survey in a group of regular dental patients2009In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 117, no 6, p. 720-727Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the factor structure of the revised dental beliefs survey (DBS-R) in a group of regular dental patients. The study group consisted of 278 patients (mean age 54 yr), 61% of whom were women. The DBS-R item mean value was 1.6. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were performed. The initial PCA among the 28 DBS-R items showed four factors with eigenvalues of > 1 explaining 67% of the total variance. Five different CFA models were tested. The final model revealed a four-factor solution with one second-order factor (i.e. a hierarchical CFA). Thus, the latent second-order variable, 'dental beliefs', explains the variance from all DBS-R items through the four first-order factors labeled 'ethics', 'belittlement', 'communication and empathy', and 'control and anxiety'. The results suggest a somewhat different factor structure of DBS-R than previously reported for dental-fear patients. Hence, the underlying factor structure of the DBS-R may differ between different patient groups. The results point towards the use of the original 28-item DBS-R and interpreting the scale as measuring an overall construct of 'dental beliefs' and thus patients' attitudes and feelings related to dentists and dentistry.

  • 3. Abzhandadze, Tamar
    et al.
    Reinholdsson, Malin
    Palstam, Annie
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg.
    Eriksson, Marie
    Sunnerhagen, Katharina S
    Transforming self-reported outcomes from a stroke register to the modified Rankin Scale: a cross-sectional, explorative study.2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 17215Article in journal (Refereed)
    Abstract [en]

    The aim was to create an algorithm to transform self-reported outcomes from a stroke register to the modified Rankin Scale (mRS). Two stroke registers were used: the Väststroke, a local register in Gothenburg, Sweden, and the Riksstroke, a Swedish national register. The reference variable, mRS (from Väststroke), was mapped with seven self-reported questions from Riksstroke. The transformation algorithm was created as a result of manual mapping performed by healthcare professionals. A supervised machine learning method-decision tree-was used to further evaluate the transformation algorithm. Of 1145 patients, 54% were male, the mean age was 71 y. The mRS grades 0, 1 and 2 could not be distinguished as a result of manual mapping or by using the decision tree analysis. Thus, these grades were merged. With manual mapping, 78% of the patients were correctly classified, and the level of agreement was almost perfect, weighted Kappa (Kw) was 0.81. With the decision tree, 80% of the patients were correctly classified, and substantial agreement was achieved, Kw = 0.67. The self-reported outcomes from a stroke register can be transformed to the mRS. A mRS algorithm based on manual mapping might be useful for researchers using self-reported questionnaire data.

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  • 4.
    af Winklerfelt Hammarberg, Sandra
    et al.
    Karolinska Institutet, Stockholm, Academic Primary Health Care Centre, Region Stockholm, Stockholm.
    Björkelund, Cecilia
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Nejati, Shabnam
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Magnil, Maria
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Hange, Dominique
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Svenningsson, Irene
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Petersson, Eva‑Lisa
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Udo, Camilla
    Dalarna University, School of Health and Welfare, Social Work. Division of Health Care Science, Marie Cederschiöld University, Stockholm; Center for Clinical Research Dalarna, Uppsala University, Falun.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Westman, Jeanette
    Karolinska Institutet, Stockholm; Academic Primary Health Care Centre, Region Stockholm, Stockholm; Uppsala University, Uppsala.
    Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12‑ and 24‑month follow‑up of a pragmatic cluster randomized controlled trial2022In: BMC Primary Care, E-ISSN 2731-4553, Vol. 23, no 1, article id 198Article in journal (Refereed)
    Abstract [en]

    Background: In previous studies, we investigated the effects of a care manager intervention for patients withdepression treated in primary health care. At 6 months, care management improved depressive symptoms, remission,return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study wasto compare the long-term effectiveness of care management and usual care for primary care patients with depressionon depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and24 months after the start of the intervention.Methods: Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control)in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderatedepression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed astructured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care managerfollowed up symptoms and treatment, encouraged behavioral activation, provided education, and communicatedwith the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixedmodel repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptomsand remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specificquestionnaire).Results: The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) butnot 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differencesin remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from theprimary care center.Conclusions: Patients with depression who had a care manager maintained their 6-month improvements in symptomsat the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients withcare managers also had significantly more confidence in primary care and belief in future support than controls.

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  • 5. Afshin, A
    et al.
    Forouzanfar, M. H
    Reitsma, M. B
    Sur, P
    Estep, K
    Lee, A
    Marczak, L
    Mokdad, A. H
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Murray, C. J. L
    Health effects of overweight and obesity in 195 countries over 25 years2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 1, p. 13-27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain.

    METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015.

    RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease.

    CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

  • 6.
    Aghanavesi, Somayeh
    et al.
    Dalarna University, School of Technology and Business Studies, Microdata Analysis.
    Westin, Jerker
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    Bergquist, Filip
    Nyholm, Dag
    Askmark, Håkan
    Aquilonius, Sten Magnus
    Constantinescu, Radu
    Medvedev, Alexander
    Spira, Jack
    Ohlsson, Fredrik
    Thomas, Ilias
    Dalarna University, School of Technology and Business Studies, Microdata Analysis.
    Ericsson, Anders
    Johansson Buvarp, Dongni
    Memedi, Mevludin
    A multiple motion sensors index for motor state quantification in Parkinson's disease2020In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 189, article id 105309Article in journal (Refereed)
    Abstract [en]

    AIM: To construct a Treatment Response Index from Multiple Sensors (TRIMS) for quantification of motor state in patients with Parkinson's disease (PD) during a single levodopa dose. Another aim was to compare TRIMS to sensor indexes derived from individual motor tasks.

    METHOD: Nineteen PD patients performed three motor tests including leg agility, pronation-supination movement of hands, and walking in a clinic while wearing inertial measurement unit sensors on their wrists and ankles. They performed the tests repeatedly before and after taking 150% of their individual oral levodopa-carbidopa equivalent morning dose.Three neurologists blinded to treatment status, viewed patients' videos and rated their motor symptoms, dyskinesia, overall motor state based on selected items of Unified PD Rating Scale (UPDRS) part III, Dyskinesia scale, and Treatment Response Scale (TRS). To build TRIMS, out of initially 178 extracted features from upper- and lower-limbs data, 39 features were selected by stepwise regression method and were used as input to support vector machines to be mapped to mean reference TRS scores using 10-fold cross-validation method. Test-retest reliability, responsiveness to medication, and correlation to TRS as well as other UPDRS items were evaluated for TRIMS.

    RESULTS: The correlation of TRIMS with TRS was 0.93. TRIMS had good test-retest reliability (ICC = 0.83). Responsiveness of the TRIMS to medication was good compared to TRS indicating its power in capturing the treatment effects. TRIMS was highly correlated to dyskinesia (R = 0.85), bradykinesia (R = 0.84) and gait (R = 0.79) UPDRS items. Correlation of sensor index from the upper-limb to TRS was 0.89.

    CONCLUSION: Using the fusion of upper- and lower-limbs sensor data to construct TRIMS provided accurate PD motor states estimation and responsive to treatment. In addition, quantification of upper-limb sensor data during walking test provided strong results.

  • 7. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Good obstetric care requires interdisciplinary collaboration2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed)
  • 8. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Svenska barnmorskeförbundet: God förlossningsvård kräver tvärprofessionellt samarbete2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 20-21Article in journal (Refereed)
  • 9. Ahlm, Kristin
    et al.
    Lindqvist, Per
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Saveman, Britt-Inger
    Björnstig, Ulf
    Suicidal drowning deaths in northern Sweden 1992-2009: The role of mental disorder and intoxication2015In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 34, p. 168-172Article in journal (Refereed)
    Abstract [en]

    Suicides by drowning have received limited attention by researchers. A recent finding that almost one-third of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

  • 10. Ahmad, Shafqat
    et al.
    Hammar, Ulf
    Kennedy, Beatrice
    Salihovic, Samira
    Ganna, Andrea
    Lind, Lars
    Sundström, Johan
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Stockholm.
    Berne, Christian
    Fall, Tove
    Effect of General Adiposity and Central Body Fat Distribution on the Circulating Metabolome: a Multi-Cohort Non-Targeted Metabolomics Observational and Mendelian Randomization Study2022In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 71, no 2, p. 329-339Article in journal (Refereed)
    Abstract [en]

    Obesity is associated with adverse health outcomes, but the metabolic effects have not yet been fully elucidated. We aimed to investigate the association between adiposity with circulating metabolites and to address causality with Mendelian randomization (MR). Metabolomics data was generated by non-targeted ultra-performance liquid-chromatography coupled to time-of-flight mass-spectrometry in plasma and serum from three population-based Swedish cohorts: ULSAM (N=1,135), PIVUS (N=970), and TwinGene (N=2,059). We assessed associations between general adiposity measured as body mass index (BMI) and central body fat distribution measured as waist-to-hip ratio adjusted for BMI (WHRadjBMI) with 210 annotated metabolites. We employed MR analysis to assess causal effects. Lastly, we attempted to replicate the MR findings in the KORA and TwinsUK cohorts (N=7,373), the CHARGE consortium (N=8,631), the Framingham Heart Study (N=2,076) and the DIRECT consortium (N=3,029). BMI was associated with 77 metabolites, while WHRadjBMI was associated with 11 and 3 metabolites in women and men, respectively. The MR analyses in the Swedish cohorts suggested a causal association (p-value <0.05) of increased general adiposity and reduced levels of arachidonic acid, dodecanedioic acid and lysophosphatidylcholine (P-16:0) as well as with increased creatine levels. The replication effort provided support for a causal association of adiposity on reduced levels of arachidonic acid (p-value 0.03). Adiposity is associated with variation of large parts of the circulating metabolome, however causality needs further investigation in well-powered cohorts.

  • 11.
    Ahmad, Shafqat
    et al.
    Uppsala University, Uppsala;Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA..
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Stockholm.
    Larsson, Susanna C.
    Karolinska Institutet, Stockholm; Uppsala University, Uppsala.
    Genetically Predicted Circulating Copper and Risk of Chronic Kidney Disease: A Mendelian Randomization Study2022In: Nutrients, E-ISSN 2072-6643, Vol. 14, no 3, article id 509Article in journal (Refereed)
    Abstract [en]

    Elevated circulating copper levels have been associated with chronic kidney disease (CKD), kidney damage, and decline in kidney function. Using a two sample Mendelian randomization approach where copper-associated genetic variants were used as instrumental variables, genetically predicted higher circulating copper levels were associated with higher CKD prevalence (odds ratio 1.17; 95% confidence interval 1.04, 1.32; p-value = 0.009). There was suggestive evidence that genetically predicted higher copper was associated with a lower estimated glomerular filtration rate and a more rapid kidney damage decline. In conclusion, we observed that elevated circulating copper levels may be a causal risk factor for CKD. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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  • 12.
    Akhter, Nargis
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Akhter, Jasmine
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Component that make a midwife grow personally and professionally: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Midwifery care is an essential component of providing quality maternal and child health care. Mother and new born health outcomes depends on the quality of education, license to practice, the scope of practice, sufficient resources, referral mechanisms and effective teamwork. The aim of this meta-synthesis was to describe components building midwifery professionalism for delivery of quality care. Method: This study was a meta-synthesis focusing to describe the components needed for building midwifery professionalism for delivery of quality care in high, low and middle-income countries. After assessing for relevance and quality in peer-reviewed journals, 30 qualitative studies were included from 2009 to 2018, written in English. This involved an electronic search using the following databases: PubMed, CINAHL, web of Science, Google Scholar, Summon and manually search. Result: After analysis and synthesis, the major findings can be summarized in two components; Clinical experiences make the midwives’ grow personally and professionally and an enabling environment enhances the midwives’ personal and professional development. Subcategories were; Collaboration with other health professionals and with colleges/ colleagues at the workplace, Extensive hands on clinical experience, Professional management of the workplace, Quality pre-service education and quality of the midwifery educators, In-service training, Policies and guidelines regulate the midwifery workforce, Being a member of a midwifery association. Conclusion: To ensure mothers quality midwifery care; midwives play a critical role in strengthening the midwifery workforce in high and low-middle income countries. This study highlights the benefits of building capacity for strengthening midwives and the midwifery profession. Clinical implications: There is a need to improving the educational status, improving policy and practice of health care program and facilitate the necessary resources. There is need for further research to identify how much improvements the newly deployed midwifery cadre service will bring in the field of quality midwifery care personally and professionally especially in rural setting.

  • 13.
    Akhter, Shirina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Akter, Jesmin
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Midwife-led care: A concept analysis2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Midwife-led care is yet to be explored as a concept in the context of Bangladesh. Anunderstanding of what constitutes midwife-led care can be lectured at midwifery education and inturn clarify the content of the midwifery practice to the midwifery workforce. The aim is to definethe concept of “Midwife-led care” from a midwifery context, through the synthesis of text fromliterature and interview data with Bangladeshi health care providers, to clarify its meaning enablingcomprehension and use of the concept in clinical practice and education.Methods: A concept analysis consisting of written text from literature and individual interviewswith Bangladeshi health care providers. In total nine participants participated in this study. Theconcept analysis was undertaken according to a hybrid model which consists of theoretical,fieldwork and analytical phases. After a literature review, the concept was empirically elucidated inthe fieldwork phase. The final step was to describe criteria and attributes of the concept.Results: The tentative criteria and attributes of midwife-led care in the context of midwiferyservices in Bangladesh included development of a trustful, friendly relationship between the womanand midwife; promoting normal processes for the pregnant woman in antenatal care, during deliveryand after delivery in the post-partum period. It includes creating awareness about benefits of normalbirth assisted by a skilled birth attendant. Further, having collaboration and communication withother health care professionals when complications arise with the woman or the baby and provide asupportive environment for care which is easily accessed and close to the communities. Finally,professional knowledge and skills are necessary components for midwives working with midwifeledcare.Conclusion: This concept analysis provides a unique examination of midwife-led care. Midwife-ledcare can be establish in the Bangladeshi midwifery context and practice. However, all the aspects ofmidwife-led care need to be supported by a functional health system for the continuity of care.Clinical implications: In midwife-led care centers, the midwifery workforce can be supported intheir clinical practice based on findings in this thesis. As such, this thesis offers a contribution foreducation in the midwife-led care approach within midwife-led maternity services. This is highlyrecommended when introducing evidence-based interventions to improve midwifery servicedelivery in real-world settings.

  • 14.
    Akter, Rahana
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Barua, Shampa
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Bhuyan, Mosammat Parvin Akter
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Woman’s choice during labour and birth: A concept analysis2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A woman has the right to give birth in the place of her choice, in privacy and with the company of a trusted supporter. The aim of this study was to define the concept "woman’s choice during labor and birthʺ in the Bangladesh context. Methods: The study design was concept analysis with data consisting of written text from literature and structured interviews. The concept analysis comprises three phases. Phase was 1) a theoretical phase, followed by 2) a field study phase, and finally 3) a synthesis phase with the field study phase in light of the theoretical phase. The setting was labor wards, nursing institutes and nursing college (post basic) at three different places in Bangladesh. Four midwifery students, one clinical midwife and four Midwifery teachers participated in this study. The interviews were recorded with the permission of the respondents. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review the concept was empirically elucidated in the fieldwork phase. Results: The tentative criteria attributes of woman’s choice during labour and birth in the Bangladeshi context are described: Woman choice during labour and birth means labour process, type of delivery, neonatal wellbeing, companionship at birth. Conclusion: Women’s choice in labour and birth is worldwide to make decisions within boundaries and particularly women’s choices are limited in Bangladesh. Professionally and personally the woman’s choices are limited by lack of options in the caring environment influenced by socio-cultural factors, socio-economic standards and education level. Clinical implications: Empirical findings from the theoretical concept analysis confirm the concept’s relevance in the midwifery context.

  • 15.
    Akter, Rina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parvin, Masuda
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Supportive components of care during cesarean section birth: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Caesarean section is the most common surgery worldwide today. The midwives support is therefore of uttermost important for women undergoing caesarean section. Aim: The aim of the meta-synthesis was to explore the experience related to planned and unplanned cesarean sections among primipara and multipara women in hospital settings worldwide. Method: This study is a meta-synthesis with meta-ethnographic analysis on women’s experiences of caesarean section birth. This is a qualitative research based on scientific literature. The inclusion criterion was peer-review qualitative articles from different original articles about women's experiences. Results: Five categories emerged: Caring attitude and behaviour, pre-existing imagination, relational influence, the need for caring and information. The findings suggest that nurse-midwife enhance their support and increase the women’s knowledge on caesarean section birth in order to improve the experience and also for women to make good choices. Women are influenced by people near to them when choosing to have a cesarean section or not. The mothers face challenges for postoperative recovery and quality of care. Midwives have a duty to assist these mothers. Conclusion: The findings emphasize the importance of person-centered communication skills and relationships in supporting a woman during caesarian section. Organizational systems and services that facilitate continuity of care giver for example, continuity of midwifery care or peer support models, are more likely to facilitate supportive care and a trust-building relationship. Clinical implication: The findings from this study can be used for educational purposes, and to create awareness about the role of midwifery care in relation to CS.

  • 16.
    Akther, Aklima
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Naher, Kalsarun
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parent’s perceptions experiences and attitudes about kangaroo mother care in neonatal wards: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    The knowledge of facility-based kangaroo mother care (KMC) in Bangladesh is comparatively recent; few facilities have been taking steps towards KMC service. Each year more than a million babies die due to the complication of prematurity. To eliminate the deaths due to prematurity, it is very important to share knowledge about the implementation, experiences, challenges and barriers for KMC practice to promote KMC intervention in the developing countries. Aim: To examine parents’ perceptions, experiences and attitude towards KMC in neonatal wards. Method: This study was a meta-synthesis focusing on parents’ perceptions and experiences of KMC. The included studies used several different qualitative methodologies compiled using Meta ethnography. Result: The results comprised of three categories were identified in this study. The First category was the Barriers towards KMC. This category comprised four preliminary patterns of parent’s perceptions of barriers to have KMC: Separating due to prematurity, Fear of harming, Pain prevented closeness, and Fear prevented closeness. The second category was facilitating factors for KMC, which covered parents’ experiences of the consult support expressed in four preliminary patterns: Own wish for closeness, Having positive experience and Support from the staff. The third category Benefits for KMC included three preliminary patterns of positive perceptions of KMC made by parents: Calming, warming and bonding, connecting with the premature baby and Being able to act as a parent. Conclusion: In this meta-synthesis, the main findings were realized into three categories of KMC- Barriers towards KMC, facilitating factors of KMC, Benefits of KMC. This is a low-cost and effectiveness method of reducing infant mortality. Clinical implications: Health care professionals have opportunities to implement Kangaroo Mother Care in low resource settings. First health care professionals have to be encouraged in all postnatal wards. Secondly, parents need to be aware about KMC so that they can promote their baby’s health and eventually save their baby’s life.

  • 17.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Sweden;Ostfold Hosp Kalnes, Norway.
    Ravn-Fischer, Annica
    University of Gothenburg, Sweden;Sahlgrenska university hospital, Sweden.
    Hollenberg, Jacob
    Karolinska Institutet, Sweden.
    Israelsson, Johan
    Linnéuniversitetet, Sjöfartshögskolan (SJÖ).
    Nordberg, Per
    Södersjukhuset, Sweden;Karolinska Institutet, Sweden.
    Strömsöe, Anneli
    Mälardalen University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Identifying the relative importance of predictors of survival in out of hospital cardiac arrest: a machine learning study2020In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, no 1, p. 1-8, article id 60Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies examining the factors linked to survival after out of hospital cardiac arrest (OHCA) have either aimed to describe the characteristics and outcomes of OHCA in different parts of the world, or focused on certain factors and whether they were associated with survival. Unfortunately, this approach does not measure how strong each factor is in predicting survival after OHCA. Aim: To investigate the relative importance of 16 well-recognized factors in OHCA at the time point of ambulance arrival, and before any interventions or medications were given, by using a machine learning approach that implies building models directly from the data, and arranging those factors in order of importance in predicting survival. Methods: Using a data-driven approach with a machine learning algorithm, we studied the relative importance of 16 factors assessed during the pre-hospital phase of OHCA We examined 45,000 cases of OHCA between 2008 and 2016. Results: Overall, the top five factors to predict survival in order of importance were: initial rhythm, age, early Cardiopulmonary Resuscitation (CPR, time to CPR and CPR before arrival of EMS), time from EMS dispatch until EMS arrival, and place of cardiac arrest The largest difference in importance was noted between initial rhythm and the remaining predictors. A number of factors, including time of arrest and sex were of little importance. Conclusion: Using machine learning, we confirm that the most important predictor of survival in OHCA is initial rhythm, followed by age, time to start of CPR, EMS response time and place of OHCA. Several factors traditionally viewed as important e.g. sex, were of little importance.

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  • 18. Al-Dury, Nooraldeen
    et al.
    Rawshani, Araz
    Israelsson, Johan
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås.
    Aune, Solveig
    Agerström, Jens
    Karlsson, Thomas
    Ravn-Fischer, Annica
    Herlitz, Johan
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 12, p. 1839-1844, article id S0735-6757(17)30451-5Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

    METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.

    RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.

    CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

  • 19.
    Andersdotter, Nora
    et al.
    Dalarna University, School of Health and Welfare.
    Robbertse, Tanya
    Dalarna University, School of Health and Welfare.
    Combating Gender-Based Violence through Education: An interview study with educators in Gauteng, South Africa, about Gender-Based Violence in the Life Orientation curriculum2021Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    BackgroundGender-Based Violence (GBV) is a global problem rooted in gender inequality. South Africa has exceptionally high rates of GBV. Despite the fact that Comprehensive Sexuality Education (CSE) has been taught as part of the school subject Life Orientation to teach topics like gender equality, studies have demonstrated inconsistent implementation of this curriculum.AimTo investigate Life Orientation educators’ experiences of teaching the curriculum in relation to GBV and gender equality and manging the issue of GBV in public schools located in the Gauteng province, South Africa, and gain information about the challenges educators experience and what they think is needed to actively work towards preventing GBV in schools.Research DesignA qualitative research design was utilised.MethodTwelve participants were interviewed online using a semi-structured interview guide. The data was transcribed, coded, and analysed using inductive thematic analysis.ResultsThe results indicate that the participating educators experience various challenges and have diverse views on potential improvements. Limited educational and training resources, deep-rooted views of gender roles and cultural traditions, limited recognition of the subject’s importance by educational authorities, as well as uncertainty regarding existing school GBV policies are crucial findings on how the educators experience teaching GBV.ConclusionThis study identified challenges and the potential benefits of improved educator training to address the topic of GBV, more detailed coverage of GBV in the curriculum, increased awareness surrounding GBV and allocating more time to these concepts.

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  • 20.
    Andersen, Kasper
    et al.
    Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Uppsala University, Uppsala, Sweden.
    Ingelsson, Erik
    Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University, Uppsala, Sweden.
    Byberg, Liisa
    Uppsala University, Uppsala, Sweden.
    Michaëlsson, Karl
    Uppsala University, Uppsala, Sweden.
    Sundström, Johan
    Uppsala University, Uppsala, Sweden.
    Skeletal muscle morphology and risk of cardiovascular disease in elderly men2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, p. 231-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While it is well known that physical inactivity is a major risk factor for cardiovascular disease, there is still a search for the mechanisms by which exercise exerts its positive effect. Skeletal muscle fibre type can be affected to some extent by exercise, and different fibre types possess different anti-inflammatory and glucometabolic properties that may influence cardiovascular disease risk.

    DESIGN: Population-based cohort study.

    METHODS: We investigated relations of skeletal muscle morphology to risk of cardiovascular events in a sample of 466 71-year-old men without cardiovascular disease, of which 295 were physically active (strenuous physical activity at least 3 h/week).

    RESULTS: During a median of 13.1 years of follow up, 173 major cardiovascular events occurred. Among physically active men, 10% higher proportion of type-I (slow-twitch oxidative) fibres was associated with a hazard ratio (HR) of 0.84 (95% confidence interval 0.74-0.95) for cardiovascular events, and 10% higher proportion of type-IIx (fast-twitch glycolytic) fibres was associated with a HR of 1.24 (1.06-1.45), adjusting for age. Similar results were observed in several sets of multivariable-adjusted models. No association of muscle fibre type with risk of cardiovascular events was observed among physically inactive men.

    CONCLUSIONS: Higher skeletal muscle proportion of type-I fibres was associated with lower risk of cardiovascular events and a higher proportion of type-IIx fibres was associated with higher risk of cardiovascular events. These relations were only observed in physically active men. Skeletal muscle fibre composition may be a mediator of the protective effects of exercise against cardiovascular disease.

  • 21.
    Andersen, Randi Dovland
    et al.
    Department of Research Telemark Hospital Skien Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway.
    Genik, Lara
    Department of Psychology University of Guelph Guelph ON Canada.
    Alriksson-Schmidt, Ann I
    Department of Clinical Sciences Lund Skåne University Hospital Orthopedics Lund University Lund Sweden.
    Anderzen-Carlsson, Agneta
    University Health Care Research Center and Swedish Institute for Disability Research Faculty of Medicine and Health Örebro University Örebro Sweden.
    Burkitt, Chantel
    Gillette Children's Specialty Healthcare Saint Paul MN USA; Department of Educational Psychology University of Minnesota Minneapolis MN USA.
    Bruflot, Sindre K
    Telemark Chapter of the Norwegian Cerebral Palsy Association Skien Norway.
    Chambers, Christine T
    Departments of Psychology & Neuroscience and Pediatrics Dalhousie University Halifax NS Canada; Centre for Pediatric Pain Research IWK Health Centre Nova Scotia Canada.
    Jahnsen, Reidun B
    Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway; Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway.
    Jeglinsky-Kankainen, Ira
    Department of Health and Welfare Arcada University of Applied Sciences Helsinki Finland.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Pain burden in children with cerebral palsy (CPPain) survey: Study protocol2022In: Paediatric & neonatal pain, ISSN 2637-3807, Vol. 4, no 1, p. 11-21Article in journal (Refereed)
    Abstract [en]

    Pain is a significant health concern for children living with cerebral palsy (CP). There are no population-level or large-scale multi-national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross-sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6-12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0-17 years) and from children with CP (8-17 years) who are able to self-report. Siblings (12-17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study-specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health-related quality of life, and the effect of the COVID-19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer-reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.

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  • 22.
    Andersson, Mathias
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Sport and Health Science. Smärtmottagningen Falun, Region Dalarna, Falun; Smärtehabilitering Säter, Region Dalarna, Säter.
    Åberg, Anna Cristina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University.
    von Koch, Lena
    Karolinska Institutet.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Women with fibromyalgia prefer resistance exercise with heavy loads: A randomized crossover pilot study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, article id 6276Article in journal (Refereed)
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  • 23. Arking, Dan E
    et al.
    Pulit, Sara L
    Crotti, Lia
    van der Harst, Pim
    Munroe, Patricia B
    Koopmann, Tamara T
    Sotoodehnia, Nona
    Rossin, Elizabeth J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Newton-Cheh, Christopher
    Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization2014In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 46, no 8, p. 826-836Article in journal (Refereed)
    Abstract [en]

    The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain similar to 8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD.

  • 24.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Mälardalen University, Västerås.
    Hedberg Graff, Jenny
    Habilitation Center Region Sormland, Eskilstuna, Sweden.
    Denison, Eva
    School of Health, Care and Social Welfare, Department of Physiotherapy Malardalen University, Vasteras, Sweden.
    Evaluation of the electro-dress Mollii® to affect spasticity and motor function in children with cerebral palsy: Seven experimental single-case studies with an ABAB design2022In: Cogent Engineering, E-ISSN 2331-1916, Vol. 9, no 1, article id 2064587Article in journal (Refereed)
    Abstract [en]

    There are limited non-invasive treatment options in the home environment for children with cerebral palsy (CP); thus, evaluating such treatment options is needed. We aimed to evaluate the effect of an innovative full-body suit approach for non-invasive surface electrical stimulation ES, the electro-dress Mollii®. The full-body suit was primarily designed to reduce spasticity and improve motor function through the mechanism of reciprocal inhibition among children with CP. This study involved seven experimental single-case studies with an ABAB design. Seven studies were performed among children aged 4–17 years. The primary outcome (spasticity) was analyzed using graphed data with a visual inspection, and median values were analyzed for secondary outcomes (mobility, sitting, upper limb activity, sleep, pain, and adherence to treatment). The study protocol was recorded at clinicaltrials.gov (NCT04078321). Seven studies were analyzed, and the treatment with the electro-dress had little or no impact on the outcomes: spasticity, mobility, sitting, upper limb activity, sleep, and pain, in any of these seven studies. In conclusion, multiple ES treatment with the innovative electro-dress Mollii® revealed little or no observable changes on primary outcome (spasticity) in any of the seven studies. Further the possible impact on motor function is recommended to be further evaluated in future studies. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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  • 25.
    Aronzon, Hanna
    et al.
    Dalarna University, School of Health and Welfare.
    Persson, Stefanie
    Dalarna University, School of Health and Welfare.
    Underlivssmärta, urininkontinens och avföringsinkontinens åtta veckor och ett år efter barnafödande: En kvantitativ enkätstudie2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 26.
    Artzi-Medvedik, Rada
    et al.
    Ben-Gurion University of the Negev, Beer-Sheva, Israel; Maccabi Health Services, Southern District, Omer, Israel.
    Kob, Robert
    Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
    Di Rosa, Mirko
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
    Lattanzio, Fabrizia
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
    Corsonello, Andrea
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy.
    Yehoshua, Ilan
    Maccabi Health Services, Southern District, Omer, Israel.
    Roller-Wirnsberger, Regina E
    Medical University of Graz, Graz, Austria.
    Wirnsberger, Gerhard H
    Medical University of Graz, Graz, Austria.
    Mattace-Raso, Francesco U S
    University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Tap, Lisanne
    University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Gil, Pedro G
    Hospital Clinico San Carlos, Madrid, Spain.
    Formiga, Francesc
    Bellvitge University Hospital-IDIBELL-L'Hospitalet de Llobregat, Barcelona, Spain.
    Moreno-González, Rafael
    Bellvitge University Hospital-IDIBELL-L'Hospitalet de Llobregat, Barcelona, Spain.
    Kostka, Tomasz
    Medical University of Lodz, Lodz, Poland.
    Guligowska, Agnieszka
    Medical University of Lodz, Lodz, Poland.
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Carlsson, Axel C
    Karolinska Institutet, Huddinge; Stockholm Region, Stockholm.
    Freiberger, Ellen
    Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
    Melzer, Itshak
    Ben-Gurion University of the Negev, Beer-Sheva, Israel.
    Quality of Life and Kidney Function in Older Adults: Prospective Data of the SCOPE Study2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 12, article id 3959Article in journal (Refereed)
    Abstract [en]

    A longitudinal alteration in health-related quality of life (HRQoL) over a two-year period and its association with early-stage chronic kidney disease (CKD) progression was investigated among 1748 older adults (>75 years). HRQoL was measured by the Euro-Quality of Life Visual Analog Scale (EQ-VAS) at baseline and at one and two years after recruitment. A full comprehensive geriatric assessment was performed, including sociodemographic and clinical characteristics, the Geriatric Depression Scale-Short Form (GDS-SF), Short Physical Performance Battery (SPPB), and estimated glomerular filtration rate (eGFR). The association between EQ-VAS decline and covariates was investigated by multivariable analyses. A total of 41% of the participants showed EQ-VAS decline, and 16.3% showed kidney function decline over the two-year follow-up period. Participants with EQ-VAS decline showed an increase in GDS-SF scores and a greater decline in SPPB scores. The logistic regression analyses showed no contribution of a decrease in kidney function on EQ-VAS decline in the early stages of CKD. However, older adults with a greater GDS-SF score were more likely to present EQ-VAS decline over time, whereas an increase in the SPPB scores was associated with less EQ-VAS decline. This finding should be considered in clinical practice and when HRQoL is used to evaluate health interventions among older adults.

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  • 27. Artzi-Medvedik, Rada
    et al.
    Kob, Robert
    Fabbietti, Paolo
    Lattanzio, Fabrizia
    Corsonello, Andrea
    Melzer, Yehudit
    Roller-Wirnsberger, Regina
    Wirnsberger, Gerhard
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University; Karolinska Institutet.
    Melzer, Itshak
    Impaired kidney function is associated with lower quality of life among community-dwelling older adults: The screening for CKD among older people across Europe (SCOPE) study.2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, no Suppl 1, article id 340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD).

    METHODS: Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m2) and low EQoL-VAS was investigated by multivariable logistic regression models.

    RESULTS: CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16-1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08-1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01-2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93-1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64-1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50-1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90-1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64-1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69-1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99-1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88-1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92-2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models.

    CONCLUSIONS: CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

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  • 28.
    Arvidsson, Sarah
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Lindahl, Janie
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Vårdpersonals erfarenheter av nollseparation mellan mamman och det nyfödda barnet: En fokusgruppsintervjustudie från ett mellanstort sjukhus i Sverige2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Despite the advantages of zero separation, there is still some separation during hospital stay between mother and child after childbirth. At present, variations are seen in the possibility of maintaining zero separation in different hospitals in Sweden. Aim: To examine the delivery-, maternity- and neonatal professionals’ experiences of zero separation between the mother and the newborn child at a medium-sized hospital in Sweden. Method: A qualitive focus group interview study with an inductive approach, with a total of 17 informants, that has been processed with qualitative content analysis. Results: After completing the content analysis 12 subcategories emerged that resulted in four categories; The meaning of zero separation, Enabling approach, Obstacles along the way and Need for improvement. A theme emerged as A mutual effort not to separate, which was regarded to the healthcare professionalls’ willingness and commitment to maintain zero separation between the mother, the child and the family. Conclusion: The healthcare professionalls’ at the concerned hospital had a strong commitment to keep the mother, newborn child and the family as a whole, but at the present there are not always conditions for achieving zero separation to the extent they wish. Clinical implications: The child’s right to their parent is strengthened by the healthcare professionalls’ application of zero separation in their work. The findings of the study could likely be taken into account by healthcare professionalls’ and could form the basis for development of routines and forms of education concerning zero separation.

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  • 29.
    Asaye, Mengstu Melkamu
    et al.
    University of Gondar, Gondar, Ethiopia.
    Gelaye, Kassahun Alemu
    University of Gondar, Gondar, Ethiopia.
    Matebe, Yohannes Hailu
    University of Gondar, Gondar, Ethiopia.
    Lindgren, Helena
    Karolinska Institutet, Solna.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, article id e0285280Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

    METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

    RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

    CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

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  • 30. Askelsdottir, B.
    et al.
    Jonge, W. L. D.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Home care after early discharge: Impact on healthy mothers and newborns2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 8, p. 927-934Article in journal (Refereed)
    Abstract [en]

    Objective: to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. Design: retrospective case-control study. Setting: a labour ward unit in Stockholm, Sweden handling both normal and complicated births. Participants: 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. Intervention: early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (. n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (. n=51). Instruments: mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. Findings: women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (. p=0.021). Contact between the mother, newborn and partner did not differ between the groups. Conclusion: early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. © 2012 Elsevier Ltd.

  • 31. Askelöf, U.
    et al.
    Andersson, O.
    Domellöf, M.
    Fasth, A.
    Hallberg, B.
    Hellström-Westas, L.
    Pettersson, K.
    Westgren, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Götherström, C.
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 12, article id e017215Article in journal (Refereed)
    Abstract [en]

    Background and objective: Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping. Design: Prospective observational study with two historical controls. Setting: A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden. Methods: Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother's abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery. Results: After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 μg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29). Conclusion: In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency. © 2017 Article author(s).

  • 32.
    Askling, Carl
    et al.
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    Thorstensson, Alf
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för biomekanik och motorisk kontroll (BMC).
    A new hamstring test to complement the common clinical examination before return to sport after injury2010In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, no 12, p. 1788-1803Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim was to introduce and evaluate the reliability and validity of an active hamstring flexibility test as a complement to common clinical examination when determining safe return to sport after hamstring injury.

    METHODS: Eleven healthy subjects (28 years) were tested on repeated occasions, and 11 athletes (21 years) with MRI-verified acute hamstring strain were tested when common clinical examination revealed no signs of remaining injury, i.e. there was no differences between the legs in palpation pain, manual strength tests, and passive straight leg raise. Flexibility, i.e. highest range of motion of three consecutive trials, was calculated from electrogoniometer data during active ballistic hip flexions and conventional passive slow hip-flexions in a supine position. A VAS-scale (0-100) was used to estimate experience of insecurity during active tests.

    RESULTS: No significant test-retest differences were observed. Intra-class correlation coefficients ranged 0.94-0.99 and coefficients of variation 1.52-4.53%. Active flexibility was greater (23%) than passive flexibility. In the athletes, the injured leg showed smaller (8%) active, but not passive, flexibility than the uninjured leg. Average insecurity estimation was 52 (range 28-98) for the injured and 0 for the uninjured leg, respectively.

    CONCLUSION: The new test showed high reliability and construct validity; furthermore, it seems to be sensitive enough to detect differences both in active flexibility and in insecurity after acute hamstring strains at a point in time when the commonly used clinical examination fails to reveal injury signs. Thus, the test could be a complement to the common clinical examination before the final decision to return to sport is made.

  • 33.
    Assaysh-Öberg, Shereen
    et al.
    Dalarna University, School of Health and Welfare.
    Borneskog, Catrin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Ternström, Elin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Women's experience of infertility & treatment - A silent grief and failed care and support.2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100879Article in journal (Refereed)
    Abstract [en]

    Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women's overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women's experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the healthcare system and society. The personal trauma and experiences included stress, grief, inability to focus, chock, insomnia, anxiety, withdrawing from others, sense of hopelessness and guilt and shame. The infertility and IVF journey also either caused conflicts in relationships or helped the couples to grow stronger. At the same time, relationships with friends and family were strained due to isolation and feeling stigmatized, and not understood. Finally, the healthcare system and providers lacked adequate support, holistic and caring care, and the women felt dehumanized and failed by the healthcare system. It is therefore critical that the healthcare system provide the time, information and support needed to deal with infertility and IVF to maintain quality of life and wellbeing.

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  • 34.
    Ayoub, Maria
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Social Work.
    Udo, Camilla
    Dalarna University, School of Health and Welfare, Social Work.
    Årestedt, Kristofer
    Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, 352 52 Växjö, Sweden.
    Kreicbergs, Ulrika
    Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden;Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, 171 77 Solna, Sweden;Louis Dundas Center, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.
    Lövgren, Malin
    Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden;Advanced Pediatric Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 64 Solna, Sweden.
    The Family Talk Intervention in Pediatric Oncology: Potential Effects Reported by Parents2024In: Children, E-ISSN 2227-9067, Vol. 11, no 1, p. 95-95Article in journal (Refereed)
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  • 35.
    Bala, Hena Rani
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Chakma, Anti
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Khatun, Most. Zubayda Rokshanara
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Birth companion during labour and birth2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Having a birth companion during labour and birth to provide mental, emotional support as well as physical support is globally found to be essential for women. The process of giving birth is not only a biological event but also a process with social and emotional aspects. It is a right for every woman to receive evidence-based care during childbirth. There is also a global interest in improving the quality of maternal and newborn care. This includes a strong focus on respectful care as an essential component of quality of care. The aim of this study was to define the concept “Birth companion during labour and birth” through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education. Methods: The design of this study is a concept analysis that comprises three phases: 1) is a theoretical phase, followed by 2) a field study phase and 3) a synthesis phase. The participants were recruited purposively and invited to the interview with an invitation letter. The interviews were based on semi-structured and open-ended questions following an interview guide. A total of nine participants were enrolled in this study, five midwifery educators, two clinical midwives, and two midwifery students who worked at antenatal care, delivery, postpartum care, menstrual regulation, post abortion care and family planning care or involved in midwifery education. Results: A birth companion supports women during childbirth provide informational support, bridge communication gaps between clinical staff and women, provide practical support and emotional support, act as an advocate for the women, help women feel in control, provide continuous physical presence. Conclusion: The concept “Birth companion during labour and birth” was redefined in the following way: The birth companion can be any person chosen by the woman to provide her with support during labour and childbirth. This support is perceived to be associated with reduced maternal anxiety, it highlights the importance of a birth companion during labour and birth and on the emotional wellbeing of women in the Bangladeshi context. Clinical implications: This paper gives a deep insight to the concept of a birth companion during labour and birth and shows what is, and preferably should be, part of the clinical settings in Bangladesh. Ensuring a birth companion during labour and birth could improve health outcomes of women and give a positive childbirth experience.

  • 36. Baldanzi, Gabriel
    et al.
    Sayols-Baixeras, Sergi
    Theorell-Haglöw, Jenny
    Dekkers, Koen F
    Hammar, Ulf
    Nguyen, Diem
    Lin, Yi-Ting
    Ahmad, Shafqat
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Fall, Tove
    Obstructive sleep apnea was associated with the human gut microbiota composition and functional potential in the population-based Swedish CardioPulmonary bioImage Study (SCAPIS)2023In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 164, no 2, p. 503-516Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent hypoxia and intermittent airway obstruction, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition and subsequent transplantation of fecal matter to other animals induced changes in blood pressure and glucose metabolism.

    RESEARCH QUESTION: Does obstructive sleep apnea in adults associate with the composition and metabolic potential of the human gut microbiota?

    STUDY DESIGN AND METHODS: We used respiratory polygraphy data from up to 3,570 individuals aged 50-64 from the population-based Swedish CardioPulmonary bioImage Study combined with deep shotgun metagenomics of fecal samples to identify cross-sectional associations between three OSA parameters covering apneas and hypopneas, cumulative sleep time in hypoxia and number of oxygen desaturation events with gut microbiota composition. Data collection about potential confounders was based on questionnaires, on-site anthropometric measurements, plasma metabolomics, and linkage with the Swedish Prescribed Drug Register.

    RESULTS: We found that all three OSA parameters were associated with lower diversity of species in the gut. Further, the OSA-related hypoxia parameters were in multivariable-adjusted analysis associated with the relative abundance of 128 gut bacterial species, including higher abundance of Blautia obeum and Collinsela aerofaciens. The latter species was also independently associated with increased systolic blood pressure. Further, the cumulative time in hypoxia during sleep was associated with the abundance of genes involved in nine gut microbiota metabolic pathways, including propionate production from lactate. Lastly, we observed two heterogeneous sets of plasma metabolites with opposite association with species positively and negatively associated with hypoxia parameters, respectively.

    INTERPRETATION: OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.

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  • 37. Baldi, Enrico
    et al.
    Grieco, Niccolò B.
    Ristagno, Giuseppe
    Alihodžić, Hajriz
    Canon, Valentine
    Birkun, Alexei
    Cresta, Ruggero
    Cimpoesu, Diana
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Centre for Clinical Research Dalarna, Uppsala University; Department of Prehospital Care, Region of Dalarna.
    Savastano, Simone
    The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 21Article in journal (Refereed)
    Abstract [en]

    Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

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  • 38. Bandak, Ghassan
    et al.
    Sang, Yingying
    Gasparini, Alessandro
    Chang, Alex R
    Ballew, Shoshana H
    Evans, Marie
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Lund, Lars H
    Inker, Lesley A
    Grams, Morgan E
    Hyperkalemia after initiating renin-angiotensin system blockade: The Stockholm creatinine measurements (SCREAM) project2017In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 7, article id e005428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Concerns about hyperkalemia limit the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium-monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE-I/ARB initiation and developed and validated a hyperkalemia susceptibility score.

    METHODS AND RESULTS: We evaluated 69 426 new users of ACE-I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow-up for 1 year thereafter. Three fourths (76%) of SCREAM patients had potassium checked within the first year. Potassium >5 and >5.5 mmol/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity-matched new ACE-I/ARB users to 20 186 new β-blocker users in SCREAM: 64% had potassium checked. The occurrence of elevated potassium levels was similar between new β-blocker and ACE-I/ARB users without kidney disease; only at estimated glomerular filtration rate <60 mL/min per 1.73 m(2) were risks higher among ACE-I/ARB users. We developed a hyperkalemia susceptibility score that incorporated estimated glomerular filtration rate, baseline potassium level, sex, diabetes mellitus, heart failure, and the concomitant use of potassium-sparing diuretics in new ACE-I/ARB users; this score accurately predicted 1-year hyperkalemia risk in the SCREAM cohort (area under the curve, 0.845, 95% CI: 0.840-0.869) and in a validation cohort from the US-based Geisinger Health System (N=19 524; area under the curve, 0.818, 95% CI: 0.794-0.841), with good calibration.

    CONCLUSIONS: Hyperkalemia within the first year of ACE-I/ARB therapy was relatively uncommon among people with estimated glomerular filtration rate >60 mL/min per 1.73 m(2), but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.

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  • 39.
    Banu, Afroza
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parvin, Shahanaj
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    "There Are Remaining Challenges in Bangladesh" A National Assessment Strategy Supports Reaching International Midwifery Standards Education: A focus group inquiry among midwifery faculty in Bangladesh2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Delivery by unskilled birth attendant is causing many maternal and neonatal deaths. Midwives can reduce maternal and neonatal deaths by providing skilled delivery care. To prepare skilled midwives a National Assessment Strategy for Midwifery Education Standards has been introduced.

    Aim: To describe midwifery faculty members’ perceptions of how to affirm quality midwifery education in Bangladesh using a national assessment strategy.

    Methods: A qualitative research design was chosen using a context-specific accreditation assessment tool, guided by the Global Standards for Midwifery Education. The participants were 33 midwifery teachers, and data were analyzed with content analysis.

    Results: The findings indicate that Bangladesh should be prepared to implement the Global Standards for Midwifery Education Accreditation Programmes. The assessment strategy has prepared the faculty for accreditation and paved the way through the development of standards in the tool, overcoming barriers, and using the possible facilitators.

    Conclusion: There are remaining challenges in Bangladesh regarding "moving midwifery". Midwifery teachers demand for separate faculty from nursing. Promotion system for careers development can be initiated. Updating teachers knowledge, having adequate number of teachers with competencies, and maintained collaboration between teaching and clinical practice organizations are important for "moving midwifery" in Bangladesh.

    Clinical application: The present study results can be useful for midwifery education and clinical practice improvement.

  • 40. Basu, S
    et al.
    Zethelius, B
    Helmersson, J
    Berne, C
    Larsson, A
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Cytokine-mediated inflammation is independently associated with insulin sensitivity measured by the euglycemic insulin clamp in a community-based cohort of elderly men2011In: International Journal of Clinical and Experimental Medicine, E-ISSN 1940-5901, Vol. 4, no 2, p. 164-168Article in journal (Refereed)
    Abstract [en]

    Both clinical and experimental studies suggest a close relation between an inflammatory state and insulin resistance. We investigated the association between cytokine-mediated inflammation (high sensitivity C reactive protein [hsCRP] and interleukin [IL] 6) and insulin sensitivity (insulin-mediated glucose disposal rate, assessed by the euglycemic insulin clamp) in a community-based cohort, with subgroup analyses of normal weight individuals without diabetes mellitus and metabolic syndrome (NCEP). hsCRP and IL- 6 were inversely associated with insulin sensitivity (multivariable-adjusted regression coefficient for 1-SD increase of hsCRP -0.12 (-0.21-(-0.03), p=0.01) and of IL-6 - 0.11 (-0.21-(-0.02), p=0.01) in models adjusting for age and components of the metabolic syndrome (systolic and diastolic blood pressure, antihypertensive drugs, HDL-cholesterol, triglycerides, fasting plasma glucose, waist circumference). The multivariable-adjusted association between hsCRP, IL-6 and insulin sensitivity were of a similar magnitude in normal weight individuals without diabetes and without the metabolic syndrome. Our data show that cytokine -mediated subclinical inflammation is independently associated with decreased insulin sensitivity also in apparently metabolically healthy normal weight individuals, indicating that the interplay between inflammatory processes and insulin resistance is present already in the early stages of the development of glucometabolic disease. (IJCEM1012002).

  • 41.
    Begum, Momtaj
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Sultana, Nazma
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Women’s and health care provider perceptions and experiences of bottlenecks in midwifery care: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Women die from preventable causes during pregnancy and childbirth and often in relation to delays in midwifery care. Professional hierarchies might hamper the rights and desires of midwives in provision of normal birth in terms of the provision of quality care to all women and newborns. In health systems where decision making in normal births are influence by doctors this is particularly relevant, with women themselves subordinate to all health care professionals. Aim: The aim of this meta-synthesis was to examine women’s and health care provider’s perceptions and experiences of bottlenecks in midwifery care related to availability, accessibility, acceptability and quality of midwifery care. Method: This study was a qualitative meta-synthesis with a deductive approach, 15 article were selected for this qualitative meta-synthesis. A framework for the evaluation of quality of care and coverage of health services was used for the deductive approach. Results: Four categories emerged based on availability, accessibility, acceptability and quality of care. The delays were due to less awareness of danger signs of severe complications in the community, and delays in decision making by male family members and less empowerment of women, and lack of collaboration between health care professionals. We also identified how to overcome this situation. Conclusion: Midwifes may provide quality maternal care to all women and children and earn trust from community people to promote normal pregnancy and birth and prevent delays when complications arise. Clinical implications: Midwives can provide continuity care and through collaboration with other health care professionals advocate for women empowerment.

  • 42.
    Begum, Mst. Marium
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Nahar., Most. Nargis
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parents’ and health care providers’ perceptions and experiences of supportive care in neonatal wards: A qualitative metasynthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Four million infants die with in the first month of life and 27% of these deaths are directly related to low birth weight (LBW) or preterm birth. The main causes of infant death in premature and LBW infants is neonatal infections. It is thus crucial that the infant is taken care of in an appropriate way regarding caring and feeding and that care is provided to improve the child’s chances of survival and to lay the foundation for a healthy life. Aim: The aim of this meta-synthesiswas to examine parent`s and health care providers perceptions and experiences of supportive care in neonatal wards. Method: A qualitative meta-synthesis based on peer-reviewed scientific literature, and meta-ethnographic analysis method. In this meta-synthesis 16 articles were included. Result: The results comprised of two categories, Parents’ perspective of supportive strategies with eight corresponding preliminary patterns and Health care providers’ perspective of supportive strategies with six corresponding preliminary patterns. In the result section, each categories are presented with its corresponding preliminary patterns. The mothers experienced that the baby was unstable and therefore they wanted to be close to the baby at all times if something happened. Important was closeness to the infant is important, parental support according to needs, adequate communication and information with parents, genuine caring and continuous support to get close to the child. It also meant less light and less noise and privacy for the infant and the parent in the NICU ward.

    Conclusion

    Parents wanted to be able to be with his infant as rapidly after birth be reunited in case something happened. The importance of receiving information about their infant’s condition underpinned all communications that the parents undertook with NICU staff both in co-care when together with the child and part-care, when separated. Information for the parents was an important requirement of accepting their situation and immediately affected their anxiety. Clinical implications: The organizers of care must take in account that parents and infants will not be befitted by being cared for apart from each other. When planning for co-care enabling infants to be close to the parents, the mother-baby dyad should be prioritized. Context specific interview studies are suggested on co-care and part-care, parents and care providers perspectives.

  • 43. Begum, Nurjahan
    et al.
    Mitu, Jannatul Ferdoues
    Nandy, Purnima
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Respectful care during labour and birth: A concept analysis2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Along with the Sustainable Development Goals (SDG) 3 and 5, the global effort is highly focused on evidence-based practice and respectful maternity care to reduce maternal and newborn mortality and morbidity. In Bangladesh disrespect and abuse against mothers during intrapartum period is common and the midwifery profession was introduced in 2013. The aim of this study is to define the concept “Respectful Care during labour and birth” through the synthesis of text from literature and interview with Bangladeshi health care providers. Methods: The study was done through a concept analysis from the literature and 10 semi-structured interviews with third-year midwifery students, clinical midwives and midwifery faculty. Results: The study found that in low-income countries women are more vulnerable to disrespectful care in various ways like physical and verbal abuse. Midwives provide only non-harmful care, due to poor salary, and lack of quality higher education. Private hospitals and midwife led-care centers provide better service than government hospitals. Conclusion: Midwives play a vital role to ensure respectful care for a mother during labour and childbirth. Clinical implications: The findings could be helpful to develop the profession for countries where the midwifery profession is new, like in Bangladesh

  • 44.
    Begun, Najma
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Upright position during labour and birth: A concept analysis2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The best birthing position for women to adopt during labour and birth is to vary the positions freely depending on the stages of labour. The aim of this study was to define the concept ‘upright position during labour and birth’ through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education.Methods: This study design was concept analysis. The setting was three different nursing institutes/colleges and nearby hospitals. Nine participants were invited to participate in an individual in-depth interview (IDI) with semi-structured open-ended questions. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically clarified in the fieldwork phase in the midwifery context of Bangladesh, described with the Quality Maternal and Newborn Care (QMNC) framework components.Results: The concept of upright position during labour and birth in the midwifery context was redefined. Altering between positions widening the pelvic relief labour pain for the woman, potentially resulting in a normal birth with a healthy mother and baby. Women do not expect upright positions in facility-based births but at homebirths.Conclusion: The women’s rights to spontaneously and freely move while in labour, altering between different vertical positions are associated with the midwives’ work “with women” supporting the women.Clinical implications: It is a simple intervention to apply in clinical setting and simple to teach to nurses, midwives and physicians and in graduate and postgraduate education.

  • 45. Beijer, K.
    et al.
    Nowak, C.
    Sundström, J.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Fall, T.
    Lind, L.
    In search of causal pathways in diabetes: a study using proteomics and genotyping data from a cross-sectional study2019In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 62, no 11, p. 1998-2006Article in journal (Refereed)
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  • 46. Bengtsson Tops, Anita
    et al.
    Ehliasson, Kent
    University of Kristianstad.
    Victimization in individuals suffering from psychosis: a Swedish cross-sectional study2012In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 19, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

    The aims of the study were to investigate: (1) self-reported adulthood and last-year victimization in male and female outpatients suffering from psychosis; (2) relationships to perpetrators; (3) whether drugs or alcohol were involved in victimization situations; (4) places where victimization occurred. Patients were randomly selected from five outpatient units geared to patients with psychosis; 174 patients participated in a structured face-to-face interview. Experiences of victimization in adulthood were reported by 67%, 33% in the previous year. During adulthood 51% had been physically and 32% sexually victimized and 39% threatened. In the previous year 21% reported threats, 20% physical and 15% sexual victimization. Women reported greater exposure to physical and sexual victimization than men during adulthood and in the previous year. Strangers and acquaintances were mainly reported as perpetrators and half (55%) of those victimized in the previous year stated no involvement of alcohol or drugs. Victimization mainly occurred in the patients’ own home (59%), outside downtown (34%), or in others homes (38%). The results of this study give reason to highlight the importance for research and clinical practices to adopt a broad frame of interpretation concerning victimization in patients, covering both individual and environmental factors.

  • 47. Bergström, Aileen L
    et al.
    Guidetti, Susanne
    Tistad, Malin
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Tham, Kerstin
    von Koch, Lena
    Eriksson, Gunilla
    Perceived occupational gaps one year after stroke: An explorative study2011In: Journal of Rehabilitation Medicine, ISSN 1651-2081, Vol. 44, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore and describe factors associated with occupational gaps and to identify factors at 3 months that predict occupational gaps one year post-stroke. A gap, a restriction in participation, is considered to be present when there is a discrepancy between what the individual wants to do and what they actually do in everyday life. DESIGN: Prospective longitudinal study. SUBJECTS: Two hundred persons with stroke. METHODS: Data from the Occupational Gaps Questionnaire, one year post-stroke, was used as the dependent variable in 3- and 12-month regression analyses. Domains of the Stroke Impact Scale, global life satisfaction, demographic and medical factors were used as independent variables. RESULTS: At 3 months, activities of daily living abilities, social participation and not being born in Sweden predicted occupational gaps at 12 months. Stroke severity and not being born in Sweden and 3 factors at 12 months: social participation, self-rated recovery, and global life satisfaction were associated with occupational gaps. CONCLUSION: Activities of daily living ability at 3 months predicted occupational gaps after stroke. Thus, it is possible to identify early on, and provide interventions for, those that risk participation restrictions. Not being born in the country might be an indicator of a risk for participation restrictions.

  • 48.
    Birath, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Edman, Sofia
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Förlossningsrädsla: En begreppsanalys ur barnmorskans perspektiv2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Fear of childbirth affects about one-fifth of all pregnant women and midwives face these in their work.

    Aim: The aim was to analys the concept fear of childbirth from a midwife perspective.

    Methods: A concept analysis with a hybrid model. First a theoretical phase with a search for literature, thereafter a fieldwork phase where five midwifes where interviewed followed by a final analytic phase.

    Results: Fear of childbirth is something that can affect women before, during or after pregnancy and childbirth. Fear of childbirth for primiparous women can be a lack of confidence in her ability to give birth, and for multiparous women have had a previous traumatic birth experience. The midwives described that fear of childbirth was a complex concept. Women did not usually use the word fear of childbirth, but the midwives interpreted what they noticed or saw in the woman as manifestations of fear of childbirth.

    Conclusion: Midwives use the concept in different ways and call for a clearer definition and way of working with fear of childbirth. The fear of childbirth is a great suffering for the pregnant woman and therefore the authors of this thesis consider that preventive work is important and that the midwife has a central and important role.

    Clinical Applicability: Midwives can use this study to develop their knowledge of fear of childbirth and see how other midwives view on the concept fear of childbirth.

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  • 49. Bjerre, M.
    et al.
    Hilden, J.
    Winkel, P.
    Jensen, G. B.
    Kjøller, E.
    Sajadieh, A.
    Kastrup, J.
    Kolmos, H. J.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institute.
    Gluud, C.
    Serum osteoprotegerin as a long-term predictor for patients with stable coronary artery disease and its association with diabetes and statin treatment: A CLARICOR trial 10-year follow-up substudy2020In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 301, p. 8-14Article in journal (Refereed)
  • 50. Bjersing, Jan L
    et al.
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Ernberg, Malin
    Bileviciute-Ljungar, Indre
    Löfgren, Monika
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin2017In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 18, no 1, article id 106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF-1) and leptin may be involved. In this study, the aim was to evaluate the role of metabolic factors in lean, overweight and obese women during resistance exercise, in relation to symptom severity and muscle strength in women with FM.

    METHODS: Forty-three women participated in supervised progressive resistance exercise, twice weekly for 15-weeks. Serum free and total IGF-1, IGF-binding protein 3 (IGFBP3), adiponectin, leptin and resistin were determined at baseline and after 15-weeks. Level of current pain was rated on a visual analogue scale (0-100 mm). Level of fatigue was rated by multidimensional fatigue inventory (MFI-20) subscale general fatigue (MFIGF). Knee extension force, elbow flexion force and handgrip force were assessed by dynamometers.

    RESULTS: Free IGF-1 (p = 0.047), IGFBP3 (p = 0.025) and leptin (p = 0.008) were significantly decreased in lean women (n = 18), but not in the overweight (n = 17) and the obese (n = 8). Lean women with FM benefited from resistance exercise with improvements in current pain (p= 0.039, n = 18), general fatigue (MFIGF, p = 0.022, n = 18) and improved elbow-flexion force (p = 0.017, n = 18). In overweight and obese women with FM there was no significant improvement in pain or fatigue but an improvement in elbow flexion (p = 0.049; p = 0.012) after 15 weeks of resistance exercise.

    CONCLUSION: The clearest clinical response to resistance exercise was found in lean patients with FM. In these individuals, individualized resistance exercise was followed by changes in IGF-1 and leptin, reduced pain, fatigue and improved muscular strength. In overweight and obese women FM markers of metabolic signaling and clinical symptoms were unchanged, but strength was improved in the upper limb. Resistance exercise combined with dietary interventions might benefit patients with FM and overweight.

    TRIAL REGISTRATION: The trial was registered 21 of October 2010 with ClinicalTrials.gov identification number: NCT01226784 .

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