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  • 1.
    Abzhandadze, Tamar
    et al.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Westerlind, Emma
    rg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Persson, Hanna C
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sick leave one year after COVID-19 infection: a nationwide cohort study during the first wave in Sweden2024In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 572Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the patterns of sick leave, as well as factors associated with sick leave due to COVID-19 during one year after the COVID-19 diagnosis, and sex-related aspects on sick leave. This nationwide study involved 11,902 individuals who received sickness benefits for COVID-19 during the first wave of the pandemic. Data from three Swedish registries were analyzed for sick leave that commenced between March 1 and August 31, 2020, with a follow-up period of 12 months. Sick leave due to COVID-19 was counted as the number of days with sickness benefits and required to include at least one registered COVID-19 diagnosis. The median duration of sick leave was 35 days, and 347 (2.9%) individuals continued their sick leave during the entire follow-up period. Furthermore, 1 year later, the cumulative incidence of sick leave was slightly higher in males (3.5%) compared to females (2.7%). Older age, being single with no children, diagnosed with the virus, medium income level, history of sick leave, and need for inpatient care were significantly associated with a higher duration of sick leave due to COVID-19, both in the total population and when stratified by sex. These results indicated that three out of 100 (3%) patients were still on sick leave 1 year after their COVID-19 diagnosis. Aspects regarding the importance of sick leave duration differed between males and females and comprised sociodemographic characteristics and need for inpatient care. The results indicated the complexity of sick leave due to COVID-19.

  • 2.
    Ahlström, Sara Wallin
    et al.
    Mälardalen University, Västerås; Center for Clinical Research Dalarna, Uppsala University, Falun; Habilitation Center in Falun.
    Almqvist, Lena
    Mälardalen University, Västerås.
    Janeslätt, Gunnel
    Center for Clinical Research Dalarna, Uppsala University, Falun; Habilitation Center in Falun, Dalarna; Uppsala University, Uppsala.
    Gustavsson, Catharina
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun; Uppsala University, Uppsala.
    Harder, Maria
    Mälardalen University, Västerås.
    The experiences and the meaning of using MyTime in the preschool context from the perspective of children in need of special support, 5-6 years of age2023In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 49, no 6, p. 1096-1103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Children in need of special support often display delays in time processing ability, affecting everyday functioning. MyTime is an intervention programme for systematic training of time processing ability. To support preschool children's development of time processing ability and everyday functioning, it is necessary to include their perspectives of the MyTime intervention programme. A previous study shows that MyTime is feasible with children in the preschool setting and shows positive effects on time processing ability for older children in special schools. Yet, there is a lack of knowledge regarding how preschool children experience the intervention programme and how they understand its meaning. The aim of this study was to explore the experiences and the meaning of using MyTime from the perspective of children with informal needs of special support (INS) 5-6 years of age in the preschool context.

    METHODS: To explore the children's perspectives, video-recorded interviews with 21 children were analysed hermeneutically. To facilitate the interview situation with the children in need of special support, the Talking Mats© was used. Both body and spoken languages were analysed.

    RESULTS: The results reveal children as active participants, willing to share their experiences of using the MyTime intervention in the preschool context. The conceptualization of the children's experiences and expressions uncovers their meaning of using the MyTime intervention as to know and to understand time by doing.

    CONCLUSIONS: When children are given the opportunity to use concrete tools to understand and measure time, they experience themselves as active participants involved and engaged in the intervention. They reveal meaningful experiences to be able to manage time that facilitate their everyday functioning and participation in the preschool context.

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  • 3. 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.

  • 4.
    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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  • 5.
    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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  • 6. Andersson, Peter
    et al.
    Tistad, Malin
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Eriksson, Åsa
    Enebrink, Pia
    Sturidsson, Knut
    Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial2022In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 27, p. 100907-100907, article id 100907Article in journal (Refereed)
    Abstract [en]

    Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants’ illness management skills and recovery. Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual. Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory. Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020–02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132). 

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  • 7.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Reg Sormland, Res & Dev Sormland; Malardalen Univ,.
    App-based strength and balance self-test in older adults: an exploratory study from a user perspective2021In: BMC Research Notes, E-ISSN 1756-0500, Vol. 14, no 1, article id 379Article in journal (Refereed)
    Abstract [en]

    Objectives Falls are a common problem, especially in the older population. The number of older adults aged over 65 years is increasing globally, leading to a major challenge in providing effective fall prevention interventions to older adults requiring such interventions. This study aimed to explore the usability of an app-based strength and balance self-tests in a small sample of four older adults. This study is a side product of another project. Results The results from this study indicated that self-test of strength and balance by using a smartphone application is a challenge for older adults. Basic test measures, such as start and stop and counts of sit-to-stand, were difficult to self-administer. However, from a user perspective, the possibility of independently performing these measures was considered important and needed to be further developed and evaluated in future studies.

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  • 8.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University; Mälardalen University.
    Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention.2023In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 18, p. 2165-2170Article in journal (Refereed)
    Abstract [en]

    Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a "train-The-trainer" approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.

  • 9.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Res & Dev Sormland, Malardalen Univ.
    Cederbom, Sara
    OsloMet, Oslo Metropolitan Univ, Norway.
    Movement toward an evidence-Based, digital fall prevention future-Perceptions from a physiotherapy perspective2023In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 39, no 1, p. 128-136Article in journal (Refereed)
    Abstract [en]

    Background Physiotherapy plays an important role in fall prevention, and is a science- and evidence-based profession that is constantly undergoing development. Currently, the possibility of digital fall prevention is being explored; however, the perception of physiotherapists (PTs) toward a digital approach is still a sparsely investigated topic. Purpose This study aimed to explore the PT's experiences with a fall prevention exercise program used in their daily work and their thoughts regarding the use of digital support in this context. Methods Discussions were held in two focus groups with seven PTs (age: 26-48 years). A qualitative content analysis was performed. Results We identified two main categories: 1) The importance of evidence-based fall prevention exercise; and 2) Transition toward a digital fall prevention exercise approach. The participants expressed that they had time- and resource-related limitations affecting evidence-based work and adherence to fall prevention exercise programs. They stated that education and management support were required. Conclusion There is a need for fall prevention exercise to be evidence-based and prioritized in physiotherapy. The study results provide insights into the lack of adherence to fall prevention exercise programs and highlighted the need for a transition toward working digitally in the future.

  • 10. Arkkukangas, Marina
    et al.
    Cederbom, Sara
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Umb Carlsson, Õie
    Older adults’ experiences with mHealth for fall prevention exercise: usability and promotion of behavior change strategies2021In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 37, no 12, p. 1346-1352Article in journal (Refereed)
    Abstract [en]

    Background: With the rapidly growing aging population, older adults need to stay healthy and active for a longer time. Mobile health (mHealth) solutions could help support, prevent, or delay functional decline and falls in old age.Purpose: The aim was to explore older persons? experiences of a mobile application for fall prevention exercise, and to identify what possible behavior change techniques to include in the further development of the application.Methods: Two focus groups were conducted with 12 older adults (seven women and five men) 70 to 83 years of age. A qualitative content analysis was performed.Results: Two main results emerged: 1) external facilitators for using the application; and 2) internal facilitators for using the application and perceived gains, in addition 10 behavior change techniques were identified.Conclusion: With support, an application could be adapted for older adults to manage, motivate, and adhere to fall prevention exercise. To achieve long-term adherence to health behavior changes, behavior change strategies and techniques are recommended to be included in further development of the fallprevention application.

  • 11.
    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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  • 12.
    Arkkukangas, Marina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Research and Development in Sörmland, Eskilstuna, Sweden.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 744Article in journal (Refereed)
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  • 13.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås; Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 22, article id 15140Article in journal (Refereed)
    Abstract [en]

    This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.

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  • 14. Arkkukangas, Marina
    et al.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Hamilton, Julia
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Pilotstudie av genomförbarheten av Judo4Balance - ett fallförebyggande träningsprogram för äldre personer i eget boende.2021In: Äldre i Centrum Vetenskapligt Supplement, ISSN 2003-9069, Vol. 1, no 1, p. 27-37Article in journal (Refereed)
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  • 15.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Fall, fallrisk och fallprevention: genom träning2021Book (Other academic)
    Abstract [sv]

    Är fallolyckor en naturlig följd av åldrandet? Vilka möjligheter finns det för trygg rörelse och aktivitet även i hög ålder? Går det att förebygga fall och fallskador genom specifik och målinriktad träning?

    Denna bok har som ambition att täcka såväl teoretiska som praktiska aspekter på de specifika fallrisker som följer med åldrandet. Författarna beskriver det aktuella kunskapsläget kring förekomst, konsekvenser, riskanalys och prevention av fallolyckor. Dessutom presenteras tydligt, i såväl bild som text, praktiska träningsprogram och övningar inriktade på att förebygga fall och fallskador.

    Fall, fallrisk och fallprevention vänder sig till studerande inom fysioterapi, arbetsterapi, omvårdnad, medicin och omsorg samt till kliniskt verksamma som arbetar med äldre personer. Boken kan även vara intressant för äldre personer som vill stärka sin hälsa och sitt välbefinnande samt minska risken för en fallolycka.

  • 16.
    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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  • 17. Baldanzi, Gabriel
    et al.
    Sayols-Baixeras, Sergi
    Ekblom-Bak, Elin
    Ekblom, Örjan
    Dekkers, Koen F
    Hammar, Ulf
    Nguyen, Diem
    Ahmad, Shafqat
    Ericson, Ulrika
    Arvidsson, Daniel
    Börjesson, Mats
    Johanson, Peter J
    Smith, J Gustav
    Bergström, Göran
    Lind, Lars
    Engström, Gunnar
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Kennedy, Beatrice
    Orho-Melander, Marju
    Fall, Tove
    Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS.2024In: EBioMedicine, E-ISSN 2352-3964, Vol. 100, article id 104989Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous population-based studies investigating the relationship between physical activity and the gut microbiota have relied on self-reported activity, prone to reporting bias. Here, we investigated the associations of accelerometer-based sedentary (SED), moderate-intensity (MPA), and vigorous-intensity (VPA) physical activity with the gut microbiota using cross-sectional data from the Swedish CArdioPulmonary bioImage Study.

    METHODS: In 8416 participants aged 50-65, time in SED, MPA, and VPA were estimated with hip-worn accelerometer. Gut microbiota was profiled using shotgun metagenomics of faecal samples. We applied multivariable regression models, adjusting for sociodemographic, lifestyle, and technical covariates, and accounted for multiple testing.

    FINDINGS: Overall, associations between time in SED and microbiota species abundance were in opposite direction to those for MPA or VPA. For example, MPA was associated with lower, while SED with higher abundance of Escherichia coli. MPA and VPA were associated with higher abundance of the butyrate-producers Faecalibacterium prausnitzii and Roseburia spp. We observed discrepancies between specific VPA and MPA associations, such as a positive association between MPA and Prevotella copri, while no association was detected for VPA. Additionally, SED, MPA and VPA were associated with the functional potential of the microbiome. For instance, MPA was associated with higher capacity for acetate synthesis and SED with lower carbohydrate degradation capacity.

    INTERPRETATION: Our findings suggest that sedentary and physical activity are associated with a similar set of gut microbiota species but in opposite directions. Furthermore, the intensity of physical activity may have specific effects on certain gut microbiota species.

    FUNDING: European Research Council, Swedish Heart-Lung Foundation, Swedish Research Council, Knut and Alice Wallenberg Foundation.

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  • 18. 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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  • 19. 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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  • 20. Baudin, Katarina
    et al.
    Sundström, Angelina
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Gustafsson, Christine
    Decision-Making Is in the Making! Aspects of Decision-Making in the Area of Assistive and Welfare Technology—A Qualitative Study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, article id 4028Article in journal (Refereed)
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  • 21. Baudin, Katarina
    et al.
    Sundström, Angelina
    Gustafsson, Christine
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    What's in it for me? A retrospective cost-consequence study of a digital assistive technology2022In: Gerontechnology, ISSN 1569-1101, E-ISSN 1569-111X, Vol. 21Article in journal (Refereed)
  • 22. Baudin, Katarina
    et al.
    Sundström, Angelina
    Gustafsson, Christine
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Äldre brukares användning av Memoplanner med fokus på aktivitet, delaktighet, hälsorelaterade livskvalitet samt dess relaterade kostnader. Närståendes erfarenheter2021Report (Other academic)
  • 23. Björkman, Frida
    et al.
    Ekblom, Örjan
    Ekblom-Bak, Elin
    Bohman, Tony
    Dalarna University, School of Health and Welfare, Medical Science. The Swedish School of Sport and Health Sciences, Stockholm.
    The ability of a submaximal cycle ergometer test to detect longitudinal changes in VO2max2021In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 13, no 1, article id 156Article in journal (Refereed)
    Abstract [en]

    Background: The purpose of the present study was to examine the ability of a submaximal cycling test to detectlongitudinal changes in maximal oxygen uptake (VO2max) and examine the conformity between changes in meas‑ured and estimated VO2max over a time span of 5–8 years.Methods: A total of 35 participants (21 men and 14 women), aged 29 to 63 years, performed the Ekblom-Bak (EB)submaximal cycle test for estimation of VO2max and a maximal treadmill running test for direct measurement ofVO2max. The baseline tests were conducted between 2009 and 2012, and the follow-up tests were completed 5to 8 years later. Pearson’s coefcient of correlation (r) and paired sample t-test were used to analyse the associationbetween change in measured and estimated VO2max. Random and systematic errors between the measured andestimated VO2max were evaluated using Bland-Altman plots. Repeated measures ANOVA were used to test difer‑ences between changes over time.Results: There was no signifcant change in mean measured VO2max between baseline and follow-up (p = 0.91),however large individual variations were noted (− 0.78 to 0.61 L/min). The correlation between individual change inmeasured and estimated VO2max was r = 0.75 (p < 0.05), and the unstandardised B-coefcient from linear regressionmodelling was 0.88 (95% CI 0.61 to 1.15), i.e., for each litre of change in estimated VO2max, the measured value hadchanged 0.88 L. The correlation between baseline and follow-up errors (the diference between estimated-measuredVO2max at each occasion) was r = 0.84 (p < 0.05). With regard to the testing procedure, repeated measures ANOVArevealed that there was no signifcant diference between the group who exercised at the same work rates at baselineand follow-up (n = 25), and those who required a change in work rate (n = 10).Conclusions: The EB test detected a change in VO2max with reasonably good precision over a time span of 5–8years. Further studies are needed to evaluate if the test can be used in clinical populations and in subjects with difer‑ent medications.

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  • 24. Björvang, Richelle D.
    et al.
    Hallberg, Ida
    Pikki, Anne
    Berglund, Lars
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University.
    Pedrelli, Matteo
    Kiviranta, Hannu
    Rantakokko, Panu
    Ruokojärvi, Päivi
    Lindh, Christian H.
    Olovsson, Matts
    Persson, Sara
    Holte, Jan
    Sjunnesson, Ylva
    Damdimopoulou, Pauliina
    Follicular fluid and blood levels of persistent organic pollutants and reproductive outcomes among women undergoing assisted reproductive technologies2022In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 208, article id 112626Article in journal (Refereed)
    Abstract [en]

    Persistent organic pollutants (POPs) are industrial chemicals resistant to degradation and have been shown to have adverse effects on reproductive health in wildlife and humans. Although regulations have reduced their levels, they are still ubiquitously present and pose a global concern. Here, we studied a cohort of 185 women aged 21-43 years with a median of 2 years of infertility who were seeking assisted reproductive technology (ART) treatment at Carl von Linnékliniken in Uppsala, Sweden. We analyzed the levels of 9 organochlorine pesticides (OCPs), 10 polychlorinated biphenyls (PCBs), 3 polybrominated diphenyl ethers (PBDEs), and 8 perfluoroalkyl substances (PFASs) in the blood and follicular fluid (FF) samples collected during ovum pick-up. Impact of age on chemical transfer from blood to FF was analyzed. Associations of chemicals, both individually and as a mixture, to 10 ART endpoints were investigated using linear, logistic, and weighted quantile sum regression, adjusted for age, body mass index, parity, fatty fish intake and cause of infertility. Out of the 30 chemicals, 20 were detected in more than half of the blood samples and 15 in FF. Chemical transfer from blood to FF increased with age. Chemical groups in blood crossed the blood-follicle barrier at different rates: OCPs > PCBs > PFASs. Hexachlorobenzene, an OCP, was associated with lower anti-Müllerian hormone, clinical pregnancy, and live birth. PCBs and PFASs were associated with higher antral follicle count and ovarian response as measured by ovarian sensitivity index, but also with lower embryo quality. As a mixture, similar findings were seen for the sum of PCBs and PFASs. Our results suggest that age plays a role in the chemical transfer from blood to FF and that exposure to POPs significantly associates with ART outcomes. We strongly encourage further studies to elucidate the underlying mechanisms of reproductive effects of POPs in humans.

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  • 25.
    Blomberg, Oscar
    et al.
    Uppsala University, Uppsala Sweden.
    Svedin, Frida
    Uppsala University, Uppsala Sweden.
    Brantnell, Anders
    Uppsala University, Uppsala Sweden.
    Farrand, Paul
    University of Exeter, Exeter United Kingdom.
    von Essen, Louise
    Uppsala University, Uppsala Sweden.
    Åberg, Anna Cristina
    Dalarna University, School of Health and Welfare, Medical Science.
    Woodford, Joanne
    Uppsala University, Uppsala Sweden.
    Development of a self‐help behavioural activation intervention INVOLVERA for people with dementia: a qualitative study2023In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 19, no S19Article in journal (Refereed)
  • 26. Blomberg, Oscar
    et al.
    Svedin, Frida
    Farrand, Paul
    Brantnell, Anders
    von Essen, Louise
    Karlsson, Johanna Patriksson
    Åberg, Anna Cristina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University.
    Woodford, Joanne
    Adaptation of a guided low-intensity behavioral activation intervention for people with dementia in Sweden: a qualitative study exploring the needs and preferences of key stakeholders2024In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 113Article in journal (Refereed)
    Abstract [en]

    Background

    Despite depression being prevalent in people with dementia, contributing to negative health outcomes and placing increased burden on individuals and family members, access to psychological interventions is limited. A potential solution is guided low-intensity behavioral activation, supported by informal caregivers and guided by healthcare professionals. However, it is necessary to adapt interventions to meet the needs and preferences of key stakeholders to enhance acceptability and relevance. Study objectives were to: (1) explore needs and preferences concerning the content and delivery model of the guided low-intensity behavioral activation intervention; and (2) adapt the intervention to ensure cultural appropriateness, relevancy, and acceptability to people with dementia and their caregivers in Sweden. 

    Methods

    Semi-structured interviews and focus group discussions were conducted with key stakeholders, including healthcare professionals (n = 18), community stakeholders (n = 7), people with dementia (n = 8), and informal caregivers (n = 19). A draft of the written low-intensity behavioral activation intervention and a description of the proposed intervention delivery model were provided to participants. Open-ended questions explored the perceived relevance of the intervention, alongside needs and preferences concerning content and delivery. A manifest content analysis approach was adopted. 

    Results

    Content analysis resulted in three categories: Content, Delivery procedures, and Illness trajectory. Results highlighted a need to consider the intervention Content via increased cultural adaptation to the Swedish context, and increasing the inclusiveness of intervention content. Delivery procedures were identified as needing to be flexible given the unpredictable nature of caring for people with dementia, with the provision of additional guidance to informal caregivers supporting the intervention. Illness trajectory was viewed as essential to consider, with the intervention regarded as suitable for those early in the dementia trajectory, alongside a need to reduce workbook text to minimize burden given dementia symptomology. 

    Conclusions

    The intervention and proposed delivery model were generally well received by all stakeholders. We were able to identify key adaptations to enhance cultural appropriateness, relevancy, and acceptability for a currently neglected population. Results will inform a feasibility study to explore the feasibility and acceptability of the intervention and study procedures to inform the design of a future superiority randomized controlled trial.

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  • 27.
    Bohman, Tony
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Holm, Lena W
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hallqvist, Johan
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skillgate, Eva
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
    Influence of work ability and smoking on the prognosis of long-duration activity-limiting neck/back pain: a cohort study of a Swedish working population2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e054512Article in journal (Refereed)
    Abstract [en]

    Objectives Long-duration activity-limiting neck/back pain is common, but the knowledge of what work and lifestyle factors that influence the prognosis is sparse. The objective was therefore to evaluate if two factors, good self-perceived work ability and no daily smoking, are associated with a favourable prognosis of long-duration activity-limiting neck/back pain in a working population, and if these exposures have a synergistic prognostic effect.

    Design A prospective cohort study based on three subsamples from the Stockholm Public Health Cohort.

    Settings A working population in Stockholm County, Sweden.

    Participants Individuals, 18–61 years old, reporting long-duration activity-limiting neck/back pain the previous 6 months at baseline in 2010 (n=5177).

    Measures The exposures were: self-perceived work ability (categorised into good, moderate and poor) and daily smoking (no/yes). The outcome in 2014 was ‘absence of long-duration activity-limiting neck/back pain’ the previous 6 months representing a favourable prognosis of reported problems at baseline in 2010. Risk ratios (RRs) and risk differences (RDs) with 95% CI was estimated by general linear regressions, and the synergistic effect was estimated by the synergy index (SI) with 95% CI.

    Results Participants with moderate or good work ability, respectively, had an adjusted RR for a favourable prognosis of 1.37 (95% CI 1.11 to 1.69), and 1.80 (1.49 to 2.17) in comparison with participants with poor work ability. The corresponding adjusted RD were 0.07 (0.02 to 0.11) and 0.17 (0.12 to 0.22). Participants not smoking on daily basis had an adjusted RR of 1.21 (1.02 to 1.42), and an adjusted RD of 0.05 (0.01 to 0.10) for a favourable outcome compared with daily smokers. The adjusted SI was 0.92 (0.60 to 1.43).

    Conclusion For participants with long-duration activity-limiting neck/back pain, moderate or good self-perceived work ability and not being a daily smoker were associated with a favourable prognosis but having both exposures seemed to have no synergistic prognostic effect.

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  • 28.
    Borg, Farhana
    et al.
    Dalarna University, School of Teacher Education, Educational Work.
    Gericke, Niklas
    Winberg, Mikael
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    A whole (pre)school approach to sustainability in eco- and non-eco-certified preschools in Sweden: Principals’ views and attitudes2023In: Konferens i pedagogiskt arbete, 2023: Book of abstracts / [ed] David Rapp, Linköping: Linköping University Electronic Press, 2023, p. 22-23Conference paper (Refereed)
    Abstract [en]

    Although a whole school approach (WSA) to sustainability has been described as one of the most meaningful education approaches, the concept of WSA has not yet been widely explored within the context of preschool education, where the play, learning, and care are preconditions for a wholeness in childhood. The concept of the WSA considers raising quality and standard across entire education institution (Henderson & Tilbury, 2004). This approach also emphasizes the needs for (pre)school to engage children, teachers, parents, and the wider community in sustainability (Mogren, Gericke & Scherp, 2019). The principals have important roles to play in reforming and prioritizing preschools activities towards sustainability (Borg & Vinterek, 2020). This paper explores 50 principals’ views and attitudes towards sustainability from a WSA perspective. Using randomized sampling, the principals were selected from 25 eco-certified and 25 non-eco-certified preschools in 25 municipalities in Sweden, out of 290. A questionnaire was utilized to collect demographic information about the preschools, number of children, number of qualified teachers, principals’ attitudes towards preschool’s activities with sustainability, and also an open-ended question about how the principals themselves integrate sustainability in their planning of preschool activities and what they actually do. The qualitative data was analyzed by using Wals and Mathie’s (2022) six component Whole School Approach Flower Model. The components are: 1. Vision, ethos, leadership and coordination; 2. Institutional practices; 3. Pedagogy and learning; 4. Curriculum; 5. Community connections; and 6. Capacity building. The components were adapted and operationalized within a preschool context. The quantitative data was analyzed by principal component analysis (PCA) in the SIMCA statistical software (Umetrics 2020). This study is a part of a project, “Eco-certified preschools and children’s learning for sustainability: Researching holistic outcomes of preschool education for sustainability (HOPES)” (Swedish Research Council, Dnr. 2018-04445). The analyses will be completed by June, 2023. 

    References

    Borg, F., & Vinterek, M. (2020). Principals´ Views on and Descriptions of Preschool Education for Sustainable Development. Journal of Applied Technical and Educational Sciences, 10(2), 18-40. doi:10.24368/jates.v10i2.170

    Henderson, K., & Tilbury, D. (2004). Whole school approaches to sustainability: An international review of sustainable school programs. Report prepared by Macquarie University for the Australian Government Department of the Environment and Heritage. Sydney.

    Mogren, A., Gericke, N., & Scherp, H.-Å. (2019). Whole school approaches to education for sustainable development: a model that links to school improvement. Environmental Education Research, 25(4), 508-531. https://doi:10.1080/13504622.2018.1455074  

    Umetrics. (2020). SIMCA-P+. In (Version 16.0) [Computer software]. Sartorius Stedim Inc. https://www.sartorius.com/en/products/process-analytical-technology/data-analytics-software/mvda-software/simca?gclid=Cj0KCQiAvvKBBhCXARIsACTePW-oD9sm_Ng1dgNBivHH9GFSApdp5wo2G0EDOydryNnzZQ-20Xoj_vIaApIwEALw_wcB  

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  • 29.
    Borg, Farhana
    et al.
    Dalarna University, School of Teacher Education, Educational Work.
    Pramling Samuelsson, Ingrid
    Göteborgs universitet.
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Davis, Julie M.
    Queensland University of Technology.
    Mikael, Winberg
    Umeå University.
    Alexiadou, Nafsika
    Umeå University.
    Gericke, Niklas
    Karlstad University.
    Methodological and Ethical Issues when Interviewing Preschool Children: Experiences from a Study on Sustainability in Sweden2023Conference paper (Refereed)
    Abstract [en]

    To contribute to the methodological and ethical discourse on children’sparticipation in research on complex issues, this case-study critically discusses experiences from a large-scale randomized interview study about preschool education for sustainability in Sweden. Young children’s ability to express their views has been subject to debate, resulting in them often being excluded asresearch participants. Hence, age-appropriate methodological approaches are needed to ensure their participation.

    This study draws from Josefsson and Wall’s(2020) concept of children’s “empowered inclusion” and Lundy’s (2007) model of voice, space, audience, and influence.

    Employing a qualitative case-studyapproach, methodological approaches and ethical considerations and experiences of a randomized study are scrutinized. A total of 403 children from 50 preschools were interviewed about sustainability using illustrations. An interview instrument was developed and pretested in two iterations. Data were analyzed thematically. The Swedish Ethical Review Authority did not raise any objection to the interview study. Consent to participate was collected from parents and children.

    They were informed that the children could withdraw at any time if they wanted. The findings demonstrate that research with young children can be undertaken in an ethically acceptable manner. The use of illustrations was helpful in creating a friendly environment and supporting children’s understanding of complex issues. Individual and pair interviews were effective while group interviews were problematic. Children’s attention dropped after 12-15 minutes. These findings suggest that preschool children can express their views on important matters under ethically acceptable and methodologically appropriate conditions.

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  • 30.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Alam, Moudud
    Dalarna University, School of Information and Engineering, Statistics.
    Boström, Anne-Marie
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm; Stockholms Sjukhem, Stockholm.
    Marmstål Hammar, Lena
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Huddinge; Mälardalen University, Västerås.
    Experiences of Assistive Products and Home Care among Older Clients with and without Dementia in Sweden2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 19, article id 12350Article in journal (Refereed)
    Abstract [en]

    The purpose was to compare selection, use and outcomes of assistive products among older home care clients with and without dementia in Sweden, and to explore the relations between the use of assistive products and perceptions of home care, loneliness and safety. Self-reported data from 89,811 home care clients aged 65 years or more, of whom 8.9% had dementia, were analysed using regression models. Excluding spectacles, 88.2% of them used assistive products. Respondents without dementia were more likely to use at least one assistive product but less likely to use assistive products for remembering. Respondents with dementia participated less in the selection of assistive products, used less assistive products, and benefited less from them. Users of assistive products were more likely to be anxious and bothered by loneliness, to feel unsafe at home with home care, to experience that their opinions and wishes regarding assistance were disregarded by home care personnel, and to be treated worse by home care personnel. The findings raise concerns about whether the needs for assistive products among home care clients with dementia are adequately provided for. They also indicate a need to strengthen a person-centred approach to providing home care to users of assistive products.

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  • 31.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Gustafsson, Christine
    Mälardalen University, Västerås; Eskilstuna Municipality, Eskilstuna.
    Landerdahl Stridsberg, Sara
    Mälardalen University, Västerås.
    Zander, Viktoria
    Mälardalen University, Västerås.
    Implementation of welfare technology: a state-of-the-art review of knowledge gaps and research needs.2023In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 18, no 2, p. 227-239Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers.

    MATERIALS AND METHODS: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles.

    RESULTS: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself.

    CONCLUSIONS: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations. IMPLICATIONS FOR REHABILITATION When planning for the implementation of welfare technology for older people and persons with disabilities, it is important to be aware that necessary evidence and guidance may not always be available in peer-reviewed scientific literature but considerable knowledge gaps and research needs remain. Actors implementing welfare technology are encouraged to include researchers in their projects to study, document and report experiences made, and thereby contribute to building the evidence base and supporting evidence-based implementation.

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  • 32.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Khasnabis, ChapalWorld Health Organization.Zhang, WeiWorld Health Organization.
    Global report on assistive technology2022Collection (editor) (Refereed)
  • 33.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Layton, Natasha
    Ostergren, Per-Olof
    Larsson, Stig
    Do Assistive Products Enhance or Equalize Opportunities?: A Comparison of Capability across Persons with Impairments Using and Not Using Assistive Products and Persons without Impairments in Bangladesh2022In: Societies, E-ISSN 2075-4698, Vol. 12, no 5, article id 141Article in journal (Refereed)
    Abstract [en]

    Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids and persons without impairments (N = 572); and (ii) data from persons with ambulatory impairment not using manual wheelchairs, persons with ambulatory impairment using manual wheelchairs and persons without impairments (N = 598). Kruskal-Wallis tests were used to compare levels of capability across the three groups in each data set. Results showed that, for all functionings in both data sets, the levels of capability were statistically significantly highest for persons without impairments. Compared to persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids scored higher in all functionings, with statistical significance at the .05 level for 12 of them. Persons with ambulatory impairment using manual wheelchairs scored higher than persons with ambulatory impairment not using manual wheelchairs for 11 of the functionings, but none of the comparisons between the two groups were significant at the .05 level. Assistive products-hearing aids more than manual wheelchairs-enhance capabilities but do not fully equalize opportunities between people with and without impairments.

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  • 34.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Winberg, Mikael
    Department of Science and Mathematics Education, Umeå University, 90187 Umeå, Sweden.
    Eide, Arne H
    Department of Health Research, SINTEF Digital, 0373 Oslo, Norway.
    Calvo, Irene
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    Khasnabis, Chapal
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    Zhang, Wei
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    On the Relation between Assistive Technology System Elements and Access to Assistive Products Based on 20 Country Surveys2023In: Healthcare, E-ISSN 2227-9032, Vol. 11, no 9, article id 1313Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to explore the relationship between assistive technology system elements and access to assistive products. Data on assistive technology system elements and self-reported survey data on access to assistive products from 20 countries were analyzed using multivariate statistical methods, including orthogonal partial least squares analyses. Access to assistive products was primarily associated with the geographic coverage of assistive technology services in a country, followed by system elements related to policy and personnel. To achieve universal access to assistive technology, geographic coverage of assistive technology services is an instrumental system element. However, it requires the implementation of appropriate policies along with sufficient funding, recruitment of adequately trained personnel, and availability of assistive products in need.

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  • 35.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Zhang, Wei
    World Health Organization, Geneva, Switzerland.
    Assistive Technology Needs, Use and Experiences among Adults in Sweden Based on a Representative Survey2022In: ICCHP-AAATE 2022 Open Access Compendium: Assistive Technology, Accessibility and (e)Inclusion / [ed] Petz, Andrea; Hoogerwerf, Evert-Jan; Mavrou, Katerina, Linz: Association ICCHP , 2022, p. 101-107Conference paper (Refereed)
    Abstract [en]

    The objective of the study was to estimate the prevalence of needs for and use of assistive products, and experiences of assistive technology among adults under COVID-19 pandemic circumstances in Sweden. Mainly during June 2021, a nationally representative telephone survey was conducted to collect data through an adapted version of the WHO rapid Assistive Technology Assessment (rATA) questionnaire. Including spectacles, the prevalence of needing at least one assistive product was 68.9% and the prevalence of using at least one assistive product was 68.1%. Excluding spectacles, these prevalence rates were 17.1% and 15.8%, respectively. The access rate was 89.7% including spectacles and 83.2% excluding spectacles. The impact of the pandemic on assistive technology provision appeared to be relatively small.

  • 36.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Zhang, Wei
    Smith, Emma M.
    Holloway, Cathy
    Introduction to the companion papers to the global report on assistive technology2021In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 33, no sup1, p. 1-2Article in journal (Refereed)
  • 37.
    Borneskog, Catrin
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Engström, Gabriella
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Islam, Noor
    Dalarna University, Falun.
    Byrskog, Ulrika
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Pedersen, Christina
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    MSc student group,
    Public nursing institute in Bangladesh.
    Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100861Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions.

    METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data.

    RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement.

    CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

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  • 38.
    Broberg, Olof
    et al.
    Skåne University Hospital, Lund; Lund University, Lund.
    Feldreich, Tobias
    Dalarna University, School of Health and Welfare, Medical Science.
    Weismann, Constance G
    Skåne University Hospital, Lund; Lund University, Lund; Ludwig-Maximilian University, Munich, DE, Germany.
    Øra, Ingrid
    Lund University, Lund; Skåne University Hospital, Lund.
    Wiebe, Thomas
    Lund University, Lund; Skåne University Hospital, Lund.
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Liuba, Petru
    Skåne University Hospital, Lund; Lund University, Lund.
    Circulating leptin is associated with adverse vascular changes in young adult survivors of childhood cancer2024In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Proteomics may help discover novel biomarkers and underlying mechanisms for cardiovascular disease. This could be useful for childhood cancer survivors as they show an increased risk of cardiovascular disease. The aim of this study was to investigate circulating cardiovascular proteins in young adult survivors of childhood cancer and their relationship to previously reported subclinical cardiovascular disease.

    METHODS: Ninety-two cardiovascular proteins were measured in 57 childhood cancer survivors and in 52 controls. For proteins that were significantly different between childhood cancer survivors and controls, we performed correlations between protein levels and measures of peripheral arterial stiffness (carotid distensibility and stiffness index, and augmentation index) and endothelial dysfunction (reactive hyperemia index).

    RESULTS: Leptin was significantly higher in childhood cancer survivors compared to controls (normalized protein expression units: childhood cancer survivors 6.4 (1.5) versus 5.1 (1.7), p < 0.0000001) after taking multiple tests into account. Kidney injury molecule-1, MER proto-oncogene tyrosine kinase, selectin P ligand, decorin, alpha-1-microglobulin/bikunin precursor protein, and pentraxin 3 showed a trend towards group differences (p < 0.05). Among childhood cancer survivors, leptin was associated with anthracycline treatment after adjustment for age, sex, and body mass index (p < 0.0001). Higher leptin correlated with lower carotid distensibility after adjustment for age, sex, body mass index, and treatments with radiotherapy and anthracyclines (p = 0.005).

    CONCLUSION: This proteomics approach identified that leptin is higher in young asymptomatic adult survivors of childhood cancer than in healthy controls and is associated with adverse vascular changes. This could indicate a role for leptin in driving the cardiovascular disease burden in this population.

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  • 39. Bruvoll, Mona
    et al.
    Torstensen, Tom Arild
    Conradsson, David Moulaee
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet; Center for Clinical Research Dalarna, Uppsala University, Falun.
    Østerås, Håvard
    Feasibility of high dose medical exercise therapy in patients with long-term symptomatic knee osteoarthritis.2022In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, no 11, p. 1615-1623Article in journal (Refereed)
    Abstract [en]

    Purpose: High repetition high dose medical exercise therapy (MET) is a promising treatment for patients with musculoskeletal pain. However, little is known regarding the feasibility of MET in patients with symptomatic knee osteoarthritis (OA). The aim of this study was to investigate the feasibility of MET in patients with symptomatic knee pain with radiographic verified OA. Methods: Patients with symptomatic knee osteoarthritis were recruited to a group-based high repetitive high dose MET intervention for 12 weeks in a primary health care setting. Indicators of feasibility included processes (recruitment, program adherence, and exercise compliance), and scientific feasibility (safety and pain evaluated by using the Visual Analogue Scale (VAS)). Results: Out of 31 individuals with symptomatic knee OA, 29 (93%) were included in this study. A total of 26 patients (90%) completed the intervention and 83% reached an attendance rate of ≥30 treatments. No adverse events were reported, and a majority of the patients reported a pain intensity <30 mm (VAS) throughout the intervention period. The results showed a 70% reduction of median pain intensity between baseline (33 mm, IQR: 39), and post-assessment (10 mm, IQR: 25, P = .003). Conclusion: These findings support an overall positive feasibility of MET for patients with symptomatic knee OA. The results also demonstrated that achieving a high dose of exercises might be challenging for this population. Thus, individual variations in exercise dose may be a confounding factor when evaluating high dose MET in future clinical studies.

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  • 40.
    Corsonello, Andrea
    et al.
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
    Soraci, Luca
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Stockholm.
    Carlsson, Axel C.
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden.
    Roller-Wirnsberger, Regina
    Department of Internal Medicine, Medical University of Graz, Austria.
    Wirnsberger, Gerhard
    Department of Internal Medicine, Medical University of Graz, Austria.
    Mattace-Raso, Francesco
    Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
    Tap, Lisanne
    Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
    Rudholm Feldreich, Tobias
    Dalarna University, School of Health and Welfare, Medical Science.
    Lattanzio, Fabrizia
    Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
    The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: A secondary analysis of a multicentre cohort study2022In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 51, no 7, article id afac168Article in journal (Refereed)
    Abstract [en]

    Background: age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods: our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results: overall, mortality was found to increase starting from eGFR = 30-44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81-5.95) to ACR = 30-300 mg/g (HR = 1.96, 95%CI = 1.23-3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45-59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78-0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71-0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions: physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild-moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function. © 2022 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

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  • 41. Dahle, Nina
    et al.
    Skau, Emma
    Leppert, Jerzy
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge, Sweden.
    Hedberg, Pär
    Poorly controlled ambulatory blood pressure in outpatients with peripheral arterial disease.2021In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 126Article in journal (Refereed)
    Abstract [en]

    Background: Patients with peripheral arterial disease (PAD) are generally less intensively managed than patients with coronary heart disease (CHD), despite that their risk of complications is believed to be equivalent. Identification of PAD patients at risk of poorly controlled blood pressure (BP) could lead to improved treatment, thus lowering the risk of cardiovascular (CV) complications. We aimed to describe the prevalence of poorly controlled cardiovascular (CV) risk factors, focusing on BP, in outpatients with PAD diagnosed in a vascular ultrasound laboratory.

    Methods: Consecutive outpatients with carotid and/or lower extremity PAD were included (n = 402) and examined with blood sampling, clinical BP, and 24-h ambulatory BP measurements. A poorly controlled clinical BP was defined as ≥140/90 mmHg, ambulatory BP ≥130/80 mmHg, low-density lipoprotein (LDL)-cholesterol level ≥2.5 mmol/L, and glycated hemoglobin (HbA1c) level >53 mmol/mol in those with diabetes.

    Results: Most of the patients had poorly controlled clinical (76.6%) and ambulatory BP (51.7%) profiles. Antihypertensive medications were prescribed in 84% of the patients. However, >40% of them used only 0-1 medication, and <25% of them used three or more agents. Clinical BP, a low number of medications, body mass index, and the presence of diabetes independently predicted a poorly controlled ambulatory BP. Nearly one-third of the patients were smokers, and most of the cohort had an LDL-cholesterol level of ≥2.5 mmol/L. An HbA1c level of >53 mmol/mol was present in 55% of diabetic patients.

    Conclusion: Poorly controlled clinical and ambulatory systolic BP profiles were common. In addition, suboptimal control of other important CV risk factors was detected. The findings of this study highlight the need for better preventive efforts against CV risk factors in outpatients with PAD.

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  • 42.
    Dahle, Nina
    et al.
    Center for Clinical Research Dalarna, Uppsala University, Falun; Primary Health Care Center Britsarvet-Grycksbo, County of Dalarna, Falun.
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Leppert, Jerzy
    Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås.
    Hedberg, Pär
    Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås; Västmanland County Hospital, Västerås.
    Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease2023In: Vascular Medicine, ISSN 1358-863X, E-ISSN 1477-0377, Vol. 28, no 4, p. 274-281Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with peripheral vascular disease (PVD) are often underdiagnosed and undertreated. Nocturnal nondipping blood pressure (BP) pattern, as diagnosed by ambulatory BP monitoring (ABPM), is associated with increased cardiovascular risk, but has not been studied in patients with PVD. We aimed to investigate if a nondipping BP pattern predicts cardiovascular events or all-cause death in outpatients with PVD.

    METHODS: Consecutive outpatients with carotid or lower-extremity PVD were examined with 24-hour ABPM (n = 396). Nondipping was defined as a < 10% fall in systolic BP level during night-time. We used Cox regression models adjusting for potential confounders. We also evaluated the incremental prognostic value of dipping status in the COPART risk score. Our primary composite outcome was cardiovascular events or all-cause death.

    RESULTS: In the cohort (mean age 70; 40% women), 137 events occurred during a 5.1-year median follow-up; incident rate of 7.35 events per 100 person-years. Nondipping was significantly associated with outcome (hazard ratio 1.55, 95% CI 1.07-2.26, p = 0.021) in a fully adjusted model. When adding nondipping to the risk markers in the COPART risk score, the model fit significantly improved (χ2 7.91, p < 0.005) and the C-statistic increased from 0.65 to 0.67.

    CONCLUSION: In a cohort of outpatients with PVD, nondipping was an independent risk factor for future cardiovascular events or mortality and seemed to be a strong predictor in patients with carotid artery disease but not in lower-extremity PVD. Additional studies are needed to evaluate the clinical utility of ABPM for improved prevention in these high-risk patients. (ClinicalTrials.gov Identifier: NCT01452165).

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  • 43.
    de Alwis, Manudul Pahansen
    et al.
    KTH Royal Inst Technol, Sch Engn Sci, Dept Engn Mech, Stockholm, Sweden..
    Lo Martire, Riccardo
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institute, Huddinge; Uppsala University, Center for Clinical Research Dalarna, Falun.
    Garme, Karl
    KTH Royal Inst Technol, Sch Engn Sci, Dept Engn Mech, Stockholm, Sweden..
    Exposure aboard high-performance Marine craft increases musculoskeletal pain and lowers contemporary work capacity of the occupants2021In: Journal of Engineering for the Maritime Environment (Part M), ISSN 1475-0902, E-ISSN 2041-3084, Vol. 235, no 3, p. 750-762, article id 1475090220981466Article in journal (Refereed)
    Abstract [en]

    High-Performance Marine Craft (HPMC) occupants are currently being investigated for various psychophysical impairments degrading work performance postulating that these deteriorations are related to their occupational exposures. However, scientific evidence for this is lacking and the association of exposure conditions aboard HPMC with adverse health and performance effects is unknown. Therefore, the study estimates the prevalence of musculoskeletal pain (MSP) among HPMC occupants and the association of their work exposure with MSP and performance degradation. It also presents a criterion for evaluating the self-reported exposure severity aboard three different types of mono-hull HPMC; displacement, semi-displacement and planing, on a par with the available standard criteria for objectively measurable exposures. Furthermore, another criterion is proposed to assess the performance-degradation of HPMC occupants based on self-reported fatigue symptoms and MSP. Swedish Coast Guard HPMC occupants were surveyed for MSP, fatigue symptoms as well as for work-related and individual risk indicators using a validated web-based questionnaire. Prevalence of MSP and performance-degradation during the past 12 months were assessed and presented as a percentage of the sample. Associations of exposure conditions aboard HPMC with MSP and performance-capacity were systematically evaluated using multiple logistic regression models and expressed as odds ratio (OR). Prevalence of MSP was 72% among which lower back pain was the most prevalent (46%) followed by neck pain (29%) and shoulder pain (23%) while 29% with degraded performance. Exposure to severe conditions aboard semi-displacement craft was associated with lower back (OR = 2.3) and shoulder (OR = 2.6) pain while severe conditions aboard planing craft with neck pain (OR = 2.3) and performance-degradation (OR = 2.6). MSP is common among Swedish coast guards. Severe exposure conditions aboard HPMC are significantly associated with both MSP and performance-degradation. The spine and shoulders are the most susceptible to work-related MSP among HPMC occupants which should be targeted in work-related preventive and corrective measures.

  • 44.
    Dekkers, Koen F
    et al.
    Uppsala University, Uppsala.
    Sayols-Baixeras, Sergi
    Uppsala University, Uppsala; Instituto de Salud Carlos III, Madrid, Spain.
    Baldanzi, Gabriel
    Uppsala University, Uppsala.
    Nowak, Christoph
    Karolinska Institute, Huddinge.
    Hammar, Ulf
    Uppsala University, Uppsala.
    Nguyen, Diem
    Uppsala University, Uppsala.
    Varotsis, Georgios
    Uppsala University, Uppsala.
    Brunkwall, Louise
    Lund University, Malmö.
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Fall, Tove
    Uppsala University, Uppsala, Sweden.
    An online atlas of human plasma metabolite signatures of gut microbiome composition2022In: Nature Communications, E-ISSN 2041-1723, Vol. 13, no 1, article id 5370Article in journal (Refereed)
    Abstract [en]

    Human gut microbiota produce a variety of molecules, some of which enter the bloodstream and impact health. Conversely, dietary or pharmacological compounds may affect the microbiota before entering the circulation. Characterization of these interactions is an important step towards understanding the effects of the gut microbiota on health. In this cross-sectional study, we used deep metagenomic sequencing and ultra-high-performance liquid chromatography linked to mass spectrometry for a detailed characterization of the gut microbiota and plasma metabolome, respectively, of 8583 participants invited at age 50 to 64 from the population-based Swedish CArdioPulmonary bioImage Study. Here, we find that the gut microbiota explain up to 58% of the variance of individual plasma metabolites and we present 997 associations between alpha diversity and plasma metabolites and 546,819 associations between specific gut metagenomic species and plasma metabolites in an online atlas ( https://gutsyatlas.serve.scilifelab.se/ ). We exemplify the potential of this resource by presenting novel associations between dietary factors and oral medication with the gut microbiome, and microbial species strongly associated with the uremic toxin p-cresol sulfate. This resource can be used as the basis for targeted studies of perturbation of specific metabolites and for identification of candidate plasma biomarkers of gut microbiota composition.

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  • 45. Dekkers, Koen F
    et al.
    Sayols-Baixeras, Sergi
    Baldanzi, Gabriel
    Nowak, Christoph
    Hammar, Ulf
    Nguyen, Diem
    Varotsis, Georgios
    Brunkwall, Louise
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Fall, Tove
    Author Correction: An online atlas of human plasma metabolite signatures of gut microbiome composition2023In: Nature Communications, E-ISSN 2041-1723, Vol. 14, no 1, article id 2971Article in journal (Refereed)
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  • 46. Eide, A. H.
    et al.
    Muller, S.
    Zhang, W.
    Khasnabis, C.
    Antypas, K.
    Blakstad, M.
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Barriers for Accessing Assistive Products in Low- and Middle-Income Countries (LMICs)2023In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 306, p. 297-302Article in journal (Refereed)
    Abstract [en]

    WHO implemented the Rapid Assistive Technology Assessment in 2021. This is a household survey on self-reported use, need and barriers for accessing AT in 35 countries globally. In order to obtain comparable data, all surveys followed guidelines developed by WHO, including national two-stage random sampling of households. The 2021 rATA survey included 32 of a total of 140 LMICs globally. Around 40 % of the total respondents (all countries) estimated travel distance to be <5 km, varying from less than 10 % to almost 60 % among the countries. Around 15 % had to travel more than 50 km, varying from 1.3 % to 37.5 %. More individuals living in rural as compared to urban areas had to travel more than 25 km to get their main assistive product. Gender differences were marginal. By far the most prevalent barrier to access assistive products was "Cannot afford", amounting to 39.9% and varying from 6.7 % to 79.1 % among countries. This was followed by "No support" with 14.3 %, varying from 2.3 % to 36.9 %, and "Not available" with 8.1 %, varying from 1 % to 21.5 %. More barriers were reported in rural than urban areas and women report more barriers than men. Variation between countries in both travel time and barriers is substantial and country-specific service development is needed to guide service development.

  • 47. Eide, Arne
    et al.
    Müller, Sebastien
    Khasnabis, Chapal
    Borg, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Blakstad, M
    Mannan, H
    Antypas, K
    Loeb, M
    Zhang, Wei
    Assistive technology for older persons – analyses of data from WHO's rapid assistive technology assessment2022In: Gerontechnology, ISSN 1569-1101, E-ISSN 1569-111X, Vol. 21Article in journal (Refereed)
  • 48. Eklund, Caroline
    et al.
    Elfström, Magnus L
    von Heideken Wågert, Petra
    Söderlund, Anne
    Gustavsson, Catharina
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Cederbom, Sara
    Thunborg, Charlotta
    Lööf, Helena
    The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement: An Empirical Phenomenological Study.2021In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, no 8, article id pzab117Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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  • 49.
    Elf, Marie
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Klockar, Erika
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Medical Science.
    Kylén, Maya
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Health Sciences, Lund University, Lund.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Theme Neuro Karolinska University Hospital, Stockholm.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Finch, Tracy
    Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
    Gustavsson, Catharina
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, United Kingdom.
    Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study2022In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, no 5, article id e37672Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.

    OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.

    METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.

    RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.

    CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.

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  • 50.
    Emami, Azita
    et al.
    The University of Washington, School of Nursing, Seattle, WA, USA; Karolinska Institutet, Stockholm.
    Theorell, Töres
    Karolinska Institutet, Stockholm; Stockholm University, Stockholm.
    Kim, Hyejin
    Rush University College of Nursing, Chicago, IL, USA.
    Berglund, Lars
    Dalarna University, School of Health and Welfare, Medical Science.
    Hallinder, Helena
    Karolinska Institutet, Stockholm.
    Engström, Gabriella
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Assessing stress using repeated saliva concentration of steroid hormones in dementia care dyads: results from a controlled pilot care music intervention2023In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 128, article id e9340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection.

    OBJECTIVE: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention.

    METHODS: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value.

    RESULTS: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133).

    CONCLUSION: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.

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