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  • 301. Bohman, Tony
    et al.
    Tegern, Matthias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Halvarsson, Alexandra
    Broman, Lisbet
    Larsson, Helena
    Reliability and agreement of the IsoKai isokinetic lift test - A test used for admission to the Swedish Armed Forces2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209419Article in journal (Refereed)
    Abstract [en]

    This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift test as it is currently administered in admission to the Swedish Armed Forces. The study included an intrarater (n = 534) and interrater reliability sample (n = 137), of Swedish male conscripts who performed the test on two test occasions about two hours apart. Two-to-four lifts were performed at each occasion, and the highest mean (IsoKai(MF)) and peak force (IsoKai(PF)) produced (N) were used for evaluation. All intraclass coefficients showed excellent reliability. The interrater analyses resulted in intraclass coefficients of 0.942 (95% CI; 0.920-0.959) and 0.858 (95% CI; 0.806-0.896) for the IsoKai(MF) and IsoKai(PF), respectively, while the corresponding coefficients for the intrarater analyses were 0.935 (95% CI; 0.923-0.946) and 0.865 (95% CI; 0.842-0.886). Agreement, the capability of a test to detect changes, was assessed by the standard error of measurement (SEM/SEM%) and the smallest real difference (SRD/SRD%). These estimate indicated that it is possible to achieve measurements relevant to use in real practice with the IsoKai isokinetic lift test. Bland and Altman analyses revealed no systematic errors in either sample. Based on these findings, the IsoKai isokinetic lift test is suggested to be a highly reliable test for maximal dynamic muscular strength. The test could be of use in selection procedures in order to accurately evaluate maximal dynamic muscular strength, and for evaluating longitudinal changes in strength.

  • 302.
    Bolin, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    En motorisk 5 års-uppföljning av underburna barn på Sundsvalls Sjukhus2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning:  Syfte: Att beskriva perinatala bakgrundsfaktorers betydelse avseende motorisk utveckling vid fem års ålder hos barn födda före vecka 32+0 GA, vårdade vid länsverksamheten Barn och Ungdom, Sundsvalls sjukhus mellan åren 2006-2009. Ett annat syfte var att se vilken motorisk förmåga denna grupp underburna barn hade vid fem års ålder jämfört med normalpopulationen.

    Metod: En retrospektiv longitudinell journalstudie där journaldata för 43 barn födda före vecka 32+0 GA vid Sundsvall sjukhus, avseende bakgrundsfaktorer som födelsevikt, födelselängd, huvudomfång samt om barnen initialt vårdats i respirator jämfördes med resultat från ett motoriskt test vid fem års ålder (Movement ABC) Resultatet vid den motoriska uppföljningen vid fem års ålder analyserades även mot normativa data från Movement ABC.

    Resultat: Gruppen barn (n=43) födda före vecka 32+0 GA visade signifikant större motoriska funktionsnedsättningar än normalpopulationen p<0,0001. Av dessa hamnade 23,3 % i kategorin avvikande motorisk förmåga (under percentil 5). Ingen skillnad noterades mellan de mycket underburna och de extremt underburna barnen (<vecka 28+0 GA). Födelselängd, födelsevikt samt hur många dygn barnen legat i respirator initialt inverkade inte på det motoriska resultatet vid femårsuppföljningen. Barn med större huvudomfång (≥+1SD) vid födseln uppvisade större motoriska svårigheter vid uppföljningen (p=0,035). En tendens sågs även mot att flickor klarade sig bättre än pojkarna motoriskt men skillnaden var inte signifikant (p=0,06).

    Slutsats: Gruppen mycket och extremt underburna får oftare än fullgångna barn motoriska svårigheter. Därför är det viktigt att denna grupp följs upp så att barn som behöver extra stöd snabbt kan få detta. Stor försiktighet bör iakttas vid tolkning av perinatala bakgrundsfaktorers påverkan då studiepopulationen var mycket liten.

  • 303.
    Boman, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Häggblom, Anette
    Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength: associated with reduced prevalence of depression among older women2015In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 19, no 12, p. 1078-1083Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression.

    Methods: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression.

    Results: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit.

    Conclusion: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.

  • 304. Boman, Helena
    et al.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    Små barn lever farligt i traktorers närhet. Håll barn borta från traktorer; gör traktorer säkrare!1999In: Läkartidningen, ISSN 0023-7205, Vol. 96, no 18, p. 2222-4Article in journal (Other academic)
    Abstract [sv]

    Under åren 1992-1997 inträffade i Sverige 14 traktorrelaterade dödsfall bland barn. Elva var pojkar och medelåldern 5 år. I nära hälften av fallen var barnets far förare av traktorn. För att förebygga dessa händelser bör barn inte tillåtas vara i närheten av traktorer i arbete eller färdas som passagerare. Med hänsyn till hur svåråtkomlig "den mänsliga faktorn" är, torde också utvecklande av skadeförebyggande åtgärder i traktorn vara av betydelse.

  • 305.
    Boman, Helena
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Hedelin, Annika
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    "Avoidable" deaths in two areas of sweden - Analysis of deaths in hospital after injury1999In: The European journal of surgery = Acta chirurgica, ISSN 1102-4151, Vol. 165, no 9, p. 828-33Article in journal (Other academic)
    Abstract [en]

    OBJECTIVE: To describe causes of death and other characteristics of "avoidable" deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. DESIGN: Retrospective analysis of medico legal autopsy material. SETTING: One northern and one western area in Sweden 1988-1996. SUBJECTS: 335 cases who died in hospital after trauma. MAIN OUTCOME MEASURES: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) head of 4 or less and cause of death. RESULTS: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. CONCLUSION: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.

  • 306.
    Boman, Niklas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Building muscle: a translation of training adaptation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Training is preparation for what is expected to come through utilization of the plastic and resistive features of nature, known as adaptation. As such, training in humans may have a number of desired goals. These are typically related to sports performance or education. Whatever the goal, a plan needs to be made for reaching it. One needs to identify or select which activities and environments constitute the event or events to which adaptation is sought. Adaptations occurs by imposing something similar to said environment and practicing the selected activities in preparation for the events that can ultimately lead to goal fulfillment.

    One quite common goal of physical training is to achieve a more lean and muscular physique, be it for reasons of performance or esthetics. A leaner and more muscular physique can have many advantages for health and quality of life. If we are to prepare the body’s physical capabilities and properties, they should be utilized in the preparation. By proper design and execution of a program for physical preparation, we set out on the path to achieve the goal.

    A factor that is often highlighted as an important key to building muscle in the human body is the steroid hormone testosterone. According to the hormone hypothesis, increases in muscle mass are achieved through transient elevations in anabolic hormones, such as testosterone and IGF1, induced by physical training. To achieve hypertrophy of the muscles through physical training, one must ensure sure that the muscles get the correct signal, the growth signal, as a result of the training.

    The work presented in this thesis is, in part, an examination of the hormone hypothesis, with both empirical and theoretical elements. The empirical foundations are results of an experiment in which a group of young men were subjected to a program of physical training, designed for all intents and purposes in accordance with contemporary knowledge, to result in muscular hypertrophy in the subjects. The goal was achieved, with an average 4.6% increase in lean body mass in the subjects after the training program. However, there was no evidence that anabolic hormones were elevated at any time during the measurement period.

    The major part of this thesis details a model for explaining the collected observations. It is not intended to merely provide a guide for achieving a leaner more muscular physique but rather is aimed at formulating the problem of inducing the desired adaptations and difficulties involved in approaching the problem. For reasons discussed in this thesis, I do not claim that this is the full and final word on the matter. However, it goes some way toward explaining why, and perhaps how, desired goals should be formulated so that the muscles may understand them.

  • 307.
    Boman, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Burén, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Antti, Henrik
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Svensson, Michael B.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Gene expression and fiber type variations in repeated vastus lateralis biopsies2015In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 52, no 2, p. 812-817Article in journal (Refereed)
    Abstract [en]

    Introduction: Muscle sample collection can introduce variation in any measured variable due to inter- and intramuscle variation. We investigated the variation in gene expression and fiber type composition after repeated biopsy sampling from the vastus lateralis muscle. Methods: Six subjects donated 3 tissue samples each. One hour after baseline sampling from 1 vastus lateralis muscle, samples from both vastus lateralis muscles were obtained. Results: The fiber type composition differed between biopsies taken from the same leg. There were no within-subject differences in gene expression between the 3 biopsies. Multivariate analysis supports a model in which gene expression differs significantly between individuals but is not affected by repeated muscle biopsy sampling from the same subject. Conclusion: One vastus lateralis muscle sample per subject is sufficient to establish a reliable baseline for comparing gene expression representing selected pathways over time within the same individual.

  • 308.
    Boman, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Idrottsmedicin.
    Burén, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Åkerfeldt, T
    Svensson, Michael B.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Idrottsmedicin.
    Effects of protein ingestion on the hormonal response to resistance exercise and increases in lean body mass after eight weeks of trainingManuscript (preprint) (Other academic)
  • 309.
    Borg, Tina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Smärtvariabilitet hos tandläkarstudenter med nackbesvär.: En longitudinell studie.2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet var att beskriva smärtfrekvens och smärtvariabilitet med avseende på nacksmärta hos en grupp tandläkarstudenter under klinisk utbildning. Ytterligare ett syfte var att redogöra för faktorer som predicerar smärtvariabilitet.

     

    Metod: Designen var en longitudinell kohortstudie. Sjutton tandläkarstudenter med nackbesvär fick besvara frågor om smärta, symptom, funktion, stress, fysisk aktivitet, hälsorelaterad livskvalitet och medicinering samt genomgå en funktionsundersökning. Därefter skattades smärtintensiteten under 4 veckor med numerical rating scale (NRS). Variabiliteten beräknades genom den intraindividuella standardavvikelsen av samtliga smärtskattningar. Multipel linjär regression användes för att undersöka predicerande faktorer.

     

    Resultat: Samtliga upplevde återkommande besvär, 53 % angav besvär ibland/då och då, 24 % flera gånger i veckan och 24 % dagligen. Medelvärdet för smärtvariabiliteten var 1,2 (variationsvidd 0-3). Att ha besvär utan diagnos predicerade ökad variabilitet (2,2 skalsteg på NRS). En diagnos på cervikalgi eller trapeziusmyalgi predicerade en minskning av variabiliteten (1,8 resp. 1,2 skalsteg på NRS).

     

    Slutsats: Tandläkarstudenter med nackbesvär upplever återkommande nackbesvär. Smärtan uppvisar variabilitet i intensitet för de allra flesta och variabiliteten motsvarar en klinisk relevant skillnad för över två tredjedelar. Att inte ha en funktionsdiagnos predicerar hög variabilitet och att ha en diagnos på trapeziusmyalgi eller cervikalgi predicerar låg variabilitet. Urvalet var litet så resultatet bör tolkas med försiktighet.

     

  • 310.
    Boström, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Rundqvist, Robert
    Virtual Reality - En Meningsfull Fritidsaktivitet För Äldre?2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abstrakt

    Fritid är en viktig del i varje individs vardag. Pensionärer (vanligast individer över 65) får mer tid över till fritid, trots detta minskar aktivitetsnivån eftersom deras fysiska och mentala tillstånd sakta försämras. Fritidsaktiviteter är väsentligt för att en person ska utveckla och behålla sin hälsa. Deltagande med Virtual Reality-konsoler kan ha positiva effekter för äldres välmående. En meningsfull aktivitet definieras i litteratur som en aktivitet som uppfyller ett mål eller syfte som är personligt eller kulturellt viktigt. Syftet med studien var att beskriva äldres upplevelse av deltagandet samt deras reflektioner i användandet av Virtual Reality som en potentiell meningsfull fritidsaktivitet samt observera utförandet. Studien genomfördes med en kvalitativ ansats. En undersökningsgrupp på fem individer alla över 65 år, observerades när de använde sig av en VR-konsol samt blev intervjuade efter utförd aktivitet. Intervjuformen var semistrukturerad. Undersökningsgruppen upplevde användandet av VR som roligt och positivt, men majoriteten upplevde det inte som en meningsfull aktivitet när de upplevde att de inte fick ut någonting av aktiviteten. Samtliga deltagare hade olika syn på vad en meningsfull aktivitet är för något. En orsak till att deltagarna inte tyckte det var meningsfullt kan vara att de inte fick välja vilken VR aktivitet de skulle göra. Efter att ha granskat resultatet har studiens syfte uppnåtts.

    Sökord: Arbetsterapi, Nintendo Wii, Deltagande

  • 311.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Depression in older people with and without dementia: non-pharmacological interventions and associations between psychotropic drugs and mortality2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to investigate associations between psychotropic drug use and death, associations between functional capacity, dependency in ADL and depression, and to evaluate a non-pharmacological intervention to reduce depressive symptoms, among older people with and without dementia.

    There is limited knowledge about the risk of death associated with psychotropic drug use among those aged ≥85 years, those with dementia, or those living in residential care facilities; groups that have a higher intake of psychotropic drugs and who are also more prone to adverse drug reactions. In a representative sample of people ≥85 years (n = 992), baseline antidepressant use was not associated with an increased 5-year mortality risk when adjusting for confounding factors. A significant interaction between gender and antidepressant use was found, with a higher mortality risk in women, than in men.  When analyzing men and women separately, no significant associations were found. In a sample of older people (i.e. ≥65 years) with dementia (n = 1037), there was a significant gender difference in 2-year mortality associated with the baseline use of antidepressant drugs, with a lower mortality risk in men, than in women. In men, the mortality risk was significantly reduced with antidepressant use, while there was no significant association in women. The association between baseline use of benzodiazepines and mortality had a tendency toward an increased risk during the first year of follow-up, although this became non-significant after adjustments. In this time period, the interaction term for sex was significant, with a higher mortality risk among men than women. When the sexes were analyzed separately, no significant associations were found. No significant associations were found between baseline use of antipsychotic drugs and mortality.

    Drug treatment for depression seems to have a limited effect in older people and may have no effect in people with dementia. In order to find alternative ways of treating or preventing depression in older age, it is important to increase our knowledge about factors associated with this condition. Functional capacity and dependency in activities of daily living (ADL) are associated with depression in community-dwelling older people. However, it is uncertain whether the same associations are to be found in very old people (i.e. ≥80 years), including those with severe cognitive or physical impairments. In a heterogeneous sample (n = 392) with a high mean age, a large range of cognitive and functional capacity, a wide spectrum of dependency in ADL, and a high prevalence of comorbidities, depressive symptoms were significantly associated with functional balance capacity, but not with overall dependency in ADL. Among individual ADL tasks, dependency in transfer and dressing were associated with depressive symptoms.

    Physical exercise has shown effect sizes similar to those of antidepressants in reducing depressive symptoms among older people without dementia, with moderate–high-intensity exercise being more effective than low-intensity exercise. However, these effects are unclear among older people with dementia. Care-facility residents with dementia (n = 186) were cluster-randomized to a high-intensity functional exercise program or a non-exercise control activity conducted for 45 minutes every other weekday for 4 months. No significant difference between the exercise and control activity was found in depressive symptoms at 4 or 7 months. Among participants with high levels of depressive symptoms, reductions were observed in both the exercise and control groups at 4 and 7 months.

    In conclusion, ongoing treatment at baseline with any of the three psychotropic drug classes antidepressants, antipsychotics and benzodiazepines did not increase the risk of mortality in older people with dementia.  Neither did antidepressant drugs in very old people. In both samples, gender differences were found in the mortality risk due to antidepressant use. In those with dementia, the mortality risk due to benzodiazepine use also differed by gender. The potential risk from initial treatment and gender differences regarding mortality risk require further investigation in randomized controlled trials or in large cohort studies properly controlled for confounding factors. In older people, living in community and residential care facilities, functional capacity seems to be independently associated with depressive symptoms whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus for future interdisciplinary multifactorial intervention studies. Among older people with dementia living in residential care facilities, a 4-month high-intensity functional exercise program has no superior effect on depressive symptoms than a control activity. Both exercise and non-exercise group activities may reduce high levels of depressive symptoms. However, this finding must be confirmed in three-armed randomized controlled trials including control groups receiving standard care.

  • 312.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial2016In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 8, p. 868-878Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.

    METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.

    RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).

    CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

  • 313.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people2014In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 9, p. 249-257Article in journal (Refereed)
    Abstract [en]

    Background: This study examined associations between depressive symptoms and functional capacity, overall dependency in personal activities of daily living (ADLs), and dependency in individual ADL tasks, respectively, in people with a high mean age, large range of functional capacity, and wide spectrum of dependency in ADLs. Methods: Cross-sectional data from three studies were used. A total of 392 individuals living in community and residential care facilities were included. Mean age was 86.2 years, 72% were women, 75% were dependent in ADLs, 42% had depression, and 39% had dementia. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), functional capacity with the Berg Balance Scale (BBS), and ADLs with the Barthel ADL Index. Multiple linear regression analyses with comprehensive adjustments were performed between GDS-15 and BBS, GDS-15 and Barthel ADL Index, and GDS-15 and each individual ADL task, separately. Results: GDS-15 score was associated with BBS score (unstandardized b=-0.03, P=0.008), but not with Barthel ADL Index score (unstandardized b=-0.07, P=0.068). No significant interaction effects of sex, dementia, or living conditions were found in these associations. Among individual ADL tasks, dependency in transfer (unstandardized b=-1.03, P=0.007) and dressing (unstandardized b=-0.70, P=0.035) were associated with depressive symptoms. Conclusion: Functional capacity seems to be independently associated with depressive symptoms in older people living in community and residential care facilities, whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus of future interdisciplinary multifactorial intervention studies.

  • 314.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Brännström, Jon
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Antidepressant use and mortality in very old people2016In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 28, no 7, p. 1201-1210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.

    METHODS: Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.

    RESULTS: Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively.

    CONCLUSION: Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

  • 315.
    Boström, Linette
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hästar som arbetstera peutisk i ntervention: Arbetstera peuters syn på hästunderstödd terapi2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Djur används allt mer i terapeutiskt  syfte för att förbättra eller bibehålla olika funktioner och kan fungera som ett verktyg i re­ habilitering . Syftet var att belysa hur hästar kan användas som medel  vid arbetsterapeutisk  intervention  samt att beskriva  ar­ betsterapeuters syn på hästens terapeutiska kvaliteter. En kvali­ tativ metod  användes för studien och datainsaml ingen skedde med  intervjuer.  Materialet  analyserades  och  kategoriserades med  hjälp  av  innehållsanalys.  Resultatet  visar  att  hästunder­ stödd terapi inom arbetsterapi  är användbart  för en bred mål­ grupp.  Interventionerna  är  målinriktade  och  utvärdering  förs kontinuerligt.  Hästen  bidrar  med  en  mängd  positiva  effekter och graderi ng och anpassning av aktiviteten, miljön och tera­ peuten är möjlig på många plan. Slutsatserna av studien är att arbetsterapeuter med intresse och kunskap inom hästar kan an­ vända hästunderstödd terapi som arbetsterapeutisk intervention

  • 316.
    Braaf, Lisa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bildarbete i utveckling av personalgrupper och organisationer: - en litteraturstudie2007Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna litteraturstudie var att undersöka bildarbete som metod i utveckling av organisationer och personalgrupper i arbetslivet. Elva artiklar erhölls via databas- och Internetsökning. En granskning och sammanfattande analys gjordes utifrån typ av organisation, motiv för bildarbetet, metod, samt resultat och slutsatser. Resultatet visar att bildarbete i personalgrupper och organisationer har gett ökad självkännedomen hos enskilda medarbetare och arbetsgrupper, förbättrad kommunikation och samarbetsförmåga, ökad kreativitet och problemlösningsförmåga, förbättrat arbetsklimat samt varit stressreducerande. En slutsats som dras är att kombinationen av bildarbete med samtal och reflektion har varit verksamt i förändringsarbetet. Bildarbetsmetod, klientgrupp, typ av organisation och vilka behov personalgruppen hade verkade vara av underordnad betydelse. Ledningens stöd framstår dock som en nödvändig förutsättning för framgång. Vidare studier inom detta område behövs.

  • 317.
    Bramell, Axel
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Differences in the relationship of heart rate and blood lactate values between running on track versus inclined treadmill: Improving laboratory testing to accurately prescribe exercise intensities2016Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to evaluate the generalisability of the heart rate-blood lactate relationship determined in laboratory testing in comparison to running over ground. This plays a crucial role to prescribe exercise intensity from laboratory results. Ten well trained runners performed a maximal oxygen uptake (VO2max) pre-test and an incremental submaximal test performed at a two degrees inclined treadmill and a running track. Statistical analysis included student’s t-test of heart rate at interpolated blood lactate levels and comparison of second order polynomial regression lines. VO2max was 60,4 ± 6 ml/kg/min for men and 56,3 ± 4,3 ml/kg/min for women. There was no significant difference in heart rate at interpolated blood lactate of 3 and 4 mmol/L. There was no significant difference between heart rate values at any running velocity. A significant difference between blood lactate values was observed 14km/h (p=0,04). When considering blood lactate values up to 6mmol/L, heart rate-blood lactate relationships were similar. In conclusion, lactate threshold testing on treadmill through incremental test protocols on a two degrees incline gives similar heart rate- blood lactate relationship as running over ground and may be used to prescribe intensity in training performed over ground. 

  • 318.
    Bramell, Axel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Jakobsson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Validation and practical evaluation of the Onesenz microdialysis lactate analyser2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study investigated the reliability of the new Onesenz on-line microdialysis lactate analyser compared to the YSI 2300 Stat Plus. Venous blood lactate concentrations were measured simultaneously with both analysers during an incremental cycle ergometer test. Eight physically active men and women completed the test to voluntary exhaustion. A total of 81 blood samples from both devices were included in the analysis. Statistical analysis was conducted through correlation, regression analysis and limits of agreement. Lactate values during graded exercise ranged from 0,5 mM/l to 14,1 mM/l. A significant correlation was observed between the two analysers, r(79)=0,98, p<0,001. Regression analysis determined the equation: [Onesenz] = 0,811*[YSI] + 0,345  and coefficient of determination (R2) was 0,95. The mean difference between the analysers was 0,15 mM/l ± 0,7 mM/l. The agreement between the two analysers deteriorated above 6 mM/l. When studying bLa values above 6 mM/l the mean difference was 1,38 ± 1,3 mM/l. In conclusion, the Onesenz lactate analyser provides reliable bLa measurements up to 6 mM/l compared to the YSI 2300. In the context of sports medicine the more time consuming method of microdialysis limits its appropriateness to longer test protocols, but on the other hand reduces human error. Still, the prototype lacks several features concerning practical usefulness.

    Keywords: Blood lactate, Microdialysis, Lactate threshold, Exercise testing, Lactate analyser

  • 319. Brandt, Å
    et al.
    Legarth, KH
    Wæhrens, Eva Ejlersen
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Occupational Therapy.
    Undersøgelse og evaluering: med aktivitet og deltagelse si fokus2007Chapter in book (Other (popular science, discussion, etc.))
  • 320.
    Brinckmann, Paula
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sjöberg, Anna
    Time to stabilization during a single-leg hop is less variabe in participants with anterior cruciate ligament reconstruction than in controls2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The purpose of this study was to compare time to stabilization (TTS) and standard deviation (SD) during a single-leg hop of individuals with anterior cruciate ligament reconstruction (ACLR) to healthy controls, and between the reconstructed and the contralateral uninjured sides.

    Design: Cross-sectional study with two groups.

    Participants: A total number of 62 participants (36 ACLR and 26 Controls).

    Main Outcome Measure: Participants performed five trials of horizontal single-leg hops for each side onto a force plate, and TTS were calculated for the landing phase. Main outcome measures were: mean TTS mediolateral direction, mean TTS anteroposterior direction, SD TTS mediolateral direction and standard deviation TTS anteroposterior direction. General linear models repeated measures analyses of variance were conducted to analyze between-group and with-in group differences (2 x 2, group x side). If significant effects or interactions were found, post-hoc analyses with Bonferroni corrections were performed (P≤0.05).

    Results: No significant group or side effects or interactions were found for mean TTS or for SD TTS in the anteroposterior direction. However, significant group effect and group x side interaction was found for SD TTS in mediolateral direction. SD TTS in the mediolateral direction was significantly lower on the ACLR injured side compared to controls (P=0.031).

    Conclusions: The results indicate that the ACLR group had a less varied movement pattern during a single-leg hop compared to the control group, as reflected by TTS.

  • 321.
    Britta, Lindström
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Karlsson, Stefan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lexell, Jan
    Isokinetic torque and surface electromyography during fatiguing muscle contractions in young and older men and women.2006In: Isokinetics and Exercise Science, ISSN 0959-3020, Vol. 14, p. 225-234Article in journal (Refereed)
  • 322.
    Bro, Sofi
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Janze, Sofia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    UPPLEVELSER AV MILJÖN I EN ARBETSSITUATION FÖR PERSONER MED ASPERGERS SYNDROM2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Aspergers syndrom är en neuropsykiatrisk störning som för den drabbade kan innebära speciella utmaningar i arbetslivet. Inom denna målgrupp är arbetslösheten hög och hur arbetsmiljön är utformad kan vara avgörande för hur personer med AS kan använda sin potential.Att ha ett arbete kan bidra till utveckling av identiteten och att känna delaktighet i samhället. Syftet med studien var att belysa miljöns betydelse i en arbetssituation för personer med Aspergers syndrom. En kvalitativ ansats valdes där fyra personer, två kvinnor och två män med Aspergers syndrom i arbetsför ålder som har eller haft ett arbete de senaste fem åren intervjuades. Intervjuerna analyserades med kvalitativ innehållsanalys och denna resulterade i fem kategorier; Stimulerande arbetsuppgifter skapar motivation och meningsfullhet, Många sinnesintryck tar energi från arbetet, Social interaktion är ofta utmanande men även stöttande, Anpassad anställningsgrad och anställningsform bidrar till varaktigt arbete, Kulturella förväntningar inom arbetssituationen är utmanande. Få sensoriska intryck och en långvarig och god kontakt bland arbetsgivare och kollegor har bidragit till en fungerande arbetssituation. De flesta utmaningarna finns i den sociala miljön men den ses som en viktig social träning. Deltagarna upplever meningsfullhet och tillfredsställelse när flera miljöfaktorer samspelar på ett stöttande sätt.

  • 323.
    Brogårdh, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Constraint Induced Movement Therapy: influence of restraint and type of training on performance and on brain plasticity2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Partial paralysis of the hand is one of the main impairments after stroke. Constraint Induced Movement Therapy (CIT) is a new treatment technique that appears to improve upper extremity function after stroke. CIT consists of 6 hours of training/day for the affected arm (mainly with shaping exercises) and of restraint (mitt) of the non affected arm for two weeks. There are concerns about the practicality and resource issues in carrying out CIT according to the original model. In this thesis the benefit of modifications of CIT, of an assessment tool and of two common types of hand training have been evaluated.

     

    CIT (n=16) administered in groups for two weeks (paper I) seems to be a feasible alternative to improve upper limb motor function after chronic stroke. The arm/hand motor performance improved significantly on Motor Assessment Scale (MAS; p= 0.003) and on Sollerman hand function test (p= 0.037). The median self reported motor ability (MAL) also improved (p < 0.001). No additional effect was seen from wearing a mitt for an extended period of three months. The reliability of the Sollerman hand function test (paper II) was studied in patients with chronic stroke. Three examiners observed 24 patients at three experimental sessions. There was agreement (kappa ≥ 0.4) between the examiners for 15/20 subtests. Using total sum scores, the agreement within the examiners was higher than 0.96 (for Spearman’s rhos and ICCs) and agreement between the examiners was higher than 0.96 (Spearman’s rhos) and 0.92 (ICCs), respectively. In a cohort of 24 patients with subacute stroke (paper III) forced use therapy (FUT; mitt use and 3 hours of training/day for 2 weeks) improved arm/hand function, but not more than regular arm therapy given to the control group. Significant improvements in arm/hand motor performance were found in the FUT group (n=12) as well as in the control group (n=12) on the Sollerman hand function test (p= 0.001), on MAS (p< 0.05) and on MAL (p < 0.05). No significant differences were seen between the groups pre- or post training or at three months follow up, demonstrating that the mitt had limited importance. In a separate study on 30 healthy subjects (paper IV), employing transcranial magnetic brain stimulation (TMS), we found that shaping exercises but not general activity training increased dexterity (p<0.05; Purdue peg board test) of the trained non dominant hand. After shaping exercises the cortical motor map shifted forwardly into the premotor area but did not expand. After general activity training the cortical motor map expanded significantly (p=0.03) in the posterior (sensory) direction. Shift of location of active TMS positions rather than their numbers might therefore be a critical factor for the interpretation of cortical plasticity.

     

    In conclusion, the studies in this thesis have shown that less resource consuming modifications of CIT may be feasible to improve upper limb motor function after stroke. The type and amount of training for the more affected arm seems to be an important factor rather than the mitt use in itself. Shaping exercises, at least in healthy people, are effective in improving dexterity and the Sollerman hand function test reliable to evaluate arm/hand function after stroke.

  • 324.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Johansson, Fredrik W
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nygren, Frida
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjölund, Bengt H
    Mode of hand training determines cortical reorganisation: A randomized controlled study in healthy adults2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 8, p. 789-794Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate two commonly used forms of hand training with respect to influence on dexterity and cortical reorganization.

    Subjects: Thirty healthy volunteers (mean age 24.2 years).

    Methods: The subjects were randomized to 25 min of shaping exercises or general activity training of the non-dominant hand. The dexterity and the cortical motor maps (number of excitable positions) of the abductor pollicis brevis muscle were evaluated pre- and post-training by the Purdue Peg Board test and transcranial magnetic stimulation, respectively.

    Results: After shaping exercises the dexterity increased significantly (p ≤ 0.005) for both hands, mostly so in the non-dominant hand. The cortical motor map of the abductor pollicis brevis muscle shifted forwardly into the pre-motor area without expanding. After general activity training, no significant improvements in dexterity were found for the non-dominant hand. The cortical motor map of the non-dominant abductor pollicis brevis muscle expanded significantly (p = 0.03) in the posterior (sensory) direction.

    Conclusion: These results indicate that shaping exercises, but not general activity training, increase dexterity of the trained non-dominant hand in parallel with a shift of location of active transcranial magnetic stimulation positions. Shifts of active cortical areas might be important for the interpretation of brain plasticity in common behavioural tasks.

  • 325.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Persson, Ann L
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjölund, Bengt H
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Intra- and inter-rater reliability of the Sollerman hand function test in patients with chronic stroke.2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 2, p. 145-154Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine whether the Sollerman hand function test is reliable in a test-retest situation in patients with chronic stroke. METHOD: Three independent examiners observed each patient at three experimental sessions; two days in week 1 (short-term test-retest) and one day in week 4 (long-term test-retest). A total of 24 patients with chronic stroke (mean age; 59.7 years, mean time since stroke onset 29.6 months) participated. The examiners simultaneously assessed the patients' ability to perform 20 subtests. Both ordinal data (generalized kappa) and total sum scores (Spearman's rank correlation coefficient (Spearman's rho), intra class correlation coefficient (ICC2, 1) and mean differences) were used in the statistical analysis. RESULTS: There was agreement (kappa >or= 0.4) between the examiners for 15 out of the 20 subtests. Using total sum scores, the agreement within the examiners, both short- and long-term, was higher than 0.96 (for Spearman's rho and ICC, respectively). The mean differences were 0.29 - 1.0/80 points within each examiner. Agreement between the examiners at each session was higher than 0.96 (Spearman's rho) and 0.92 (ICC), respectively. Systematic differences (p < 0.05) were, however, found between examiners A and B/C for all sessions. CONCLUSIONS: The Sollerman hand function test seems to be a reliable test in patients with chronic stroke, but we recommend that the same examiner evaluates a patient's hand function pre- and post-treatment.

  • 326.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjölund, Bengt H
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Constraint Induced Movement Therapy in patients with stroke: A pilot study on effects of small group training and of extended mitt use2006In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 3, p. 218-227Article in journal (Refereed)
  • 327.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Vestling, Monika
    Sjölund, Bengt H
    Forced use therapy in patients with subacute stroke: The mitt can be thrown!: A randomised controlled study with blinded observersManuscript (preprint) (Other academic)
  • 328.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Rehabilitation, Lund University Hospital, Lund.
    Vestling, Monika
    Sjölund, Bengt H
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. 3Rehabilitation and Research Centre for Torture Victims, Copenhagen and University of Southern Denmark, Odense, Denmark.
    Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint: a randomized controlled study with independent observers2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 4, p. 231-236Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the effect of using a mitt during shortened constraint-induced movement therapy for patients in the subacute phase after stroke.

    Subjects: Twenty-four patients with stroke (mean age 57.6 (standard deviation 8.5) years; average 7 weeks post-stroke) with mild to moderate impaired hand function.

    Methods: The patients were randomized to mitt use or no mitt use on the less affected hand for 90% of waking hours for 12 days. All patients received 3 h of arm and hand training per day for 2 weeks. Assessments were made by blinded observers using the modified Motor Assessment Scale, the Sollerman hand function test, the 2-Point Discrimination test and Motor Activity Log test.

    Results: Patients in both groups showed significant improvements in arm and hand motor performance and on self-reported motor ability after 2 weeks of therapy and at 3 months follow-up. However, no statistically significant differences between the groups were found in any measures at any point in time.

    Conclusion: In this study, no effect of using a restraint in patients with subacute stroke was found. Thus, this component in the constraint-induced therapy concept seems to be of minor importance for the outcome.

  • 329.
    Broman, Karolina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "Den svåra balansgången": Pedagogers upplevelse av att arbeta med barn med motoriska svårigheter: En kvalitativ studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Prevalensen av barn med fördröjd utveckling är nästan ett av var sjätte barn, och eftersom barns första åtta år är en viktig period för tillväxt och utveckling som kan påverka barnets fortsatta liv, bör barnen tidigt erhålla ett gott stöd.

    Syfte: Syftet med uppsatsen är att nå ökad kunskap om hur pedagoger upplever sitt arbete med barn med motoriska svårigheter, och vilket stöd de upplever att de får av en fysioterapeut.

    Metod: Kvalitativ studie grundad på semistrukturerade intervjuer med fem pedagoger som arbetar med barn som har motoriska svårigheter. Barnens ålder är 1-9 år. Intervjuerna analyserades med hjälp av the grounded theory, och för att öka trovärdigheten i datamaterialet genomfördes en triangulering av materialet med totalt tre personer.

    Resultat: En huvudkategori: ”Den svåra balansgången” och fem kategorier: ”Områden som skapar osäkerhet hos pedagogen”,Stöd för pedagogen”, ”Varför en diagnos? ”, ”Målet: ett självständigt barn” och ”Respekt” identifierades. Huvudkategorin, ”Den svåra balansgången”, representerar pedagogernas strävan att nå balans i sitt arbete med barn som har motoriska svårigheter medan kategorierna visar delar som påverkar balansen.

    Slutsats: Pedagogerna upplever att deras arbete är en ständig balansgång där olika delar i arbetet måste avvägas mot varandra i en kontinuerlig strävan efter jämnvikt.

  • 330.
    Brumskine, Darlington
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Kanyamuneza, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Vuxnas erfarenheter av att leva med ADHD utifrån ett aktivitets- och delaktighetsperspektiv: Kvalitativ studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Attention Deficit Hyperactivity Disorder (ADHD) är en neuropsykiatrisk störning som inte går att bota, men med rätt stöd kan symptomen minska och personen få en fungerande vardag. Tidigare forskning visar att det är vanligt att personer som inte har fått hjälp eller behandling senare i livet kan utveckla svårigheter att planera i vardagen, hantera impulser och upprätthålla rutiner. Syftet med denna studie var att beskriva erfarenheterna av att leva med ADHD utifrån ett aktivitets- och delaktighetsperspektiv. Denna studie genomfördes utifrån en kvalitativ metod där fyra utvalda självbiografier och en biografi som helt eller delvis skrivits av personer med ADHD analyserades med hjälp av en kvalitativ innehållsanalys. I studiens resultat framkom betydelsen av tidiga insatser, stöd med bland annat struktur och även bestämda vanor och rutiner vid utförande av vardagsaktiviteter. Ytterligare forskning kring arbetsterapi och ADHD krävs dock för att utvärdera resultatet av det stöd och den behandling arbetsterapeuter kan erbjuda för personer med ADHD.

     

    Sökord: arbetsterapi, intervention, neuropsykiatrisk funktionsnedsättning

  • 331.
    Brändström, Helge
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Giesbrecht, Gordon
    University of Manitoba, Winnipeg, Canada. Dep of Anesthesia.
    Ängquist, Karl-Axel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Fatal hypothermia: an analysis from a sub-arctic region2012In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 71, no 0, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Objectives. To determine the incidence as well as contributing factors to fatal hypothermia.

    Study design. Retrospective, registry-based analysis.

    Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy protocols were studied.

    Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40%) were found within approximately 100 meters of a building. The majority (75%) occurred during the colder season (October to March). Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma.

    Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying) citizens.

  • 332.
    Brännare, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hedén, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Naturen som intervention vid stressrelaterade tillstånd: En litteraturstudie2013Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Psykisk ohälsa i form av stress är ett växande problem i dagens samhälle och är en av de främsta orsakerna till sjukskrivning. Naturen med dess rehabiliterande inverkan har varit en del av sjukvården vid upprepade tillfällen under människans historia.

    Syftet var att undersöka hur naturen kan användas som intervention vid stressrelaterade tillstånd hos människan. En litteraturstudie utfördes för att identifiera befintlig kunskap inom det valda ämnet. Genom sökning i fem databaser och manuella sökningar kunde 16 artiklar från åtta olika länder inkluderas i studien. Analysen frambringade tre kategorier: Naturens inverkan på stress, Naturens terapeutiska värde och Olika miljöers påverkan. Resultatet visade att naturen har positiv inverkan på såväl den psykiska som fysiska  hälsan, betydelsen av att fä utföra meningsfulla aktiviteter i naturen för ökat välbefinnande, social interaktion, känsla av kompetens och aktivitetsbalans, samt olika miljöers betydelse för avslappning. Resultatet ger indikationer på att naturen kan vara en arbetsterapeutisk metod vid behandling av stressrelaterade symptom . En slutsats av studien är att naturen kan bidra med positiva hälsoeffekter som borde kunna nyttjas i terapeutiska sammanhang. Vidare forskning behövs för att finna renodlade arbetsterapeutiska interventioner och för att stärka evidensen för naturens rehabiliterande inverkan.

  • 333.
    Brännlund, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sahlström, Robin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Trapezius pain pressure threshold as a predictor for neck muscle functions and cervical range of motion: A comparison of female chronic neck pain patients with or without traumatic background2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Neck pain is one of the most common causes of disability with a lifetime prevalence of approximately 50%. Few previous studies have investigated the correlation between pain and muscle functions and they’ve all used subjective self-estimated pain-rating scales as pain measurements. Pain pressure threshold (PPT) as a pain measurement gives a definite value of the pain which could be clinically useful for therapists.

    Purpose: The primary purpose of this study is to examine if Trapezius PPT can predict muscle functions and cervical range of motion (CROM) in women with chronic neck pain. Other purposes are to examine differences between patients with whiplash associated disorders (WAD) and idiopathic neck pain (INP) as well as if central sensitization affects the examined variables.

    Method: The subjects were devided into three groups; healthy controls (n=29), WAD (n=28) and INP (n=36). PPTs, neck muscle strengths, neuromuscular controll, muscle endurance and CROM were measured and regression analysis as well as difference tests were performed.

    Result: The results show several significant differences between the WAD and INP patients. The regression analysis shows that Trapezius PPT might be used for predicting muscle functions and CROM in the WAD group. The results also show that central sensitization negatively affects the examined variables.

    Conclusion: There are major differences between chronic WAD and INP patients. One might suggest to separate these groups in future studies. The clinical usability of Trapezius PPT as a single predictor for neck muscle functions and CROM needs to be further examined.

  • 334.
    Brännström, André
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Yu, Ji-Guo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Åkerfeldt, Torbjörn
    Stridsberg, Mats
    Svensson, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Vitamin D in relation to bone health and muscle function in young female soccer players2017In: European Journal of Sport Science, ISSN 1746-1391, E-ISSN 1536-7290, Vol. 17, no 2, p. 249-256Article in journal (Refereed)
    Abstract [en]

    The present work investigated serum vitamin D (25(OH)D) status in relation to bone and muscle qualities and functions in 19 female soccer players (13–16 years) resident at northern latitude with very low sun exposure (∼32–36 h/month) during winter season (late January to early March). Serum 25(OH)D, parathyroid hormone and bone turnover markers osteocalcin (OC) and beta carboxy-terminal collagen cross-links (β-Ctx), as well as body composition and muscle performance were examined. Hormones were tested using routine laboratory methods. Fat mass, lean mass, and bone mineral density in whole body, as well as femur and lumbar spine were evaluated with dual-energy X-ray absorptiometry. Muscle performance was assessed through isokinetic knee extension and flexion, countermovement jump, and sprint running. 25(OH)D was low (50.5 ± 12.8 nmol l−1), whereas the values of bone turnover markers were markedly high (OC: 59.4 ± 18.6 μg l−1; β-Ctx: 1075 ± 408 ng l−1). All bone and muscle measurements were normal or above normal. 25(OH) D was not significantly correlated with most of the parameters of bone and muscle quality or function, except the knee extension time to peak torque (r = −0.50, p = .03). In conclusion, the level of vitamin D is markedly low in adolescent female soccer players during the winter in Sweden. However, vitamin D levels did not significantly correlate with measures of bone and muscle except a moderate correlation in time to peak torque in the knee extensors. The practical implication of low vitamin D levels in young growing female athletes remains unclear.

  • 335.
    Brännström Gullehag, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine.
    Stiglund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine.
    Fysisk aktivitet och sociala medier: - En deskriptiv enkätundersökning på vuxna kvinnor 18-60 år2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: One of the primary functions of the human body is to be physically active and this is essential throughout life. Adults over 18 years of age are recommended to achieve at least 150 minutes of physical activity per week with moderate intensity spread throughout the week. Physical activity reduces the risk of premature death and cardiovascular diseases. Health-inspiring apps can improve lifestyle habits such as diet and physical activity and thus prevent diseases. Social media is a collective name for communication platforms. A connection between the use of social media and a deteriorated self-image and body image has been found.  

    Purpose: The purpose of the study was to give an insight into how physical activity in adult women in the age group 18-60 years is influenced by the use of social media and health-inspired apps, and how social media affects self-image and body image in younger and older women.

    Participants: The participants were 165 women in the ages 18 to 60 years. The younger age group (18-30 years) included 114 participants. There were 19 participants in the age group 31-40 years and 32 participants in the age group 41-60 years.

    Method: A digitized questionnaire was designed to answer questions about background information, use of social media, physical activity, body image and self-image.

    Result: The study's results show that 95% of the women were physically active and 33% of these were active 4-6 hours per week. The study has shown little awareness regarding how social media can be applied to physical activity in women 18-60 years. Younger women use social media to a greater extent and experienced poorer body image and self-image compared to older women

    Conclusion: The study has answered the purpose that the use of social media and apps promote physical activity in women and that there is a difference in the use of social media, comparison and self-image between the age group 18-30 and 31-60.

  • 336.
    Brännström, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Teamsamarbete i företagshälsovården: En kartläggning i fyra svenska län2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion

    Teamsamarbete mellan professioner inom företagshälsovård kan förbättra arbetets kvalité, resultat och säkerhet.Vidare kan teamsamarbete främja teamets interna hälsa och teamets rehabiliteringsfokus kan vara avgörande för patientens arbetsåtergång.

     

    Syfte

    -Att kartlägga hur teamsamarbetet fungerar inom företagshälsovård.

    -Att undersöka skillnader mellan respondenter som upplevde sällan respektive oftast välfungerande team vad gäller arbetstillfredställelse, självskattad hälsa samt syn på rehabilitering avseende hälsa och arbetsåtergång

     

    Metod

    Enkäten Assessment of Interprofessional Team Collaboration Scale – Svensk version (AITCS-s), med subskalorna partnerskap/delat beslutsfattande, samarbete och koordination användes vid kartläggningen av teamsamarbetet utifrån en femgradig skala. Frågor kring självskattad hälsa, arbetstillfredställelse samt syn på patientrehabilitering avseende hälsa och arbetsåtergång bifogades enkäten.och den tredje 168 personer vid 14 företagshälsovårdsenheter erbjöds deltagande varav 73 personer ingick i studien.

     

    Resultat

    Respondenterna skattade sitt teamsamarbete som välfungerande inom subskalorna partnerskap/delat beslutsfattande (4,11 poäng, SD 0,59) och samarbete (4,13 poäng, SD 0,56). Subskalan koordination skattades lägre (3,88 poäng, SD 0,63). Ingen skillnad mellan respondenter som upplevde sällan respektive oftast välfungerande team noterades för arbetstillfredställelse (p=0,058), självskattad hälsa (p=0,31) eller syn på rehabilitering (hälsa: p=1,00 och arbetsåtergång: p=0,20)

     

    Konklusion

    Teamsamarbetet bedömdes vara välfungerande vilket indikerar effektiv rehabilitering avseende arbetsåtergång. Ingen skillnad mellan sällan respektive oftast välfungerande team noterades för arbetstillfredställelse, självskattad hälsa eller syn på rehabilitering. 

  • 337.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Psychotropic drug use and mortality in old people with dementia: investigating sex differences2017In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 18, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein.

    Methods: In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for.

    Results: In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40–0.92 and HR 1.09, 95% CI 0.87–1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women.

    Conclusions: Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.

  • 338.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Molander, Lena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gender disparities in the pharmacological treatment of cardiovascular disease and diabetes mellitus in the very old: an epidemiological, cross-sectional survey2011In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 28, no 12, p. 993-1005Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There are many reports of disparities in health and medical care both between women and men and between various age groups. In most cases, men receive better treatment than women and young and middle-aged people are privileged compared with the old and the very old. Cardiovascular morbidity and diabetes mellitus are common, increase with age and are often treated extensively with drugs, many of which are known to have significant adverse effects.

    OBJECTIVE: The aim of the study was to analyse gender differences in the pharmacological treatment of cardiovascular disease and diabetes among very old people.

    METHODS: The study took the form of an epidemiological, cross-sectional survey. A structured interview was administered during one or more home visits, and data were further retrieved from medical charts and interviews with relatives, healthcare staff and other carers. Home-dwelling people as well as people living in institutional care in six municipalities in the county of Västerbotten, Sweden, in 2005-7 were included in the study. Half of all people aged 85 years, all of those aged 90 years and all of those aged ≥95 years living in the selected municipalities were selected for inclusion in the study. In total, 467 people were included in the present analysis. The main study outcome measures were medical diagnoses and drug use.

    RESULTS: In total, women were prescribed a larger number of drugs than men (mean 7.2 vs 5.4, p < 0.001). Multiple logistic regression models adjusted for age and other background variables as well as relevant medical diagnoses (hypertension, heart failure) showed strong associations between female sex and prescriptions of thiazide diuretics (odds ratio [OR] 4.4; 95% CI 1.8, 10.8; p = 0.001), potassium-sparing diuretics (OR 3.5; 95% CI 1.4, 8.7; p = 0.006) and diuretics as a whole (OR 1.8; 95% CI 1.1, 2.9; p = 0.021). A similar model, adjusted for angina pectoris, showed that female sex was associated with prescription of short-acting nitroglycerin (OR 3.7; 95% CI 1.6, 8.9; p = 0.003). However, more men had been offered coronary artery surgery (p = 0.001). Of the participants diagnosed with diabetes, 55% of the women and 85% of the men used oral antihyperglycaemic drugs (p = 0.020), whereas no gender difference was seen in prescriptions of insulin.

    CONCLUSIONS: Significant gender disparities in the prescription of several drugs, such as diuretics, nitroglycerin and oral antihyperglycaemic drugs, were observed in this study of very old people. In most cases, women were prescribed more drugs than men. Men more often had undergone coronary artery surgery. These disparities could only in part be explained by differences in diagnoses and symptoms.

  • 339.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation2019In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 76, no 2, p. 172-179Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Treatment with antidepressants has been associated with hip fracture. This association could restrict the treatment options, especially in older patients. OBJECTIVE: To investigate the association between antidepressant drug treatment and hip fracture starting 1 year before the initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS: In this nationwide cohort study, 204 072 individuals in the Prescribed Drugs Register of Sweden's National Board of Health and Welfare aged 65 years or older who had a prescription of antidepressants filled between July 1, 2006, and December 31, 2011, were matched by birth year and sex to 1 control participant who was not prescribed antidepressants (for a total of 408 144 people in the register). Outcome data were collected from 1 year before to 1 year after the index date (date of prescription being filled). Data analysis was performed from July 1, 2005, to December 31, 2012. EXPOSURES: First filled prescription of an antidepressant drug. MAIN OUTCOMES AND MEASURES: Incident hip fractures occurring in the year before and year after initiation of antidepressant therapy were registered. Associations were investigated using multivariable conditional logistic regression models and flexible parametric models. RESULTS: Of the 408 144 people in the register who were included in the study, 257 486 (63.1%) were women, with a mean (SD) age of 80.1 (7.2) years. Antidepressant users sustained more than twice as many hip fractures than did nonusers in the year before and year after the initiation of therapy (2.8% vs 1.1% and 3.5% vs 1.3%, respectively, per actual incidence figures). In adjusted analyses, the odds ratios were highest for the associations between antidepressant use and hip fracture 16 to 30 days before the prescription was filled (odds ratio, 5.76; 95% CI, 4.73-7.01). In all separate analyses of age groups, of men and women, and of individual antidepressants, the highest odds ratios were seen 16 to 30 days before initiation of treatment, and no clear dose-response relationship was seen. CONCLUSIONS AND RELEVANCE: The present study found an association between antidepressant drug use and hip fracture before and after the initiation of therapy. This finding raises questions about the association that should be further investigated in treatment studies.

  • 340.
    Bråndal, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue.

    Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake.

    Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity.

    Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

  • 341.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Sciences, Karolinska Institute, Danderyd hospital, Stockholm, Sweden.
    Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry2019In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 19, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.

    Methods: Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/ depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.

    Results: The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17–2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55–0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17–1.92), toileting (OR: 1.30, 95%CI: 1.05–1.61), and dressing (OR: 1.23, 95%CI: 1.02–1.48).

    Conclusion: In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.

  • 342.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Reliability and validity of the Swedish Fatigue Assessment Scale when self-administrered by persons with mild to moderate stroke2016In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 23, no 2, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Objective: To examine internal consistency, test-retest reliability, floor/ceiling effects and construct validity of the Fatigue Assessment Scale (FAS), when self-administrated by persons with mild to moderate stroke.

    Method: The FAS was translated into Swedish and tested for psychometric properties when self-administrated by persons with mild to moderate stroke. Participants, consequently selected from the stroke unit admission register received a letter with three questionnaires: the FAS, Short Form Health Survey (SF-36) subscale for vitality and Geriatric Depression Scale, GDS-15. Within two weeks, a second letter with FAS was sent for re-test.

    Result: Seventy-tree persons with mild to moderate stroke participated in the study. Internal consistency was good (Cronbach’s alpha 0.82). The test and retest reliability of individual items showed that five items out of 10 items were good (weighted kappa > 0.60), four were moderate (0.40-0.60), and one was fair (0.22). The relative reliability between total scores was good (ICC 3.1 = 0.73) and the absolute reliability was nine points, meaning that a change of at least nine points in total score implies a real change of fatigue level. Correlation analysis showed that the Swedish FAS correlated with the SF-36 subscale for vitality (rs = - 0.73) and GDS-15 (rs = 0.62), suggesting convergent construct validity. There were no floor or ceiling effects.

    Conclusion: The Swedish translation of the FAS used as a self-administrated questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

  • 343.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Does a cardiorespiratory interval training program at home improve post-stroke fatigue? Study protocol of a randomized controlled trialManuscript (preprint) (Other academic)
  • 344.
    Brömster, Sandra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Relationen mellan aktivitet eller delaktighet och depression eller depressionssymtom hos ungdomar: En litteraturstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Depression hos ungdomar är ett ökande problem i dagens samhälle vilket kan ha negativ inverkan på dessa personers välmående och utförande av aktiviteter i vardagen. Syftet med denna studie var att undersöka vilken relation som finns mellan aktivitet eller delaktighet och depression eller depressionssymtom hos ungdomar, med specifikt fokus på aktiviteter relaterade till skola och fritid. En litteraturstudie genomfördes och fem kvantitativa artiklar inkluderades. Analysen gjordes enligt en analysmodell för litteraturstudier av Friberg (2012). Resultatet visade att skolrelaterade aktiviteter ökade depressionssymtomen hos ungdomar och att fritidsaktiviteter utan relation till skola antingen minskar depressionssymtomen eller att inget samband finns mellan aktiviteten och depressionssymtomen. Internetspel, fysisk aktivitet och aktiviteter där sociala interaktioner med vänner och familj fanns minskade depressionssymtomen hos ungdomarna.  

  • 345.
    Bucht, Gösta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Clinical and etiological studies on dementia of Alzheimer type and multiinfarct dementia1983Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    1. Clinical studies. Clinical diagnosis of dementia has been made largely on the basis of clinical findings supported by appropriate radiological and laboratory investigations. A minority of patients have treatable or reversible underlying causes for their dementing syndrome. It is important to distinguish between the two main forms of dementia Alzheimer's disease, senile dementia of Alzheimer type (AD/SDAT) and MID so that advantage can be taken of any future progress in treatments.

    In the clinical study significant differences between several diagnostic procedures were found between patients with AD/SDAT and MID. Blood pressure was significantly lower in the AD/SDAT group and focal neurological signs were seen in 70% of the MID patients but only in 6% of patients with AD/SDAT. Electrocardiogram was normal in all patients with AD/SDAT but pathological in 75% of the MID patients. Electroencephalogram showed generalized slow frequencies in 79% of the AD/SDAT patients and localized changes in 65% of the MID patients. Computerized tomography showed a significantly greater dilation of the ventricular system in MID patients compared to AD/SDAT patients and controls. Monoamine metabolites in the cerebrospinal fluid were lower in AD/SDAT patients and normal in MID patients. Psychopathological signs were found to be more variable and more pronounced in the AD/SDAT group compared with MID patients.

    2. Etiological studies. Immunoglobulin and albumin were found changed in serum and CSF of both AD/SDAT and MID, indicating a more active immune response in MID and a less dense cerebrospinal fluid barrier in both MID and AD/SDAT. There appears to be a consumption of IgG in the central nervous system in patients with AD/SDAT.

    Abnormal chromosomes appearing as acentric fragments, i.e. without visible centromeres, were found in 90% of patients with AD/SDAT, 30% of patients with MID, and not at all in the control group. Increased aneuploidy was also seen both in patients with MID and AD/SDAT.

    Diabetes mellitus in old age and AD/SDAT do not seem to coexist. Furthermore, patients with AD/SDAT have changed carbohydrate metabolism with decreased fasting blood sugar concentrations, increased glucose tolerance and higher concentration of insulin during an oral glucose tolerance test.

  • 346.
    Buck, Sebastian
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Development of a new functional test targeting proprioceptive ability following anterior cruciate ligament injury2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Movement control is critically dependent on exteroceptive and proprioceptive information. Reduced proprioception of the knee has been demonstrated after injury of the anterior cruciate ligament (ACL). Various test have been proposed in research, but their implementation and evaluation still represent clinical challenges. There is thus a pronounced need for improved clinical discriminative knee function tests related to proprioceptive ability.

    Aim: Our main aim of this pilot study was to develop and evaluate a new functional proprioception test, and secondly evaluate if our test could discriminate ACL injured from controls.

    Method: We developed a test in which participants step repeatedly over an obstacle, with downward vision occluded. Kinematics were collected in 3D motion laboratory from participants with ACL injury (n=8) and healthy controls (n=10). Coefficient of variation were calculated for the following variables: foot clearance, knee flexion angle and step length and compared between legs within group and between groups.

     

    Results: For between-group comparison larger variability of step length on the trailing leg of both legs were found in the ACL group. No other significant differences were found between the groups and within group differences were also nonsignificant.  

    Conclusion: Our test, so far in a small population, did not discriminate between legs within ACL injured persons or between ACL injured persons and healthy controls. This test needs to be further developed to determine whether it can discriminate between ACL injured and controls. If so, obstacle task may provide a valuable functional test of sensorimotor control following an ACL injury.

  • 347.
    Bugge Jakobsen, Knut Erling
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wilén, Catarina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    ”Tejpen ger mig liksom en trygghet”: - tävlingsidrottares upplevelse av att använda Kinesiotape®2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Kinesiotape® är ett populärt verktyg vid både rehabilitering och prevention av idrottsskador inom idrotten, dess påvisade effekt är dock ännu osäker. Ingen kvalitativ studie är tidigare gjord på upplevelsen av att använda Kinesiotape®.

    Syfte: Syftet med studien var att utforska tävlingsidrottares upplevelser av att använda Kinesiotape® vid rehabilitering av idrottsskador eller som prevention.

    Metod: I denna studie användes semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman. Totalt fem tävlingsidrottare deltog i intervjuerna; två från Sverige och tre från Norge.

    Resultat: Analysen resulterade i de tre kategorierna Läkande effekt, Trygghetskänsla och Smärtlindring. Informanterna uttryckte bland annat att Kinesiotape® hade påskyndat läkning av inflammation, ökat blodcirkulation verkat smärtlindrande och fungerat som psykiskt stöd. Tejpen användes enskilt eller i kombination med andra metoder. Effekterna kom tydligt fram i flera intervjuer, dock fanns även upplevelser av att tejpen inte hade gett någon effekt alls.

    Konklusion: Resultatet visade att Kinesiotape® hade bidragit till flera positiva effekter. Tolkning av intervjuerna antyder även att det kan vara ett enkelt och säkert verktyg att använda för fysioterapeuter, då möjligtvis som ett komplement till andra behandlingsmetoder.

  • 348. Bui, Kim-Ly
    et al.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rabinovich, Roberto
    Saey, Didier
    Maltais, François
    The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: A Review For Clinicians2019In: Clinics in Chest Medicine, ISSN 0272-5231, E-ISSN 1557-8216, Vol. 40, no 2, p. 367-383Article in journal (Refereed)
    Abstract [en]

    "Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."

  • 349. Bui, Kim-Ly
    et al.
    Nyberg, André
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Maltais, François
    Saey, Didier
    Functional tests in chronic obstructive pulmonary disease part 1: clinical relevance and links to the International classification of functioning, disability and health2017In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 14, no 5, p. 778-784Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part Seminar Series, we aim to describe the various domains of functional status, to elucidate terms and key concepts intertwined with functioning, and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living, in agreement with the International Classification of Functioning, Disability and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first paper also serves as an introduction to Part 2 of this Seminar Series, where the main functional tests available to assess upper and lower body functional capacity of these patients will be discussed.

  • 350. Bui, Kim-Ly
    et al.
    Nyberg, André
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Maltais, François
    Saey, Didier
    Functional tests in chronic obstructive pulmonary disease part 2: measurement properties2017In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 14, no 5, p. 785-794Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity in activities of daily life are necessary. In Part 2 of this Seminar Series, we will discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD, to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving and climbing, as well as carrying, moving and handling objects. We will review the validity, reliability and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences and normative values for these functional tests.

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