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  • 51.
    Suarez, Nivia Carballeira
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bullington, Jennifer
    Regaining health and wellbeing after traumatic spinal cord injury2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 10, p. 1023-1027Article in journal (Refereed)
    Abstract [en]

    Objective: Traumatic spinal cord injury is typically a devastating event, leading to permanent physical disability. Despite the severity of the condition, many persons with traumatic spinal cord injury manage to lead both active and independent lives. The aim of this study was to investigate the experience of health and wellbeing of persons living with a traumatic spinal cord injury for at least 20 years.

    Design and methods: A qualitative design was used. Data was analysed using a phenomenological-hermeneutical method. Rich narratives were obtained from 14 persons with paraplegia due to traumatic spinal cord injury sustained at least 20 years ago.

    Results: The key finding was that health and wellbeing were attained when persons were able to perceive themselves as being "normal" in everyday relationships and circumstances. The normalization process involved learning to negotiate and/or prevent potentially embarrassing situations by acting in a "parallel world", covertly "behind the scenes".

    Conclusion: The subjective experience of wellbeing and health after traumatic spinal cord injury depends upon the ability to prevent or resolve potentially embarrassing situations without this being noticed by others. Performing this work "behind the scenes", enables persons with traumatic spinal cord injury to interact smoothly with others and thereby be perceived as normal, despite substantial disability.

  • 52.
    Svensson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University Hospital.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Carballeira Suarez, Nivia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University Hospital.
    Parent's experiences of having and caring for a child with an eating disorder2016In: Innovations in family therapy for eating disorders: novel treatment developments, patient insights, and the role of carers / [ed] Stuart Murray, Leslie Anderson, and Leigh Cohn, New York: Routledge, 2016, p. 249-260Chapter in book (Refereed)
  • 53.
    Svensson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Suarez, Nivia Carballeira
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Parents' experiences of having and caring for a child with an eating disorder2013In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 21, no 5, p. 395-407Article in journal (Refereed)
    Abstract [en]

    Eating disorders (ED) are serious conditions that affect both patients and their families. Little is known about the influence of these disorders on family life in a Swedish population and the ways that affected families actually attempt to cope. The aim of this study was to specifically investigate parental experiences of having and caring for a child with ED. A qualitative approach was used and rich narratives were obtained from interviews with 10 parents. Results promote insights into lived experiences concerning social disruption, emotional impact, and coping strategies related to ED. This knowledge can be utilized to further develop programs to help affected families.

  • 54. Tomson, T
    et al.
    Nilsson, B Y
    Richard, Levi
    Impaired visual contrast sensitivity in epileptic patients treated with carbamazepine.1988In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 45, no 8, p. 897-900Article in journal (Refereed)
    Abstract [en]

    Critical flicker fusion frequencies and visual contrast sensitivity were determined in 27 adult epileptic patients receiving carbamazepine monotherapy and in 24 healthy, drug-free control subjects. Flicker fusion thresholds were the same in patients and control subjects, whereas the contrast sensitivity was significantly reduced in the patient group at all spatial frequencies. There was a significant negative correlation between the plasma concentration of carbamazepine and the contrast sensitivity at 11.4 and 22.8 cycles per degree, indicating that the reduced contrast sensitivity was due to the drug therapy.

  • 55.
    Wahman, Kerstin
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Spinalis R&D Unit, Stockholm.
    Nash, Mark S
    Univ Miami, Miller Sch Med, Dept Neurol Surg, ; Univ Miami, Miller Sch Med, Dept Rehabil Med, ; Univ Miami, Miller Sch Med, Miami Project Cure Paralysis.
    Lewis, John E
    Univ Miami, Miller Sch Med, Dept Psychiat & Behav Sci, ; Univ Miami, Miller Sch Med, Ctr Complementary & Integrat Med..
    Seiger, Åke
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Spinalis R&D Unit, Stockholm ; Stockholms Sjukhem Fdn, Stockholm.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm, Sweden.
    Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: the Stockholm spinal cord injury study2011In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 43, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the need for intervention on cardio-vascular disease risks in persons with paraplegia according to: (i) two multifactorial risk models; and (ii) these models in combination with the additional risk of overweight/obesity.

    DESIGN: Cross-sectional.

    SUBJECTS: A total of 134 out of 153 persons, comprising more than 80% of a regional prevalence population with traumatic paraplegia (American Spinal Injury Association Impairment Scale A-C) of minimum one year duration.

    METHODS: Participants were screened for cardiovascular disease risk using two multifactorial risk models: the Systematic Coronary Risk Evaluation and the Framingham Risk Equation. Risk factors included were: age, gender, systolic blood pressure, antihypertensive medication, smoking, total cholesterol, high-density lipoprotein cholesterol, and total cholesterol/total cholesterol ratio. In addition, overweight/obesity was assessed by body mass index.

    RESULTS: Twenty-seven percent to 36% of the cohort was eligible for cardiovascular disease risk intervention, depending on the risk model used. When overweight/obesity (spinal cord injury adjusted cut-score body mass index ≥ 22) was also considered, over 80% of the participants qualified for intervention.

    CONCLUSION: Almost one-third of persons with paraplegia were eligible for cardiovascular disease risk intervention according to authoritative assessment tools. The number in need of intervention was dramatically increased when overweight/obesity as a cardiovascular disease risk was considered.

  • 56. Wahman, Kerstin
    et al.
    Nash, Mark S
    Lewis, John E
    Seiger, Åke
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Increased cardiovascular disease risk in Swedish persons with paraplegia: the Stockholm spinal cord injury study2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 489-492Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Comparison of prevalence of cardiovascular disease risks in persons with chronic traumatic paraplegia with those in the general population.

    DESIGN: Cross-sectional comparative study.

    SUBJECTS: A total of 135 individuals, age range 18-79 years, with chronic (> or = 1 year) traumatic paraplegia.

    METHODS: The prevalences of diabetes mellitus, dyslipidaemia, hypertension, overweight, and smoking, were assessed in the study population and were compared with an age- and gender-matched sample of the general population in the region under study. History of myocardial infarction and medication for dyslipidaemia, hypertension, and diabetes mellitus were also recorded. chi2 tests were used to compare the paraplegic cohort with the general population sample.

    RESULTS: Significantly more persons with paraplegia reported a history of myocardial infarction (5.9%) than those in the comparison group (0.7%). The prevalences of diabetes mellitus (5.9%), dyslipidaemia (11.1%), and hypertension (14.1%) were also significantly higher in the paraplegic group, as were drug treatment for these disorders.

    CONCLUSION: Persons with paraplegia report increased prevalences of diabetes mellitus, hypertension, and dyslipidaemia, in particular, compared with the general population. Population-based screening and therapeutic counter-measures for these conditions may therefore be particularly indicated for this patient group.

  • 57. Wahman, Kerstin
    et al.
    Nash, Mark S
    Westgren, Ninni
    Lewis, John E
    Seiger, Åke
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Cardiovascular disease risk factors in persons with paraplegia: the Stockholm spinal cord injury study2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 3, p. 272-278Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine cardiovascular disease risk factors and risk clusters in Swedish persons with traumatic wheelchair-dependent paraplegia.

    DESIGN: Prospective examination.

    SUBJECTS: A total of 135 individuals aged 18-79 years with chronic (>or= 1 year) post-traumatic paraplegia.

    METHODS: Cardiovascular disease risk factors; dyslipidemia, impaired fasting glucose, hypertension, overweight, smoking, and medication usage for dyslipidemia, hypertension, and diabetes mellitus, were analyzed according to authoritative guidelines. Stepwise regression tested the effects of age, gender, and injury characteristics on cardiovascular disease risks.

    RESULTS: High-prevalence risk factors were dyslipidemia (83.1%), hypertension (39.3%), and overweight (42.2%) with pervasive clustering of these risks. Being older was related to increased cardiovascular disease risk, except for dyslipidemia. Hypertension was more common in low-level paraplegia. Prevalence of impaired fasting glucose was lower than previously reported after paraplegia. A high percentage of persons being prescribed drug treatment for dyslipidemia and hypertension failed to reach authoritative targets for cardiovascular disease risk reduction.

    CONCLUSION: Swedish persons with paraplegia are at high risk for dyslipidemia, hypertension, and overweight. Impaired fasting glucose was not as common as reported in some previous studies. Pharmacotherapy for dyslipidemia and hypertension often failed to achieve recommended targets. Population-based screening and therapeutic countermeasures to these cardiovascular disease risks are indicated.

  • 58. Westgren, N
    et al.
    Hultling, C
    Richard, Levi
    Westgren, M
    Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980-1991.1993In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 81, no 6, p. 926-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the incidence of delivery in women after a traumatic spinal cord injury and to describe pregnancy outcome in this group of patients.

    METHODS: Between 1980-1991, 29 women with a traumatic spinal cord injury experienced 49 pregnancies and gave birth to 52 children in Sweden. A retrospective chart review of the antepartum, intrapartum, and perinatal records of these patients was performed. In addition, all patients participated in a telephone interview held by one of the authors. Of the 29 women, 12 had lesions above T5 and 17 had lesions at T5 or below.

    RESULTS: Antenatal complications occurred frequently in this group. Nine of 12 patients with lesions above T5 had symptoms of autonomic hyperreflexia during pregnancy and/or delivery. Only in a minority of the women was the problem recognized by the medical professionals. Nine of the infants (19%) were born preterm and two were small for gestational age. The perinatal mortality rate was two of 52 (3.8%) and occurred in two cases of abruptio placentae. Few of the patients were allowed to deliver vaginally. The cesarean delivery rate for women with lesions above T5 was 47% and for women with lesions below that level, 26%.

    CONCLUSION: The overall prognosis for these women was favorable. However, women with higher spinal cord lesions would probably benefit from referral to centers with a particular interest and expertise in the management of their problems.

  • 59.
    Westgren, N
    et al.
    Solberga Project, Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, S-126 91, Stockholm, Sweden.
    Richard, Levi
    Solberga Project, Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, S-126 91, Stockholm, Sweden.
    Motherhood after traumatic spinal cord injury.1994In: Paraplegia, ISSN 0031-1758, Vol. 32, no 8, p. 517-523Article in journal (Refereed)
    Abstract [en]

    The present study includes all women with a traumatic spinal cord injury in Sweden who became pregnant and delivered live infants during 1980-1991. This group comprises six tetraplegic and 20 paraplegic patients, all confined to a wheelchair. During the above mentioned period the patients had delivered a total of 47 children. The study evaluated parental ability and quality of family life as regards interpersonal relationships, family relationships, social integration, recreational interests and demand for external assistance. An individual standardised interview was performed with all patients. In addition a standardised questionnaire was sent to all spouses (n = 20) and to all children above 10 years of age (n = 10). All 26 patients participated, 18 spouses completed and returned the questionnaires and all children took part in the study. We found an overall favourable outcome as regards the parameters evaluated. The families seem to live a rich and complete family life with very little demand for external help. They report a well functioning social network and seem socially integrated both as individuals and as families. To conclude, the study indicates that there is no reason to question females with an SCI in their roles as parents. The spinal cord injury per se, in females, thus does not preclude the possibility of having a family and caring for children adequately.

  • 60. Westgren, N
    et al.
    Richard, Levi
    Quality of life and traumatic spinal cord injury.1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 11, p. 1433-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine associations between major outcome variables after traumatic spinal cord injury (SCI) and quality of life (QL).

    SUBJECTS: Of a total population of 353 SCI patients, 320 participated, 261 men and 59 women living in the greater Stockholm area: 124 were tetraplegic, 176 were paraplegic, and 20 had no classified level. Mean age was 42 years (range, 17 to 78).

    METHOD: The Swedish SF-36 Health Survey was used to assess QL. The SF-36 is a self-administered questionnaire containing 36 items, divided into 8 multi-item dimensions, covering physical function, physical and emotional role function, social function, bodily pain, mental health, vitality and overall evaluation of health. Neurologic, general medical, and psychosocial variables were obtained from the Stockholm Spinal Cord Injury Study (SSCIS) data base. QL indices were analyzed for the SCI group as a whole, as well as for subgroups. Descriptors for subgroups were demographic variables, presence or absence of common medical problems, and subjective evaluation of the degree of impact of the medical problem on well-being/daily activities.

    RESULTS: QL in individuals with SCI was significantly lower in all subscales as compared with a normative population. No difference in QL was seen in subgroups according to extent of lesion, with the exception of physical functioning. Several medical complications such as neurogenic pain, spasticity, and neurogenic bladder and bowel problems were associated with lower QL scores.

    SUMMARY: QL, as defined by SF-36, is better in persons injured many years ago, as compared with those recently injured, suggesting an adaptive process operating over a long period. The presence of complicating medical problems, such as severe pain, problematic spasticity, and incontinence, seem to have more negative effects on QL than the extent of SCI as such.

  • 61. Westgren, N
    et al.
    Richard, Levi
    Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury1999In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 17, no 4, p. 309-319Article in journal (Refereed)
  • 62.
    Westgren, Ninni
    et al.
    Spinalis SCI Research Unit and Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Hultling, Claes
    Spinalis SCI Research Unit Karolinska Institute, Stockholm, Sweden.
    Richard, Levi
    Spinalis SCI Research Unit and Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Seiger, Åke
    Spinalis SCI Research Unit and Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Westgren, Magnus
    Obstetrics & Gynaecology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Sexuality in women with traumatic spinal cord injury1997In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, no 10, p. 977-983Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

    METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

    RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

    CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

12 51 - 62 of 62
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