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  • 1.
    Alex, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Experiences of Well-Being Among Sami and Roma Women in a Swedish Context2013Inngår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 34, nr 8, 707-726 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Our aim was to explore the experiences of well-being and lack of well-being among middle-aged and older women belonging to two national minority groups in Sweden. Interviews from nine older Sami women and four middle-aged Roma women were analyzed using grounded theory with the following categories identified: contributing to well-being (with the subcategories belonging to a healthy family, being spiritual, cultural norms as health promoting, and having had a life of one's own); and contributing to lack of well-being (with the subcategories living subordinate to the dominant society, living in a hierarchical family, and living in the shadow of tuberculosis.)

  • 2.
    Benson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    “Find out what is expected of you” The interdependence between the senior consultant on call and the junior doctor – from the senior consultans perspective2017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 3. Couppe, C
    et al.
    Thorborg, K
    Hansen, M
    Fahlstrom, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Bjordal, JM
    Nielsen, D
    Baun, M
    Storgaard, M
    Magnusson, SP
    Shoulder rotational profiles in young healthy elite female and male badminton players2014Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, nr 1, 122-128 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the present study was to profile shoulder passive range of motion (ROM) and isometric strength for external (ER) and internal (IR) rotation as part of a preseason screening in adolescent national badminton players. Passive external range of motion (EROM) and internal range of motion (IROM) were examined on the dominant and nondominant shoulder in 31 adolescent national badminton players (12 females and 19 males) with a standard goniometer. Muscle strength was examined with a hand-held dynamometer in ER and IR. Total range of motion (TROM=EROM+IROM) was lower on the dominant side compared with the nondominant side in both groups (P<0.001). Males were generally stronger than females in all strength measurements except for IR on the dominant side (P<0.01). In females, IR dominant side strength was greater compared with IR on the nondominant side (P<0.05). TROM was reduced on the dominant side compared with the nondominant side in young elite badminton players, irrespective of gender. No rotational strength differences existed between the dominant and nondominant side in male players, but in female players a higher IR strength on the dominant side was not balanced by a higher ER strength.

  • 4. Crenshaw, Albert
    et al.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Lyskov, Eugene
    A gender comparison of electromyography (EMG) during repetitive arm work with and without mental stress2013Inngår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 27, 1152.21- s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 5.
    Elcadi, Guilherme H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Forsman, Mikael
    Public Health Sciences, Karolinska Institute, Centre for Musculoskeletal Research, University of Gävle.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Crenshaw, Albert G
    Department of Occupational and Public Health , University of Gävle.
    Shoulder and forearm oxygenation and myoelectric activity in patients with work related muscle pain and healthy subjects2013Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, nr 5, 1103-1115 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We tested hypotheses of (i) reduced oxygen usage, oxygen recovery, blood flow and oxygen consumption; and (ii) increased muscle activity for patients diagnosed with work related muscle pain in comparison to healthy controls. Oxygenation was measured with near infrared spectroscopy (NIRS), and muscle activity with EMG for the extensor carpi radialis (ECR) and trapezius descendens (TD) muscles. Eighteen patients with diffuse neck-shoulder-arm pain and seventeen controls (matched in age and sex) were equipped with NIRS and EMG probes. After determining an individual’s maximum voluntary contraction (MVC) force, short term (20 sec) isometric contractions for the ECR and TD of 10%, 30%, 50% and 70% MVC generated ∆StO2% and StO2% recovery (Rslope) from NIRS, and RMS%max from EMG signals. In addition, upper arm venous (VO) and arterial (AO) occlusions generated slopes of total hemoglobin (HbTslope) and deoxyhemoglobin (HHbslope) for the resting ECR as surrogates of blood flow and oxygen consumption, respectively. Mixed Model analyses, t-tests, and Mann-Whitney test were used to assess differences between groups. There was no significant difference in MVC between groups for either muscle. Also, ∆StO2%, Rslope for either muscle, and ECR-HbTslope were not different between groups, thus our hypotheses of reduced oxygen use, recovery, and blood flow for patients were not confirmed. However, patients had a significantly lower ECR-HHbslope confirming our hypothesis of reduced consumption. Further, there was no difference in RMS%max during contractions meaning that the hypothesis of increased activity for patients was not confirmed. When taking into account the number of NIRS variables studied, differences we found between our patient group and healthy controls (i.e. in forearm oxygen consumption and shoulder oxygen saturation level) may be considered modest. Overall our findings may have been impacted by the fact that our patients and controls were similar in muscle strength, which is in contrast to previous studies.

  • 6.
    Elcadi, Guilherme H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Högskolan Gävle.
    Forsman, Mikael
    Högskolan Gävle; Karolinska institutet Stockholm.
    Hallman, David M
    Högskolan Gävle.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fahlstrom, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Crenshaw, Albert G
    Högskolan Gävle.
    Oxygenation and hemodynamics do not underlie early muscle fatigue for patients with work-related muscle pain.2014Inngår i: PLoS ONE, ISSN 1932-6203, Vol. 9, nr 4, e95582Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC)--sustained for 12-13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO2%) was similar between groups for the ECR, but StO2% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO2% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.

  • 7.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Boström, Carina
    Lewis, John E.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 9, 886-890 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.

    Design:

    Descriptive, cross-sectional study.

    Subjects:

    A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.

    Methods:

    Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.

    Results:

    One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.

    Conclusion:

    Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 8.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Dyslipidemia is common after spinal cord injury - independent of clinical measures2015Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 1, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.

    Design: Descriptive, cross-sectional study.

    Subjects: 78 patients with SCI, at different injury and functional level.

    Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.

    Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.

    Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.

  • 9.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Department of Neurobiology, Care Sciences and Society, Division of Neurodegeneration, Section Neurorehabilitation, Karolinska Institutet, Sweden; Rehab Station, Stockholm/Spinalis R&D Unit, Sweden.
    Martin, Fahlström
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Pain, anxiety and depression in spinal cord injured patients2017Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 3, nr 1, 028Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden. Design: Descriptive, cross-sectional study. Setting: Specialist Clinic at a University Hospital. Participants: 78 patients with chronic spinal cord injury, at different injury and functional level. Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS). Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm. Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression. Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

  • 10.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 5, 440-443 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (>= 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

  • 11.
    Hadrevi, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Bjorklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Kosek, E.
    Hallgren, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Fahlstrom, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Hellstrom, F.
    Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls2015Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, 15925Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

  • 12.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Haukenes, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Fjellman Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Evengard, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs2014Inngår i: PLoS ONE, ISSN 1932-6203, Vol. 9, nr 5, e97134Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS). Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high-and low-educated men. Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

  • 13.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Annandale, Ellen
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Christianson, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Elwer, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Eriksson, Carola
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gilenstam, Kajsa
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Harryson, Lisa
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Verdonk, Petra
    Central gender theoretical concepts in health research: the state of the art2014Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, nr 2, 185-190 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

  • 14.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Haukenes, Inger
    Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health; Research Unit for General Practice, Uni Research Health, Kalfarveien 31, Bergen, Norway.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients: A Study of Pain Rehabilitation2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 4, e0152735Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.

    METHODS: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.

    RESULTS: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.

    IMPLICATIONS: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.

    CONCLUSIONS: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.

  • 15. Kalawy, Hatem
    et al.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Linetsky, Felix
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: An ultrasound pilot study2013Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, nr 4, 173-179 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neovessels. Grey-scale US and CD are reliable methods used to evaluate structural homogeneity, thickness, and blood flow in the peripheral tendons. The aim of this study was to utilize CD to qualitatively evaluate for the presence of abnormal high blood flow in paravertebral tissues after whiplash injuries in patients with chronic neck pain.

    Methods

    Twenty patients with chronic neck pain after whiplash-associated disorder (WAD) and 20 pain-free control subjects were included in the study. The same experienced radiologist performed all grey-scale US and CD examinations.

    Results

    More regions with high blood flow were observed in the patient group than in the control group. At all levels, the high blood flow pattern was detected at the enthesis of the spinous processes and bilaterally juxtapositioned to the facet joints.

    Conclusion

    All regions identified by the patients as painful and tender corresponded to the positive high blood flow found during the CD examination.

    Implications

    These findings document increased blood-flow/neovascularisation at insertions of neck muscles which may indicate that there are pathological neovascularisation with accomanying pain- and sympathetic nerves, similar to what has been found in Achilles-tendinosis. These findings promise that similar treatments that now is successful with Achilles tendinosis, may be effective in the WAD-painful muscle insertions of the neck.

  • 16.
    Lehti, Arja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain2017Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, nr 1, 45-53 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.

    SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.

    RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.

    CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.

  • 17.
    Lilja, Aina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    DeMarinis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Theology, Psychology of Religion and Cultural Psychology, Uppsala University, Uppsala, Sweden; Mental Health Division, Innlandet Hospital Trust, Hamar, Norway.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 10, e011647Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare.

    DESIGN: Qualitative study using in-depth interviews and systematic text condensation analysis.

    PARTICIPANTS: 17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind.

    SETTING: The secular Swedish society.

    RESULTS: A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions.

    CONCLUSIONS: Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

  • 18. Ritte, Rebecca
    et al.
    Tikk, Kaja
    Lukanova, Annekatrin
    Tjonneland, Anne
    Olsen, Anja
    Overvad, Kim
    Dossus, Laure
    Fournier, Agnes
    Clavel-Chapelon, Francoise
    Grote, Verena
    Boeing, Heiner
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Berrino, Franco
    Mattiello, Amalia
    Tumino, Rosario
    Sacerdote, Carlotta
    Ramon Quiros, Jose
    Buckland, Genevieve
    Molina-Montes, Esther
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Amiano, Pilar
    Bueno-de-Mesquita, H. Bas
    van Gils, Carla H.
    Peeters, Petra H. M.
    Wareham, Nick
    Khaw, Kay-Tee
    Key, Timothy J.
    Travis, Ruth C.
    Weiderpass, Elisabete
    Dumeaux, Vanessa
    Lund, Eliv
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Andersson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Romieu, Isabelle
    Rinaldi, Sabina
    Vineis, Paulo
    Merritt, Melissa A.
    Riboli, Elio
    Kaaks, Rudolf
    Reproductive factors and risk of hormone receptor positive and negative breast cancer: a cohort study2013Inngår i: BMC Cancer, ISSN 1471-2407, Vol. 13, Article Number: 584- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The association of reproductive factors with hormone receptor (HR)-negative breast tumors remains uncertain. Methods: Within the EPIC cohort, Cox proportional hazards models were used to describe the relationships of reproductive factors (menarcheal age, time between menarche and first pregnancy, parity, number of children, age at first and last pregnancies, time since last full-term childbirth, breastfeeding, age at menopause, ever having an abortion and use of oral contraceptives [OC]) with risk of ER-PR-(n = 998) and ER+PR+ (n = 3,567) breast tumors. Results: A later first full-term childbirth was associated with increased risk of ER+PR+ tumors but not with risk of ER-PR-tumors (= 35 vs. = 19 years HR: 1.47 [95% CI 1.15-1.88] p(trend) < 0.001 for ER+PR+ tumors; = 35 vs. = 19 years HR: 0.93 [95% CI 0.53-1.65] p(trend) = 0.96 for ER-PR-tumors; P-het = 0.03). The risk associations of menarcheal age, and time period between menarche and first full-term childbirth with ER-PR-tumors were in the similar direction with risk of ER+PR+ tumors (p(het) = 0.50), although weaker in magnitude and statistically only borderline significant. Other parity related factors such as ever a full-term birth, number of births, age-and time since last birth were associated only with ER+PR+ malignancies, however no statistical heterogeneity between breast cancer subtypes was observed. Breastfeeding and OC use were generally not associated with breast cancer subtype risk. Conclusion: Our study provides possible evidence that age at menarche, and time between menarche and first full-term childbirth may be associated with the etiology of both HR-negative and HR-positive malignancies, although the associations with HR-negative breast cancer were only borderline significant.

  • 19.
    Semb, Olof
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Kaiser, Niclas
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Sven-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Learning psychology as a challenging process towards development as well as "studies as usual": a thematic analysis of medical students' reflective writing2014Inngår i: Advances in Medical Education and Practice, ISSN 1179-7258, Vol. 5, 491-498 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1) the course has enabled me and the class to develop, which is good albeit arduous; 2) understanding myself is a resource in understanding people as well as knowing psychology; 3) the course provided me with new, purely intellectual skills as well as eye-openers; and 4) the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students' writing process, concluded that students perceive the course as "Learning psychology as a challenging process towards development" as well as "studies as usual". Ethical, psychological, and pedagogical aspects are discussed in the paper.

  • 20.
    Stålnacke, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Haukenes, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Bergen, Norway.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Wiklund, Anncristine Fjellman
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 4, 365-371 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment. Methods: The population consisted of consecutive patients (n=589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record. Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker. Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.

  • 21. Sunding, Kerstin
    et al.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Werner, Suzanne
    Forssblad, Magnus
    Willberg, Lotta
    Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale2016Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 6, 1988-1996 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: In tendon research, using ultrasound (US), studies often refer to tendon thickness, structural abnormalities and neovascularisation. The reliability concerning these measurements and evaluations is seldom reported. The aim of this study was to assess the intra- and inter-observer reliability for quantitative measures (thickness) and qualitative evaluations (structure and neovascularisation) of symptomatic and asymptomatic Achilles and patellar tendons with US and colour Doppler using a modified Öhberg score.

    METHODS: Twenty-eight consecutive patients with symptomatic and asymptomatic Achilles (n = 27) and patellar tendons (n = 26) were included. Tendon anteroposterior thickness was measured. Tendon structure and neovascularisation were evaluated using a modified Öhberg score. US-images were evaluated twice by four independent observers.

    RESULTS: Mean thickness for Achilles and patellar tendons was 8.4 mm (±2.0) and 5.5 mm (±1.7), respectively. The reliability for measures of distance was high all over (ICC = 0.963-0.999). A moderate-strong correlation was found between observers concerning evaluation of neovascularisation (r = 0.767-0.992) and poor-moderate correlation concerning evaluation of structural changes (r = 0.379-0.837). Intra-observer reliability was moderate strong for evaluations of both tendon structure (k = 0.537-0.873) and neovascularisation (k = 0.639-0.864).

    CONCLUSIONS: With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.

  • 22. Sunding, Kerstin
    et al.
    Willberg, Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Werner, Suzanne
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Sclerosing injections and ultrasound-guided arthroscopicshaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study2015Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, nr 8, 2259-2268 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.

    METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-"Back in full loading activity?" yes or no.

    RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.

    CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.

  • 23.
    Sundström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Axelproblem hos badmintonspelare och brottare.2015Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 24.
    Thörn, Anton
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Stress och Stresshantering hos Läkarstudenter2015Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 25.
    Truedsson, Petra
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    ”Arbetsplatsträffen som verktyg i det systematiska arbetsmiljöarbetet”2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 26.
    von Knorring, Johanna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Om bara tiden räckte till? AT-läkares erfarenheter av empati i yrket och läkarblivandet.2014Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 27.
    Wemmert, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    "Because you become a newcomer in this world when you leave the cult.”2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 28. Wiitavaara, Birgitta
    et al.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Djupsjöbacka, Mats
    Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden: an investigation of 2000 randomly selected patient records2017Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, nr 2, 325-332 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES: The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC.

    METHODS: Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi-squared.

    RESULTS: The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled.

    CONCLUSIONS: The present study points out some weaknesses regarding diagnostics and management of MSD in primary care.

  • 29.
    Wiklund, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, 31542Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

    Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

    Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.

    Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

    Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

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