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  • 1.
    Anåker, Anna
    et al.
    Falun, Sweden.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Elf, Marie
    Falun, Sweden.
    Nurses' perceptions of climate and environmental issues: a qualitative study2015Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, nr 8, s. 1883-1891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.

    BACKGROUND: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.

    DESIGN: This is a descriptive, explorative qualitative study.

    METHODS: Nurses (n = 18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.

    RESULTS: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.

    CONCLUSIONS: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

  • 2. Heggelund, Julie E.
    et al.
    Haugen, Espen
    Lygren, Birgitte
    Mackenzie, Alasdair
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Vasile, Francesca
    Reina, Jose J.
    Bernardi, Anna
    Krengel, Ute
    Both El Tor and classical cholera toxin bind blood group determinants2012Ingår i: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 418, nr 4, s. 731-735Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cholera is a disease which shows a clear blood group profile, with blood group 0 individuals experiencing the most severe symptoms. For a long time, the cholera toxin has been suspected to be the main culprit of this blood group dependence. Here, we show that both El Tor and classical cholera toxin B-pentamers do indeed bind blood group determinants (with equal affinities), using Surface Plasmon Resonance and NMR spectroscopy. Together with previous structural data, this confirms our earlier hypothesis as to the molecular basis of cholera blood group dependence, with an interesting twist: the shorter blood group H-determinant characteristic of blood group 0 individuals binds with similar binding affinity compared to the A-determinant, however, with different kinetics. (C) 2012 Elsevier Inc. All rights reserved.

  • 3.
    Holmner, Åsa
    et al.
    Department of Chemistry and Bioscience, Chalmers University of Technology, PO box 462, SE-40530 Göteborg, Sweden; Department of Chemistry, University of Oslo, PO box 1033 Blindern, NO-0315 Oslo, Norway.
    Askarieh, Glareh
    Ökvist, Mats
    Krengel, Ute
    Blood group antigen recognition by Escherichia coli heat-labile enterotoxin2007Ingår i: Journal of Molecular Biology, ISSN 0022-2836, E-ISSN 1089-8638, Vol. 371, nr 3, s. 754-764Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a number of bacterial infections, such as Helicobacter pylori, Campylobacter jejuni and Vibrio cholerae infections, a correlation between the severity of disease and blood group phenotype of infected individuals has been observed. In the present investigation, we have studied the molecular basis of this effect for enterotoxigenic Escherichia coli (ETEC) infections. ETEC are non-invasive bacteria, which act through second messenger pathways to cause diarrhea. It has been suggested that the major virulence factor of ETEC from human isolates, i.e. the human heat-labile enterotoxin (hLT), recognizes certain blood group epitopes, although the molecular basis of blood group antigen recognition is unknown. The 2.5 angstrom crystal structure of the receptor-binding B-subunit of hLT in complex with the blood group A antigen analog GalNAc alpha 3(Fuc alpha-2)Gal beta 4(Fuc alpha-3)Glc beta provides evidence of a previously unknown binding site in the native toxin. The structure reveals the molecular interactions underlying blood group antigen recognition and suggests how this protein can discriminate between different blood group epitopes. These results support the previously debated role of hLT in the blood group dependence of ETEC infections. Similar observations regarding the closely related cholera toxin in V. cholera infections are also discussed.

  • 4.
    Holmner, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. ClimAdapt, LLC, Seattle, Washington, United States of America.
    Lazuardi, Lutfan
    Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Carbon footprint of telemedicine solutions - unexplored opportunity for reducing carbon emissions in the health sector2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 9, artikel-id e105040Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.

    OBJECTIVES: To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.

    METHODS: A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.

    RESULTS: Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.

    CONCLUSIONS: Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.

  • 5.
    Holmner, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Climate change and eHealth: a promising strategy for health sector mitigation and adaptation2012Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, s. 1-9Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Climate change is one of today's most pressing global issues. Policies to guide mitigation and adaptation are needed to avoid the devastating impacts of climate change. The health sector is a significant contributor to greenhouse gas emissions in developed countries, and its climate impact in low-income countries is growing steadily. This paper reviews and discusses the literature regarding health sector mitigation potential, known and hypothetical co-benefits, and the potential of health information technology, such as eHealth, in climate change mitigation and adaptation. The promising role of eHealth as an adaptation strategy to reduce societal vulnerability to climate change, and the link's between mitigation and adaptation, are also discussed. The topic of environmental eHealth has gained little attention to date, despite its potential to contribute to more sustainable and green health care. A growing number of local and global initiatives on 'green information and communication technology (ICT)' are now mentioning eHealth as a promising technology with the potential to reduce emission rates from ICT use. However, the embracing of eHealth is slow because of limitations in technological infrastructure, capacity and political will. Further research on potential emissions reductions and co-benefits with green ICT, in terms of health outcomes and economic effectiveness, would be valuable to guide development and implementation of eHealth in health sector mitigation and adaptation policies.

  • 6. Lazuardi, Lutfan
    et al.
    Sanjaya, Guardian Yoki
    Candradewi, Ika
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Automatic Platelets Counter for Supporting Dengue Case Detection in Primary Health Care in Indonesia2013Ingår i: Medinfo 2013: proceedings of the 14th World Conference on Medical and Health Informatics, Pts 1 and 2 / [ed] Lehmann, CU Ammenwerth, E Nohr, C, IOS Press, 2013, s. 585-588Konferensbidrag (Refereegranskat)
    Abstract [en]

    Dengue fever is a major problem in many developing countries, including Indonesia. Laboratory examination is used to diagnose dengue infection and to monitor disease progression. Hematology tests, such as platelet count, are also used for timely recognition of the development of severe dengue. In primary health care centers platelet counting is typically performed manually, which is labor intensive and requires an experienced laboratory technician. To address this challenge, we have developed an automatic platelet counter for primary health care and resource-poor settings. The technology is based on a conventional microscope equipped with a digital camera linked to a personal computer, which can capture and analyze microscope images of blood samples. To evaluate the accuracy of the technology, it was compared to platelet counts performed manual by an experienced laboratory technician. Statistical analysis shows no difference between the techniques with a kappa coefficient of 0.6. This method is judged to have great potential as a tool to help primary health centers and other facilities with limited resources to deal with the burden of dengue.

  • 7.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 1, s. 11-26Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used. 

    Methods: Randomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.

    Results: Nine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95% CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education. 

    Conclusions: The use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.

  • 8.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. School of Education, Health and Social Studies, Dalarna University, Sweden.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective2017Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, artikel-id 467Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.

    Methods: The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.

    Results: The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.

    Conclusions: There is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.

  • 9.
    Ramadona, Aditya Lia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Center for Environmental Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia.
    Lazuardi, Lutfan
    Hii, Yien Ling
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Kusnanto, Hari
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Prediction of Dengue Outbreaks Based on Disease Surveillance and Meteorological Data2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 3, artikel-id e0152688Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research is needed to create early warnings of dengue outbreaks to inform stakeholders and control the disease. This analysis composes of a comparative set of prediction models including only meteorological variables; only lag variables of disease surveillance; as well as combinations of meteorological and lag disease surveillance variables. Generalized linear regression models were used to fit relationships between the predictor variables and the dengue surveillance data as outcome variable on the basis of data from 2001 to 2010. Data from 2011 to 2013 were used for external validation purposed of prediction accuracy of the model. Model fit were evaluated based on prediction performance in terms of detecting epidemics, and for number of predicted cases according to RMSE and SRMSE, as well as AIC. An optimal combination of meteorology and autoregressive lag terms of dengue counts in the past were identified best in predicting dengue incidence and the occurrence of dengue epidemics. Past data on disease surveillance, as predictor alone, visually gave reasonably accurate results for outbreak periods, but not for non-outbreaks periods. A combination of surveillance and meteorological data including lag patterns up to a few years in the past showed most predictive of dengue incidence and occurrence in Yogyakarta, Indonesia. The external validation showed poorer results than the internal validation, but still showed skill in detecting outbreaks up to two months ahead. Prior studies support the fact that past meteorology and surveillance data can be predictive of dengue. However, to a less extent has prior research shown how the longer-term past disease incidence data, up to years, can play a role in predicting outbreaks in the coming years, possibly indicating cross-immunity status of the population.

  • 10.
    Sulistyawati, Sulistyawati
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia.
    Dwi Astuti, Fardhiasih
    Rahmah Umniyati, Sitti
    Tunggul Satoto, Tri Baskoro
    Lazuardi, Lutfan
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Andersson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Dengue Vector Control through Community Empowerment: Lessons Learned from a Community-Based Study in Yogyakarta, Indonesia2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 6, artikel-id E1013Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Effort to control dengue transmission requires community participation to ensure its sustainability. We carried out a knowledge attitude and practice (KAP) survey of dengue prevention to inform the design of a vector control intervention. A cross-sectional survey was conducted in June⁻August 2014 among 521 households in two villages of Yogyakarta, Indonesia. Demographic characteristics and KAP questions were asked using a self-managed questionnaire. Knowledge, attitudes and practice scores were summarized for the population according to sex, age, occupation and education. The average knowledge score was rather poor-3.7 out of 8-although both attitude and practice scores were good: 25.5 out of 32 and 9.2 out of 11 respectively. The best knowledge within the different groups were found among women, the age group 30⁻44 years, people with a university degree and government employees. Best practice scores were found among retired people and housewives. There were several significant gaps in knowledge with respect to basic dengue symptoms, preventive practices and biting and breeding habits of the Aedes mosquito. In contrast, people's practices were considered good, although many respondents failed to recognize outdoor containers as mosquito breeding sites. Accordingly, we developed a vector control card to support people's container cleaning practices. The card was assessed for eight consecutive weeks in 2015, with pre-post larvae positive houses and containers as primary outcome measures. The use of control cards reached a low engagement of the community. Despite ongoing campaigns aiming to engage the community in dengue prevention, knowledge levels were meagre and adherence to taught routines poor in many societal groups. To increase motivation levels, bottom-up strategies are needed to involve all community members in dengue control, not only those that already comply with best practices.

  • 11.
    Tistad, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. School of Education, Health and Social Studies, Dalarna University, Falun.
    Lundell, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Usefulness and relevance of an eHealth Tool in supporting the self-management of chronic obstructive pulmonary disease: explorative qualitative study of a cocreative process2018Ingår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, nr 4, artikel-id e10801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives.

    Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers.

    Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis.

    Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge.

    Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.

  • 12.
    Wadell, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Bergmann, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Longitudinal, home-based study of lung function, saturation and disease-related symptoms in COPD2018Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Many telehealth (TH) systems have been designed to identify signs of COPD exacerbations, but few previous studies have reported the nature of recorded lung function data and what variations to expect in stable versus unstable patients.

    Aims: To evaluate the nature of individual diurnal, day-to-day and long-term variation in important prognostic markers of COPD exacerbations in a heterogeneous patient group by employing a newly developed TH system.

    Methods: Eight women and five men with COPD performed measurements (FEV1, IC, SpO2 and CAT) three times per week during 4-6 months using the TH system. Feasibility was based on the repeatability and quality of the FEV1 and IC measurements, as defined by ERS/ATS guidelines. Short-term and long-term individual variations were assessed using the relative density and mean (SD) respectively.

    Results: Close to 1100 FEV1 and IC measurements respectively were performed during a total of 240 patient weeks. The 2SD ranges for intra-individual variation were ± 210 mL and ± 350 mL for FEV1 and IC respectively. The values both increased and decreased without corresponding influence on symptoms (CAT) or SpO2 and no exacerbation was reported. However, it was unusual with a decrease of more than 50 mL per measurement in FEV1 between three consecutive measurement days.

    Conclusions: This study reveals important and, to our knowledge, previously not reported information about short and long-term variability in lung function measurements in stable patients with COPD, of significance when defining criteria for detecting exacerbations with TH systems.

  • 13.
    Öhberg, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Claesson, Kenji
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Edström, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Home-based system for recording pulmonary function and disease-related symptoms in patients with chronic obstructive pulmonary disease, COPD: a pilot study2016Ingår i: SM Journal of Pulmonary Medicine, ISSN 2574-240X, Vol. 2, nr 1, artikel-id 1011Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Many patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from acute exacerbations characterized by an increase in symptoms beyond normal day-to-day variation. The prognosis of patients with frequent exacerbations is poor and effort to curb these worsening episodes has great potential to improve the patient’s quality of life and to reduce associated costs. Telemonitoring has been proposed as a promising strategy in this respect. However, information on what physical signs or symptoms that should be recorded and how recorded data should be interpreted is largely missing in the literature.

    Methods: A new home-based system, based on a tablet computer, which can guide COPD patients to perform spirometry (inspiratory capacity, IC and forced expiratory volume in one and six seconds, FEV1 and FEV6) and record symptoms (COPD assessment test, CAT) was developed. The system was evaluated for 8-12 weeks in four patients with moderate to severe COPD with the aims to; i) assess the feasibility of the system to be used unsupervised by COPD patients and, ii) to evaluate the quality and ability of recorded parameters to reveal early signs of an exacerbation. Pearson bivariate correlation was performed between all outcome measures and descriptive information about inherent subject properties were presented.

    Results: The system was well accepted by all study subjects and the study generated a total of 253 measurements of which 94.5% were considered acceptable for analysis. One of the subjects developed an acute exacerbation towards the end of the study, whereas the other three subjects remained stable. Descriptive analysis of the data suggest that trends in the CAT score may indicate changes in health status and that IC tends to be more responsive to these changes compared to FEV1.

    Conclusion: The system developed in this study is well suited to be used unsupervised by COPD patients. Recorded data, in particular CAT, may be sensitive enough to detect early signs of an acute COPD exacerbation, although more data is needed to fully resolve the nature of such an association.

  • 14.
    Öhberg, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Zachrisson, Adam
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Holmner-Rocklöv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Three-Dimensional Camera System for Measuring Arm Volume in Women with Lymphedema Following Breast Cancer Treatment2014Ingår i: Lymphatic Research and Biology, ISSN 1539-6851, E-ISSN 1557-8585, Vol. 12, nr 4, s. 267-274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Lymphedema is a common complication following breast cancer treatment, estimated to affect 20% of breast cancer survivors. The condition is associated with a number of symptoms, such as impaired range of motion and anxiety. A wide range of methods for determining the volume of the lymphedematous arm have been described. Circumference measurement (CM) is commonly used in clinics to appraise arm volume, while water displacement (WD) is often used in studies. The aim of the study was to assess the performance of a new method using 3D-technology in comparison to CM and WD. Methods and Results: The study was performed on 25 subjects with lymphedema secondary to breast cancer treatment. Volumetric data from CM, WD, and the 3D-camera were gathered on all subjects. The measurements were performed by two physiotherapists, each subject being measured by one of the physiotherapist. Estimates of differences between the methods was calculated through analyzing the data collected from the three methods using mixed-design analyses of variance. The results indicated a tendency for the 3D-camera to overestimate the volume in comparison the WD by 45.25 mL, 95% confidence interval (CI) -36.31 - 126.82 (p value 0.270). Conversely, CM showed a tendency to underestimate the volume compared to WD (-24.28 mL, CI -99.78 - 51.22, p value 0.521). Thus, no statistically significant difference was found between the methods. Conclusions: The 3D-camera is a viable method for measuring arm volume, performing on level with the established methods WD and CM.

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