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Introduktion: Diskbråck i ländryggen med symtom av ischias, bensmärta, är en vanlig orsak till specifika ryggbesvär. Konservativa behandlingsmetoder rekommenderas före kirurgi. Diagnosen diskbråck är förknippad med kraftig smärta och begränsningar och är en vanlig orsak till att söka vård och behandling. Trots detta finns det idag ingen konsensus kring vilka behandlingsmetoder som är mest effektiva vid diskbråck.

Syfte: Att undersöka effekten av nervrotsblockad i kombination med individanpassad fysioterapi på smärta och aktivitetsförmåga för patienter med symtomgivande lumbosakralt diskbråck.

Metod: Studiens utformning var en Single Subject Experimental Design (SSED), med en A-B design. Under baslinjefasen, A och interventionsfasen, B utfördes systematiska och upprepade mätningar av smärtintensitet och aktivitetsförmåga över tid. Totalt fem patienter med lumbosakralt diskbråck rekryterades från en klinik. Studien omfattades av två interventioner. Två patienter behandlades med nervrotsblockad (NRB) i kombination med individanpassad fysioterapi och tre patienter behandlades endast med NRB. Mätdata presenteras med grafer i linjediagram och analyserades visuellt.

Resultat: De två patienterna som fick NRB i kombination med individanpassad fysioterapi förbättrades avseende smärta respektive aktivitetsförmåga, under nio respektive fem veckors interventionsfas. Av de tre patienter som behandlades enbart med NRB upplevde en patient en försämring avseende smärta och aktivitetsförmåga, en valde att avsluta sin medverkan och en behandlades som bortfall.

Slutsats: NRB i kombination med individanpassad fysioterapi kan minska smärta och förbättra aktivitetsförmåga för enskilda patienter med symtomgivande lumbosakralt diskbråck.

Study Design Randomized controlled trial. Background Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. Objective To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Methods Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Methods Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Results Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). Conclusion An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance.

Study design: Inter-rater reliability study. Background: Physiotherapists (PTs) use clinical tests including movement tests to identify faulty movement patterns. Aims: To investigate the inter-rater-reliability of active movement tests in the cervical spine, shoulder joint and scapulo-thoracic joint, and to describe the reasons for judgment of a positive test. Methodology: Four PTs, two experienced and two recently educated (novice), rated performance of five movement tests for 36 participants. Twenty-one of the participants were patients under treatment because of neck and/or shoulder problems, while 15 participants declared no problem from this region of the body. All tests were video recorded and the ratings were done by observing the video recordings. First, the PTs judged the tests as negative (the movement being ideally performed) or positive (the movement not being ideally performed). Then, the PTs described why the movements that they judged positive were not being ideally performed, using a predefined protocol, which represented different movement quality aspects. The inter-rater reliability was calculated for each test using Kappa statistics between the two experienced and the two novice PTs, respectively, and between each of the experienced and each of the novice PTs. Major findings: The experienced PTs had a higher inter-rater reliability than the novice PTs. The reasons for considering a movement test being positive differed highly between the (novice) PTs. Principal conclusion: This study supports previous studies concluding that the observation of active movement tests is reliable when assessed by experienced PTs. Novice PTs might benefit from further supervision.

Background: The main aim was to examine whether patients with persistent upper quadrant pain have higher end-point variability in goal directed pointing movements than pain-free controls when the pointing task is performed in total darkness and under full vision. An additional aim was to study associations between the magnitude of end-point variability and a clinical movement control test battery and self-rated functioning among patients.

Methods: Seventeen patients and 17 age- and gender-matched pain-free controls performed a pointing task that evaluated end-point variability of repetitive shoulder movements in horizontal adduction and abduction with full vision, and abduction with no visual information, completed a movement control test battery of neck and shoulder control tests and answered questionnaires.

Results: Patients had higher end point variability for horizontal abduction when performed with no visual information. For horizontal adduction the variability was higher, but only when it was controlled for movement time. No significant correlations were found between end-point variability and self-rated functioning, nor between end-point variability and neuromuscular control of the glenohumeral joint.

Conclusions: This study provides preliminary evidence that patients with persistent neck/shoulder pain can partly compensate proprioceptive deficits in goal-directed arm movement when visual feedback is present.

The aims of the study were to evaluate the relative and absolute variability of upper (T11-L2) and lower (L2-S2) lumbar spinal alignment in power- and weightlifters during the deadlift and back squat exercises, and to compare this alignment between the two lifting groups. Twenty-four competitive powerlifters (n = 14) and weightlifters (n = 10) performed three repetitions of the deadlift and the back squat exercises using a load equivalent to 70% of their respective one-repetition maximum. The main outcome measures were the three-dimensional lumbar spinal alignment for start position, minimum and maximum angle of their spinal alignment, and range of motion measured using inertial measurement units. Relative intra-trial reliability was calculated using the two-way random model intraclass correlation coefficient (ICC) and absolute reliability with minimal detectable change (MDC). The ICC ranged between 0.69 and 0.99 and the MDC between 1 degrees-8 degrees for the deadlift. Corresponding figures for the squat were 0.78-0.99 and 1 degrees-6 degrees. In all participants during both exercises, spinal adjustments were made in both thoracolumbar and lumbopelvic areas in all three dimensions. In conclusion, when performing three repetitions of the deadlift and the squat, lumbar spinal alignment of the lifters did not change much between repetitions and did not differ significantly between power- and weightlifters.

BACKGROUND: Low back pain (LBP) is a common pain problem in powerlifters. There is a lack of evidence to guide powerlifters and health-care professionals in understanding the role of powerlifting in the development of LBP and treatment of injuries in powerlifters. This study aimed to describe functional impairments and patho-anatomical findings in eight powerlifters with and without LBP. METHODS: First, four powerlifters with LBP were recruited. Each powerlifter was then matched with a pain-free lifter (Control) by age, Body Mass Index and competition weight class. They all performed physical performance tests and were examined with magnetic resonance imaging. Four weeks prior to the examination the powerlifters also recorded training load. Powerlifters with LBP were also examined by a physiotherapist in order to define their pain and impairments. RESULTS: The four male powerlifters with LBP had a nociceptive pain associated with non-ideal squatting technique, higher flexibility in their lumbar spine than in their hips and patho-anatomical findings such as degenerated discs (four), spondylolysis (one) and spinal stenosis (one). However, the controls also showed similar functional impairments and patho-anatomical findings. CONCLUSIONS: Powerlifters with and without LBP show similar functional impairments and patho-anatomical findings. However, powerlifters' LBP seems associated with pain during movement and loading of the lumbar spine. The association and causation between specific functional impairments, patho-anatomical findings and LBP in powerlifters has to be further investigated in studies including more participants.

Prolonged computer use, especially if fatigue ensues, is associated with visual and musculoskeletal symptoms. The aim was to determine the time-course of perceived fatigue in the wrist, forearm, shoulder and eyes during a 60-min mouse task (painting rectangles), and whether object size and/or mouse use demands were of infl uence. Also, we investigated performance (number of rectangles painted), and whether perceived fatigue was paralleled by local muscle fatigue or tissue oxygenation.

Ten women performed the task for three conditions (crossover design). At condition 1, rectangles were 45 25 mm, square paint cursor size 1.3 1.3 mm, and mouse – pointer movement ratio 1:26. At condition 2, the same cursor size and mouse – pointer movement ratio was used, but rectangles were smaller. At condition 3, the smaller rectangles were used, but the cursor size was also smaller and mouse – pointer movement ratio was 1:8. The results showed increased self-reported fatigue over time, with the observed increase greater for the eyes, but no change in physiological responses. Condition 2 resulted in higher performance and increased eye fatigue. Perceived fatigue in the muscles or physiological responses did not differ between conditions. In conclusion, computer work tasks imposing high visual and motor demands, and with high performance, seemed to have an infl uence on eye fatigue.

STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.

OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.

SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.

METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.

RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.

CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.

LEVEL OF EVIDENCE: 3.

The main aim of the Swedish physical activity and fitness cohort study (SPAF-1958) was to describe physical fitness, physical activity, health, and lifestyle across part of the lifespan, and to assess the influences on these factors from the environment, personal factors, and genetics. There is inevitable dropout from longitudinal studies, and it may be systematic. The aim of this first paper of the second follow-up of SPAF-1958 was to provide a dropout analysis to consider to what extent the participants, at 52 years of age, remain a representative sample of the original adolescent study population. Additional aims were to provide an overview of the study protocol and the ongoing study population. Ongoing study participants in SPAF born in 1958 were, at the second follow-up at the age of 52, still representative of the study cohort in terms of sex, adolescent geographical area, upper secondary school program, adolescent body composition, muscular strength, and muscular endurance. However, a higher physical activity and, among women, a higher aerobic capacity in adolescence decreased the risk for dropout. It is important when interpreting results from longitudinal studies to adjust for the systematic dropout that could bias the conclusions drawn from the results.

The aims of the study were (1) to investigate the effects of participation in low impact body conditioning classes on physical fitness in sedentary women at different ages and (2) to examine the correspondence between physical self-concept and participation in, and fitness change after, the participation. Ninety-two sedentary women (mean age 44.2 years) participated in 11-weeks of bi-weekly classes that included cardiovascular, strength, core, endurance and mobility exercises, all performed in synchrony with music. Cardiorespiratory fitness, maximal lifting strength, mobility and balance tests were performed pre- and post the exercise period and the short-form Physical Self-Description Questionnaire (PSDQ-S) was completed. Zero-order Spearman correlation analyses showed that women who rated the PSDQ-S dimension Sport competence higher participated in a larger number of sessions (rs=0.24, p=0.040). At post-tests, all participants had increased their balance, the participants aged 20-34 years had increased their lifting strength, and the participants aged 35-65 years had increased their cardiorespiratory fitness and mobility. Most PSDQ-S dimensions did not affect performance change, but the perception of being physically active was related to increased cardiovascular fitness. We conclude that women with a sedentary lifestyle who wish to increase their physical capacity benefit from music exercise and that inquiries about perceived sport competence and physical activity can improve recommendations made by strength and conditioning professionals.

Background Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports.

Objective The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting.

Design Systematic review.

Data sources Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015.

Eligibility criteria for selecting studies Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality.

Results 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4–3.3 injuries/1000 hours of training and 1.0–4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors.

Summary/conclusions The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries.

Trial registration number PROSPERO CRD42015014805.

Vad är viktigast för att få en god hälsa som vuxen? Sedan 1974 har vi följt samma personer från 16 års ålder in i medelåldern och studerat deras hälsa från flera olika synvinklar. Nu pågår den tredje mätomgången.

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.

Introduktion: Spegeln har en lång historia som en väsentlig del i rehabilitering och används med varierade syften inom olika fysioterapeutiska områden. Forskning har dock visat att träning i speglade miljöer kan ge en negativ påverkan på självkänslan. Det är därför av stor vikt för fysioterapeuter att vara medveten om och inventera speglarnas olika påverkan.

Syfte: Syftet med studien var att utforska unga styrketränande kvinnors förhållande till speglar på gymmet och hur det påverkar deras kroppsuppfattning och självkänsla.

Metod: Studien baseras på kvalitativa intervjuer med fyra unga kvinnor. Inkluderingskriterierna är var unga styrketränande kvinnor i åldrarna 20-25 år. Intervjuguiden som användes är var semistrukturerade och analysmetoden är var Grounded Theory.

Resultat: Resultatet av analysen utmynnade i kärnkategorin ”Den laddade gymspegeln” och kategorier med tillhörande underkategorier. De kategorier som formulerades fram var: ”Speglad trygghet och motivation”, ”Reflekterad osäkerhet”, ”Den dömande gymspegeln”, ”Gymspegeln skapar bidrar till stressig gymmiljö”, ”Gymspegeln som förstärkare av krävande kroppsideal”. Som sista steg i analysen skapades en modell.

Konklusion: Unga styrketränande kvinnor upplevdeer att det finns en såväl positiv som negativ laddning med speglar på gymmet. Det var viktigt med speglar ur teknik- och skadepreventionssyfte. Samtidigt bidrog den speglade miljön till ett jämförande och ökat dömande. Det är fördelaktigt för fysioterapeuter att vara medvetna om speglarnas påverkan på unga styrketränande kvinnors självkänsla och kroppsuppfattning. Mer forskning krävs inom området.

The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting injection treatment. As the last resort, intra- or peritendinous open or endoscopic surgery are employed even though these also show varying results. This ESSKA basic science committee current concepts review follows the first part on the biology, biomechanics and anatomy of tendinopathies, to provide a comprehensive overview of the latest treatment options for tendinopathy as reported in the literature.

Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.

Proximal patellar Tendinopathy, commonly denominated as Jumper´s Knee, is widely considered to be a challenge to treat (Abat et al. in J Exp Orthop. 3:34, 2016). The treatment of patellar tendinopathy focuses on reducing if not eliminating the pain and improving function. At present, there are a several distinct treatments oriented to that end, and a “gold-standard” treatment might be in sight. (Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Spang C, Stephen J, van Bergen CJA, de Girolamo L. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options. J Exp Orthop. 2018 Sep 24;5(1):38. https://doi.org/10.1186/s40634-018-0145-5.)

Purpose: The present study aims to analyze the accuracy of injections aimed to hit the proximal and depth part of the patellar tendon "target point" in patellar tendinopathy, comparing ultrasound-guided or non-ultrasound-guided (blind) injections.

Methods: A cadaver randomized study was carried out. Injections were performed under ultrasound control, as well as blinded. There were 26 knees from fresh cadavers and injections were placed by 26 practitioners with experience in the use of musculoskeletal ultrasound and injection treatment. Each participant performed 6 ultrasound-guided and 6 blind punctures in different cadaveric specimens. This provided 312 injections that were analyzed in 2 different anatomical cuts, thus providing a database of 624 measurements for statistical analysis.

Results: Statistically significant differences were observed (p < 0.0001) in the distance from the target point between the ultrasound-guided and the non-guided infiltrations. The "unguided" injections were considered to have been performed on average 10 mm away from the target point compared to the "ultrasound-guided" injections. The ultrasound-guided injections obtained an accuracy of 74.36% while the "non-ultrasound-guided" injections obtained an accuracy of 11.54% (p < 0.0001).

Conclusion: The use of ultrasound to guide the positioning of injections on the dorsal side of the proximal patellar tendon had a significantly higher accuracy compared to blind injections. The finding provides knowledge of importance for injection treatment.

Chronic painful tendinopathy is common in elite and recreational athletes and in sedentary subjects; all may have to stop or decrease their level of physical activity [1, 2]. Midportion Achilles tendinopathy and for the younger and heavy loading population also patellar tendinopathy are problematic injuries. However, recent research on innervation patterns histopathology and pain mechanisms in Achilles and patellar tendons has led to an increased knowledge about the chronic painful tendon [3–6].

Stressrelaterad ohälsa är idag den vanligaste orsaken till nya sjukskrivningar i Sverige. Idag används trädgårdsterapi i ett rehabiliterande syfte för personer med stressrelaterad psykisk ohälsa. Det finns fortfarande ett kunskapsbehov angående behandlingsprocesser rörande målgruppen samt terapeutiska insatser i trädgårdsmiljö. Syftet med studien var att beskriva arbetsterapeuters erfarenheter av att arbeta i trädgårdsterapi för personer med stressrelaterad psykisk ohälsa. Fyra arbetsterapeuter med erfarenhet av trädgårdsterapi intervjuades och materialet analyserades med kvalitativ innehållsanalys. Resultatet visade att trädgårdsterapi främjar deltagarnas återhämtningsprocess. Trädgårdsterapins aktiviteter bidrar i synnerhet till återhämtning genom aktivitetsbalans, något som ej uppmärksammats i tidigare forskning. Vidare forskning behövs för att belysa ett deltagarperspektiv i trädgårdsterapi.

Introduktion: Fysisk inaktivitet är vanligt, och många äldre uppnår inte WHO:s rekommendationer om fysisk aktivitet, vilket kan leda till ohälsa. Fysisk aktivitet har positiv hälsopåverkan på autonoma nervsystemet, ANS, vilket kan återspeglas i hög hjärtfrekvensvariabilitet, HRV. Högintensiv intervallträning, HIT, är tidseffektivt och har påvisats påverka HRV och autonom kontroll.

Syfte: Syftet med studien är att i) undersöka hur autonom funktion hos äldre, mätt som hjärtfrekvensvariabilitet i vila samt hjärtfrekvens under aktivitet, påverkas av högintensiv intervallträning ,HIT, i form av extremt korta cykelsprintintervaller, samt ii) undersöka genomförbarheten av självständiga mätningar av autonom funktion i hemmet.

Metod: Åtta friska, fysiskt aktiva forskningspersoner, 65-75 år, genomförde modifierat Borgs Cycle Strength test och modifierat submaximalt Åstrandstest för att estimera maximal aerob och anaerob förmåga. Sju forskningspersoner (ett bortfall) genomförde en gruppträningsintervention av 6-sekunders HIT-intervaller. Självständiga HRV-mätningar genomfördes med pulsklocka, fyra ggr/vecka, under fem veckor. HRV, mätt i rMSSD,  samt hjärtfrekvens under uppvärmning och nedvarvning analyserades hos tre forskningspersoner i en single-subject-analys. Genomförbarheten av HRV-mätningarna studerades.

Resultat: Positiv påverkan på autonom kontroll, mätt i Root Mean Square of Successive Differences, rMSSD,, påvisades med statistik signifikans hos två av tre forskningspersoner, a=0,05. Hjärtfrekvens under uppvärmning och nedvarvning, HR_ex, var lägre under nedvarvning vid sista träningstillfället än det första hos alla forskningspersoner. HR_ex under uppvärmning minskade från första till sista träningstillfället för en forskningsperson, och var densamma för två forskningspersoner. Genomförbarhetsundersökningen resulterade i 20/20 insamlade mätpunkter för HRV.

Konklusion: HIT tycks ha positiv påverkan på autonom kontroll, i form av ökad HRV, hos friska, fysiskt aktiva äldre personer. Det är möjligt för äldre personer att självständigt mäta HRV med pulsklocka i hemmet.

Trots att individer med allergier själv vidtar åtgärder för att undvika allergiexponering och försöker minimera risker för insjuknande, utsätts de inför situationer i sin omgivande miljö som de inte kan kontrollera. Omgivningens kunskaper och synsätt kring allergier varierar. Syftet med denna studie var då att belysa hur individer med astma, allergi- och överkänsligheter upplever att omgivningens indirekta- och direkta bemötande inverkar på sättet att se på sig själva, sin livssituation och sin delaktighet i aktivitet. Fyra kvinnor med olika typer av astma, allergi och överkänslighet intervjuades. Kvalitativ innehållsanalys användes för att bearbeta det insamlade intervjumaterialet. Resultatet presenterades i fem huvudkategorier: Viljan att berätta beror på vem du möter. Att tvingas prioritera och acceptera risker för att få vara delaktig. Familj och vänners stöd underlättar. Vårdens och samhällets bemötande skapar osäkerhet. Andras agerande och kunskap påverkar. Denna studie visar bland hur omgivningens sätt att bemöta kan ha en försvårande och underlättande effekt för individer med allergiers självbild, livssituation och delaktighet i samhället, både fysiskt och socialt. Slutsatsen är att andra människors bemötanden, beteenden och sätt att vara har betydelse för hur individer med allergier påverkas av sin sjukdom. Arbetsterapeuter kan med sina kunskaper bidra till ökad förståelse och delaktighet för målgruppen i samhället.

Sökord: allergi, hanteringsstrategier, bemötande, delaktighet, aktivitetsorättvisor, arbetsterapi   

Trots att individer med allergier själv vidtar åtgärder för att undvika allergiexponering och försöker minimera risker för insjuknande, utsätts de inför situationer i sin omgivande miljö som de inte kan kontrollera. Omgivningens kunskaper och synsätt kring allergier varierar. Syftet med denna studie var då att belysa hur individer med astma, allergi- och överkänsligheter upplever att omgivningens indirekta- och direkta bemötande inverkar på sättet att se på sig själva, sin livssituation och sin delaktighet i aktivitet. Fyra kvinnor med olika typer av astma, allergi och överkänslighet intervjuades. Kvalitativ innehållsanalys användes för att bearbeta det insamlade intervjumaterialet. Resultatet presenterades i fem huvudkategorier: Viljan att berätta beror på vem du möter. Att tvingas prioritera och acceptera risker för att få vara delaktig. Familj och vänners stöd underlättar. Vårdens och samhällets bemötande skapar osäkerhet. Andras agerande och kunskap påverkar. Denna studie visar bland hur omgivningens sätt att bemöta kan ha en försvårande och underlättande effekt för individer med allergiers självbild, livssituation och delaktighet i samhället, både fysiskt och socialt. Slutsatsen är att andra människors bemötanden, beteenden och sätt att vara har betydelse för hur individer med allergier påverkas av sin sjukdom. Arbetsterapeuter kan med sina kunskaper bidra till ökad förståelse och delaktighet för målgruppen i samhället.

Sökord: allergi, hanteringsstrategier, bemötande, delaktighet, aktivitetsorättvisor, arbetsterapi   

Personer med ätstörningsproblematik kan ha en bristande insikt och ett kontrollbehov gentemot sin ätstörning. De kan även stundtals vara omotiverade till behandling och kan känna svårigheter i att förändra sitt beteende för att kunna bli fri från sin ätstörning. Detta kan försvåra för arbetsterapeuten att få dessa personer delaktiga i behandlingen, och därför blir syftet med studien att belysa arbetsterapeuters erfarenheter av vad som kan möjliggöra eller hindra delaktighet i behandlingen för personer med ätstörningsproblematik. Fem arbetsterapeuter intervjuades för att kunna besvara syftet och innehållet analyserades utifrån kvalitativ innehållsanalys. Resultatet presenterades i fyra kategorier; samarbete med patienten, klientcentrerad behandling, att medvetet använda sig själv och motivationens betydelse. Studiens slutsats är att om arbetsterapeuten lyckas skapa ett förtroende hos patienten, kan detta möjliggöra att patienten blir mer motiverad till att vilja bli fri från sin ätstörning. Detta kan uppnås genom att arbetsterapeuten bemöter patienten som en unik och kompetent person och tillsammans med denne reflekterar över personens livssituation och sätter upp mål i behandlingen, vilket leder till en ökad delaktighet i behandlingen. 

We present a procedure for performing an ANOVA test on functional data, including pairwise group comparisons. in a Scheff´e-like perspective. The test is based on the Interval Testing Procedure, and it selects intervals where the groups significantly differ. The procedure is applied on the 3D kinematic motion of the knee joint collected during a functional task (one leg hop) performed by three groups of individuals.

Motivated by the analysis of the dependence of knee movement patterns during functional tasks on subject-specific covariates, we introduce a distribution-free procedure for testing a functional-on-scalar linear model with fixed effects. The procedure does not only test the global hypothesis on the entire domain but also selects the intervals where statistically significant effects are detected. We prove that the proposed tests are provided with an asymptotic control of the intervalwise error rate, that is, the probability of falsely rejecting any interval of true null hypotheses. The procedure is applied to one-leg hop data from a study on anterior cruciate ligament injury. We compare knee kinematics of three groups of individuals (two injured groups with different treatments and one group of healthy controls), taking individual-specific covariates into account.

Background: To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.

Methods: The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.

Results: Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026–1.152, p < 0.05) and (OR 1.057; 95% CI 1.017–1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918–0.984, p < 0.05) and (OR 0.781; 95% CI 0.645–0.946, p < 0.05), respectively.

Conclusions: Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.

Depression kan drabba personer i alla åldrar och är en av de vanligaste psykiska sjukdomarna i Sverige och i världen. I Sverige drabbas ca 4-10% av befolkningen av depression och symtom kan återkomma flera gånger under en livstid, vilket beskrivs som depressiva episoder. Sjukdomstillståndet kan leda till nedsatt livskvalitet som orsakas av depressiva symtom som nedstämdhet, minskat intresse, aptitförändring, sömnsvårigheter, energilöshet, pessimistiska tankar, koncentrationssvårigheter och självmordstankar. Studiens syfte var att identifiera och beskriva effekten av arbetsterapeutiska interventioner vid diagnostiserad depression samt att belysa upplevelsen av dessa interventioner.  Nio vetenskapliga artiklar granskades och analyserades i en litteraturöversikt. Endast vuxna deltagare med egentlig depression som primär diagnos inkluderades i sökning i databaserna PsycINFO, Academic Search Elite, PubMed, - OT-Seeker och CINAHL. Resultatet presenterar aktivitetsbaserade interventioner för att hantera vardagen så som arbetsinriktade interventioner, skapande aktiviteter och programbaserade interventioner. Effekter av dessa arbetsterapeutiska interventioner beskrivs förbättra klientens livskvalitet, minska depressions symtom, öka känsla av delaktighet och tillfredställelse i vardagliga aktiviteter, samt främja klientens återgång till arbete utan att uppleva ökad stress. Författaren i den här studien anser att det kan vara av stor betydelse för yrkesverksamma arbetsterapeuter att använda sig av aktivitetsbaserade interventioner som känns meningsfulla och tillfredställande för klienten. Ytterligare forskning behövs dock, då det finns för få studier som undersöker effekten av arbetsterapeutiska interventioner för personer med depression och upplevelse av att leva med depression. 

Fotboll är en högintensiv sport med intermittent arbete och har höga krav på den aeroba förmågan. För att utveckla den aeroba förmågan hos fotbollsspelare används ofta small sided games (SSG). Träningsmetoden liknar match men spelas på mindre yta med färre spelare. I ett idrottssammanhang visar tidigare forskning på samband mellan inre motivation och större upplevd glädje till aktiviteten, så även uthållighet i att utföra aktiviteter till hands. Detta kan komma att påverka idrottares utveckling samt prestation. Studien jämförde yttre fysisk belastning (Total distans (TD), sprintlöpningar (SL), höghastighetslöpningar (HHL), accelerationer (ACC) och deaccelerationer (DEC) i SGG mellan olika planstorlekar och antal spelare. Vidare undersöktes om spelarnas typ av motivation skiljde sig mellan uppläggen, samt om samband mellan motivationsformerna och yttre fysisk belastning fanns. Sjutton fotbollsspelare (18 ± 1 år) från ett pojklag deltog i studien. Global Positioning System data samlades in via Polar Team Pro applikation som tilldelades av fotbollsklubben. Planstorlek för uppläggen var 7 mot 7(7vs7); 50m x 35-45m, 4 mot 4(4vs4); 32m x 20m. Distansen var längre i SSG 7vs7 än i SSG 4vs4 (p <0.05), spelare gjorde även fler accelerationer (p <0.05) såväl som deaccelerationer (p <0.05) i SSG 7vs7. En enkät baserad på Situational Motivation Scale (SIMS) användes för att identifiera spelarnas motivationsform; Inre motivation, identifierad reglering, extern reglering och amotivation. Resultatet visade inga signifikanta skillnader i motivationsform mellan SSG 7vs7 och SSG 4vs4. Resultatet visade ett signifikant negativt samband mellan amotivation och TD i SSG 7vs7, samt ett mellan identifierad reglering och SL i SSG 7vs7. Studien visar att olika upplägg av smålagsspel påverkar den yttre fysiska belastningen hos unga fotbollsspelare på olika sätt samt att spelarnas motivationsform kan påverka utfallet av träningen och utvecklingen. Vidare krävs mer forskning på unga fotbollsspelare för att säkerställa pålitliga resultat.  

Invariance of surveys across different groups means that the respondents interpret the items in the same way, as reflected in similar factor loadings, for example. Invariance can be assessed using various statistical procedures, such as Multi-Group Confirmatory Factor Analysis. However, these analyses require access to raw data. Here, we introduce a meta-analytic method that requires only the factor correlation matrices of samples as input. It compares the structures of intercorrelations of factors by correlating these values across two samples, yielding a value of overall similarity for how the factors intercorrelate in different samples. This method was tested in three different ways. We conclude that the method yields useful results and can assess invariance when raw data are not available.

Attention deficit hyperactivity disorder (ADHD) är den vanligaste diagnosen inom neuropsykiatriska funktionsnedsättningar för barn. Utmärkande symptom för en person med diagnosen ADHD är svårigheter att utföra uppgifter, fokusera, bibehålla uppmärksamhet och passa tider, vilket är faktorer som kan påverka skolgången negativt. Arbetsterapeutiska interventioner har framtagits för att främja delaktigheten av barn med ADHD i skolmiljö. Det är dock oklart vad dessa interventioner har för effekt bland barn med ADHD. Syftet med denna litteratöversikt var att beskriva arbetsterapeutiska interventioner och dess effekt för barn i åldern 6-18 år med diagnosen ADHD i skolmiljö samt diskutera dessa utifrån ett arbetsterapeutiskt perspektiv. Till denna litteraturstudies metod användes en kvantitativ litteraturöversikt och de valda databaserna till huvudsökningen var Cinahl, PubMed och Academic Search Premier. Utifrån de sju inkluderade artiklarna hittade författarna interventioner som föll under två rubriker som presenterades enligt följande: Kompensatoriska interventioner i stillasittande skolarbete och dess effekt och Intervention för målsättning och effekt. Slutsatsen visade på att interventionerna viktväst, Cognitive-Functional, sittdynor och tidshjälpmedel hade positiv effekt på barns prestation i skolmiljö, förmåga att skapa egna mål och bibehålla uppmärksamheten i klassrumsmiljö. Terapibollar påvisade ingen effekt. Det finns ett fortsatt behov av forskning inom detta område då det finns en begränsad mängd forskning om ämnet i nuläget och särskilt när det gäller flickor med diagnosen.

Objective: To assess the impact of coronavirus on the physical activity levels before and during self-quarantine, and the effect of self-isolation on the total mood status of Iranian citizens during the covid-19 pandemic. 

Material and Methods: A national sample of 2359 middle-aged (M age=42.8±5.3 years, n=1183,50.1%, male; n=1148, 48.7% female) Iranian completed an online questionnaire that assessed changes in daily physical activity behavior and mood status from March 20th to April 20th, 2020. The questionnaire implemented to collect the total duration, intensity, and frequency of physical activity and their psychological mood condition via the BRUMS Mood Scale.

Results: There were significant differences between physical activity frequency, duration, and intensity before and during the coronavirus pandemic. There was no significant difference between the total mood conditions between the sex categories. The main key finding of the current study is that the total physical activity participation behavior of our middle-aged populations has decreased meaningfully.

Conclusion: The present study has provided important approaches that should be implemented to promote the engagement of middle-aged adults in physical activity. Therefore, based on scientific evidence, maintaining a regular physical activity routine regarding world health organization guidelines is a key strategy for physical health.

BACKGROUND: Co-creation is an approach that aims to democratize research and bridge the gap between research and practice, but the potential fragmentation of knowledge about co-creation has hindered progress. A comprehensive database of published literature from multidisciplinary sources can address this fragmentation through the integration of diverse perspectives, identification and dissemination of best practices, and increase clarity about co-creation. However, two considerable challenges exist. First, there is uncertainty about co-creation terminology, making it difficult to identify relevant literature. Second, the exponential growth of scientific publications has led to an overwhelming amount of literature that surpasses the human capacity for a comprehensive review. These challenges hinder progress in co-creation research and underscore the need for a novel methodology to consolidate and investigate the literature.

OBJECTIVE: This study aimed to synthesize knowledge about co-creation across various fields through the development and application of an artificial intelligence (AI)-assisted selection process. The ultimate goal of this database was to provide stakeholders interested in co-creation with relevant literature.

METHODS: We created a novel methodology for establishing a curated database. To accommodate the variation in terminology, we used a broad definition of co-creation that encompassed the essence of existing definitions. To filter out irrelevant information, an AI-assisted selection process was used. In addition, we conducted bibliometric analyses and quality control procedures to assess content and accuracy. Overall, this approach allowed us to develop a robust and reliable database that serves as a valuable resource for stakeholders interested in co-creation.

RESULTS: The final version of the database included 13,501 papers, which are indexed in Zenodo and accessible in an open-access downloadable format. The quality assessment revealed that 20.3% (140/688) of the database likely contained irrelevant material, whereas the methodology captured 91% (58/64) of the relevant literature. Participatory and variations of the term co-creation were the most frequent terms in the title and abstracts of included literature. The predominant source journals included health sciences, sustainability, environmental sciences, medical research, and health services research.

CONCLUSIONS: This study produced a high-quality, open-access database about co-creation. The study demonstrates that it is possible to perform a systematic review selection process on a fragmented concept using human-AI collaboration. Our unified concept of co-creation includes the co-approaches (co-creation, co-design, and co-production), forms of participatory research, and user involvement. Our analysis of authorship, citations, and source landscape highlights the potential lack of collaboration among co-creation researchers and underscores the need for future investigation into the different research methodologies. The database provides a resource for relevant literature and can support rapid literature reviews about co-creation. It also offers clarity about the current co-creation landscape and helps to address barriers that researchers may face when seeking evidence about co-creation.

Introduktion: Vikten av fysisk aktivitet är väl utredd, men kunskapsunderlaget om hur aktiva våra yngre barn är idag är fortfarande tunt. Tri-accelerometer har visat sig vara en valid metod att mäta aktivitet hos barn.

Syfte: Syftet med studien är att undersöka och kartlägga den totala fysiska aktivitetsnivån under en veckas tid hos barn i årskurs tre på en skola i norra Sverige. Ytterligare syfte är att se hur stor andel av barnen som når upp till rekommenderad dos av daglig aktivitet, samt om det finns någon signifikant skillnad i aktivitetsnivå sett utifrån kön eller deltagande i organiserad idrott eller ej.

Metod: Fyrtio barn deltog i studien. Deltagarnas aktivitet registrerades under en veckas tid genom en tri-accelerometer. Ett kortare frågeformulär angående deras fysiska aktivitet besvarades även.

Resultat: Ingen signifikant skillnad avseende kön eller deltagande i organiserad idrott eller ej kunde påvisas. 39 av 40 deltagare nådde upp till rekommenderad dos av daglig aktivitet.

Diskussion: Utifrån studien så förefaller barn i årskurs tre vara tillräckligt aktiva för att uppnå kraven på daglig aktivitetsdos, ett positivt resultat då larmrapporter om alltmer stillasittande förekommer. Större och djupare studier behövs för att se om dessa resultat stämmer i ett större sammanhang.

Inledning:

I Sverige förväntas medelåldern att stiga och den äldsta åldersgruppen förutspås växa sig allt större. Nedgång i fysisk funktion och kognitiv funktion är vanligt bland människor som är äldre. Nyligen genomförda tvärsnitts- och longitudinella studier visar att det finns ett samband mellan gång och kognition. Tyvärr är forskningen begränsad då den nästintill exkluderar mycket gamla människor.Syfte:

Utforska sambandet mellan självvald gånghastighet och kognition hos mycket gamla människor. Det specifika syftet är att analysera sambandet vid baslinjen och vid 5 års uppföljning samt sambandet i förändringen hos mycket gamla människor. Metod:

Deltagare undersökta i Umeå 85 + / Gerontologisk regional databas-studie (GERDA), med en ålder på 85 år eller äldre, bedömdes vid baslinjen och med 5 års uppföljning. Självvald gånghastighet mättes med 2,4 meters gångtest och individernas kognitiva funktion undersöktes med hjälp av Mini-Mental State Examination.Resultat:

Medelåldern vid baslinjen var 89,76 (SD ± 4,82). Korrelation för förändringen i självvald gånghastighet och Mini-Mental State Examination mellan baslinjen och vid uppföljningen (n = 277), r = .251, p <.001, r2 värde .063. Konklusion:

Det finns ett samband mellan självvald gånghastighet och kognitiv funktion bland de mycket gamla, både tvärsnitt och longitudinellt. Sambandet är starkt bland de som utvecklar demens.

Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

Implications for rehabilitation

Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

Objective: The objective of this study was to from a gender perspective, explore elementary school teacher' experiences of their work situation, and identify conditions that could be health risks. Participants: Eighteen female teachers who work in an elementary school in Northern Sweden. Method: Thematic interviews were conducted using an interview guide. The interviews were tape-recorded and transcribed verbatim. Qualitative content analysis was used to analyse the transcribed text and interpretations were made within gender theory. Results: Four categories emerged: "Squeezed between dream and reality", "Effort to keep up with demands", "We can make it together" and "The school needs men's qualities". The categories were linked together with the theme "A struggle for time to teach". The theme describes the conflict between the teachers' ambitions to teach and create a stimulating learning environment versus the increased need for behaviour control that took time from classroom work. Beside work at the school, the teachers carried a large burden of domestic work. Conclusions: Teachers' work includes both endless demands and great joy. Their work is structured within the schools gender system in which caring duties are subordinated despite a growing demand for behaviour control. Traditional gender roles affect their domestic work load.

BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.

PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.

METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.

RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".

CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

The objective of this study was to assess the relationships between physical and psychosocial work exposures, engagement in domestic work and work-home imbalance in relation to symptoms of musculoskeletal disorders and emotional exhaustion in white- and blue-collar men and women. Three thousand employees from 21 companies were asked to answer a questionnaire on family structure, household and child care tasks, work exposure, work-home imbalance and symptoms of neck/shoulder disorders, low back disorders and emotional exhaustion. Women reported more musculoskeletal disorders and engagement in domestic work. Adverse at-work exposures were highest in blue-collar women. High engagement in domestic work was not separately associated with symptoms but paid work exposure factors were associated. High engagement in domestic work interacted with adverse work exposure and increased risk estimates for low back disorders and emotional exhaustion. Reported work-home imbalance was associated with neck/shoulder disorders in women and with emotional exhaustion in both women and men.

Practitioner Summary. The current article adds to earlier research by showing that high engagement in domestic work is not separately associated with increased symptoms, but interacts with psychosocial work exposure variables to produce emotional exhaustion in both women and men and low back disorders in women.

To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.

Bakgrund: Hjärnskakning är en vanlig diagnos och vissa patienter upplever att fysisk ansträngning utlöser symtom lång tid efter hjärnskakningen. En förändring i reglering av cerebralt blodflöde (CBF) har visats vara en potentiell orsak bakom detta. Konditionsträning under tröskeln för symtomexacerbation kan förkorta återhämtningstiden för patienterna. På Neurorehab vid Norrlands universitetsjukhus i Umeå identifieras tröskeln med ett stegrat arbetsprov på ergometercykel. Det finns inte någon studie där transkraniell doppler (TCD) använts för att mäta förändringar i cerebralt blodflöde (CBF) under detta arbetsprov.

Syfte: Att undersöka genomförbarhet och klinisk relevans av att använda TCD för mätning av blodflödeshastighet i arteria cerebri media (ACMh), hos friska män, under stegrat arbetsprov.

Metod: Sex friska och regelbundet aktiva män genomförde ett stegrat arbetsprov på ergometercykel under samtidig mätning av hjärtfrekvens, blodtryck, partialtryck end-tidal CO2 (PetCO2) och blodflödeshastighet i arteria cerebri media (ACMh, mätt med TCD). Smärta från TCD-utrustning och upplevd ansträngning skattades. Tidsåtgången för TCD-tillägget samt eventuell signalförlust noterades.

Resultat: Fem studiedeltagare rapporterade ökad smärta (huvudvärk), skattad med Borg CR10 skala, från TCD-utrustningen. Total tidsåtgång för TCD-tillägget var 7 minuter och 40 sekunder i median (IQR, 5 minuter och 32 sekunder). Signalförlust uppstod för en studiedeltagare på vänster sida. PetCO2 och ACMh följdes åt under arbetsprovet bortsett från avvikelser vid två tillfällen.

Slutsatser: Studien visar att mätning av ACMh med TCD är genomförbart och ger relevant information om hur CBF ter sig under genomförandet av stegrat arbetsprov. TCD-utrustningen orsakade smärta vilket kan vara problematiskt vid genomförande för personer med postkontusionellt syndrom.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.

In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).

We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. 

In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention. 

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.