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  • 1. Bergström, Erik
    et al.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dahlqvist, Rune
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Birgander, Lisbeth Slunga
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    [Do better next time]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 8, p. 527-Article in journal (Other academic)
  • 2. Bergström, Erik
    et al.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dahlqvist, Rune
    Birgander, Slunga Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    [Criticism against a prioritization project in Vasterbotten. Serious prioritization work requires knowledge and open ethical principles]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 3, p. 126-127Article in journal (Other academic)
  • 3.
    Claesson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Birgander, Lisbeth Slunga
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Lindahl, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burell, G
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mattsson, Cecilia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized-controlled trial.2006In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 260, no 4, p. 320-331Article in journal (Refereed)
  • 4.
    Claesson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Slunga Birgander, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nasic, Salmir
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Åström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Burell, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Women's hearts - stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial.2005In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 25, no 2, p. 93-102Article in journal (Refereed)
  • 5.
    Dahlgren, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsman, Mikael
    IMM Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, Sweden.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Correlations between Ratings and Technical Measurements in Hand-Intensive Work2023In: Bioengineering, E-ISSN 2306-5354, Vol. 10, no 7, article id 867Article in journal (Refereed)
    Abstract [en]

    An accurate rating of hand activity and force is essential in risk assessment and for the effective prevention of work-related musculoskeletal disorders. However, it is unclear whether the subjective ratings of workers and observers correlate to corresponding objective technical measures of exposure. Fifty-nine workers were video recorded while performing a hand-intensive work task at their workplace. Self-ratings of hand activity level (HAL) and force (Borg CR10) using the Hand Activity Threshold Limit Value® were assessed. Four ergonomist observers, in two pairs, also rated the hand activity and force level for each worker from video recordings. Wrist angular velocity was measured using inertial movement units. Muscle activity in the forearm muscles flexor carpi radialis (FCR) and extensor carpi radialis (ECR) was measured with electromyography root mean square values (RMS) and normalized to maximal voluntary electrical activation (MVE). Kendall’s tau-b correlations were statistically significant between self-rated hand activity and wrist angular velocity at the 10th, 50th, and 90th percentiles (0.26, 0.31, and 0.23) and for the ratings of observers (0.32, 0.41, and 0.34). Significant correlations for force measures were found only for observer-ratings in five of eight measures (FCR 50th percentile 0.29, time > 10%MVE 0.43, time > 30%MVE 0.44, time < 5% −0.47) and ECR (time > 30%MVE 0.26). The higher magnitude of correlation for observer-ratings suggests that they may be preferred to the self-ratings of workers. When possible, objective technical measures of wrist angular velocity and muscle activity should be preferred to subjective ratings when assessing risks of work-related musculoskeletal disorders.

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  • 6.
    Dahlgren, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsman, Mikael
    IMM Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, Sweden.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ratings of hand activity and force levels among women and men who perform identical hand-intensive work tasks2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 24, article id 16706Article in journal (Refereed)
    Abstract [en]

    We compared hand activity and force ratings in women and men doing identical hand-intensive work tasks. Musculoskeletal disorders are more common in women and hand-intensive work leads to an increased risk of these disorders. Knowledge of the gender influence in the rating of work exposure is lacking. The aim of this study was to investigate whether women and men performing identical hand-intensive work tasks were equally rated using hand activity and normalized peak force levels with the Hand Activity Threshold Limit Value®. Fifty-six workers participated, comprising 28 women-men pairs. Four observers-two woman-man pairs-were also involved. Self-ratings and observers' ratings of hand activity and force level were collected. The results of these ratings showed no significant gender differences in self-rated hand activity and force, as well as observer-rated hand activity. However, there was a significant gender difference in the observer-rated force, where the women were rated higher (mean (SD): women 3.9 (2.7), men 3.1 (1.8) (p = 0.01)). This difference remained significant in the adjusted model (p = 0.04) with grip strength and forearm-finger anthropometrics. The results provide new insights that observers' estimates of force can be higher in women compared with men in the same work tasks. Force should be further investigated and preferably compared to objective measurements.

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  • 7.
    Erelund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nordendahl, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Sundström, Nina
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Heart rate variability and long-term survival in females with ischemic heart diseaseManuscript (preprint) (Other academic)
  • 8.
    Eskilsson, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ek Malmer, Elin
    Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder2020In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 3, p. 361-368Article in journal (Refereed)
    Abstract [en]

    It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.

  • 9.
    Eskilsson, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stigsdotter Neely, Anna
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre.
    Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial2017In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 17, no 1, article id 322Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program.

    METHODS: In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity.

    RESULTS: In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls.

    CONCLUSION: Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017.

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  • 10.
    Hadrévi, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Myte, Robin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Work-Related Stress Was Not Associated with Increased Cancer Risk in a Population-Based Cohort Setting2021In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 31, no 1, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Background: Stress is a commonly perceived cause of cancer, but the evidence to date is limited and inconclusive. We examined work-related stress in relation to cancer incidence in a population-based cohort, with outcome data from Swedish national registries.

    Methods: The study population included 113,057 participants in the Västerbotten Intervention Programme. HRs were estimated using Cox proportional hazards regression, for cancer overall and for types with ≥500 cases, and adjusting for several potential confounders. The primary exposure was prediagnostic work-related stress, using the well established Karasek job demand/control model. Demand and control variables were dichotomized at the median, and participants were classified according to combinations of these categories. We also considered social network and aspects of quality of life.

    Results: "High-strain" work (high demand/low control) was not associated with cancer risk compared with "low-strain" work (low demand/high control): multivariable HR 1.01 [95% confidence interval (CI), 0.94-1.08] for men and 0.99 (95% CI, 0.92-1.07) for women. Results were also null for most cancer types assessed: prostate, breast, colorectal, lung, and gastrointestinal (GI). The risk of GI cancer was lower for "passive" (low demand/low control) versus "low-strain" work, particularly for colorectal cancer in women: multivariable HR 0.71 (95% CI, 0.55-0.91), but statistical significance was lost after adjustment for multiple testing.

    Conclusions: The findings of this population-based, cohort study do not support a role for work-related stress in determining cancer risk.

    Impact: This study helps fill an important knowledge gap given the common concern about stress as a risk factor for cancer.

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  • 11.
    Lind, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Torbjörn K
    Ohlin, Ann-Kristin
    Birgander, Lisbeth Slunga
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Thrombomodulin as a marker for bleeding complications during warfarin treatment.2009In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 169, no 13, p. 1210-1215Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The major adverse effect of warfarin treatment is hemorrhage. Several risk factors for bleeding complications are also risk factors for thromboembolic events, making the clinical decision to initiate or withhold anticoagulant treatment difficult. Specific markers that solely identify patients at high risk of bleeding would have great clinical impact. This study aimed to test if thrombomodulin (TM) concentrations were associated with bleeding complications, cardiovascular events, or mortality in long-term anticoagulant-treated patients. METHODS: In a longitudinal cohort study we followed up 719 patients receiving warfarin treatment for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified. Soluble TM antigen (sTM) concentration in plasma was measured with an enzyme-linked immunosorbent assay method. RESULTS: During the follow-up time, 113 clinically relevant bleeding events and 73 major bleeding events occurred. Increased concentration of sTM was associated with both clinically relevant bleeding and major bleeding events after adjustment for age. In the multivariable models, hazard ratios for the highest tertiles compared with the lowest were 2.29 (95% confidence interval, 1.35-3.89) and 2.33 (95% confidence interval, 1.21-4.48), respectively. No association between sTM concentration and nonfatal ischemic cardiovascular events or all-cause mortality was found. CONCLUSIONS: Increased levels of sTM are associated with bleeding complications during warfarin treatment but not with cardiovascular events or all-cause mortality. Soluble TM antigen concentration has potential as a new specific marker to identify patients at high risk of bleeding during warfarin treatment.

  • 12.
    Lind, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Torbjörn K
    Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cystatin C and creatinine as markers of bleeding and mortality during oral anticoagulant treatment2012Manuscript (preprint) (Other academic)
  • 13.
    Lind, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Torbjörn K
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Von Willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 271, no 3, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Aims.  Oral anticoagulation (OAC), predominantly with warfarin, is an effective treatment to prevent thromboembolic events. Serious bleeding is a frequent and feared treatment complication. In this longitudinal cohort study of OAC-treated patients, we aimed to evaluate the relationship between von Willebrand factor (VWF) levels and risk of bleeding complications, cardiovascular mortality and all-cause mortality.

    Methods and results.  A total of 719 patients receiving warfarin treatment were observed for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified into clinically relevant bleeding (CRB) and major bleeding. Ischaemic stroke, peripheral arterial embolism, myocardial infarction, and death were also recorded. We identified 113 cases of CRB and 73 of major bleeding. In total, 161 deaths occurred during follow-up with cardiovascular disease identified as the cause of death in 110 patients. Patients in the highest tertile of VWF had a significantly increased risk of bleeding complications: hazard ratio (HR) 2.53 (95% CI 1.41-4.56) for major bleeding and HR 2.19 (95% CI 1.38-3.48) for CRB. VWF, expressed either in tertiles or as a continuous variable, showed a significant association with cardiovascular mortality (HR 1.68, 95% CI 1.40-2.01) and all-cause mortality (HR 1.77, 95% CI 1.52-2.05). In multivariate Cox regression analysis, the findings remained significant after adjusting for age, high-sensitivity C-reactive protein and creatinine.

    Conclusions.  Patients with high levels of VWF had an increased risk of bleeding complications, cardiovascular mortality and all-cause mortality during OAC treatment. Our findings imply that the use of VWF as a risk marker for thromboembolic events is complicated by the association of VWF with bleeding complications.

  • 14.
    Lind, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Torbjörn
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment2014In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 47, no 7-8, p. 570-573Article in journal (Refereed)
    Abstract [en]

    Objectives: Previous studies have shown that biomarkers in blood plasma can predict bleeding complications during anticoagulant treatment as well as thromboembolic events and may improve existing risk stratification schemes in patients on or considered for oral anticoagulant treatment. The aim of this study was to investigate if levels of D-dimer, tissue plasminogen activator (tPA) and its complex with plasminogen inhibitor type 1 (tPA/PAI-1 complex) can predict major bleedings, cardiovascular events and all-cause mortality in patients with warfarin treatment.

    Design and methods: In a longitudinal cohort study, 719 patients on oral anticoagulant treatment were followed for a total of 3001 treatment years. Major bleeding, stroke, arterial emboli, myocardial infarction and death were recorded and classified. Blood samples collected at baseline were analyzed for D-dimer, tPA, and tPA/PAI-1 complex.

    Results: In multivariate Cox regression analysis, high levels of D-dimer were associated with major bleeding (HR 1.27 per SD; 95% CI: 1.01-1.60), cardiovascular events (HR 1.23 per SD; 95% CI: 1.05-1.45) and all-cause mortality (HR 1.25 per SD; 95% CI: 1.06-1.47). Neither tPA nor the tPA/PAI-1 complex was associated with major bleeding, cardiovascular events or all-cause mortality.

    Conclusion: We conclude that high levels of D-dimer predict major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. (C) 2014 The Canadian Society of Clinical Chemists. 

  • 15.
    Lind, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Torbjörn K.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Järvholm, Lisbeth Slunga
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cystatin C and creatinine as markers of bleeding complications, cardiovascular events and mortality during oral anticoagulant treatment2013In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 132, no 2, p. E77-E82Article in journal (Refereed)
    Abstract [en]

    Introduction: Impaired kidney function has been linked to both ischemic events as well as bleeding complications in several clinical conditions. Our aim was to investigate if cystatin C, creatinine and calculated glomerular filtration rate (eGFR) were related to future risk of bleeding complications, cardiovascular events or all-cause mortality during oral anticoagulant treatment.

    Materials and methods: In a cohort study, 719 patients on long-term vitamin K antagonist (VKA) treatment were followed for a mean of 4.2 years. Blood sampling was taken at inclusion and patients were followed prospectively. Cystatin C and creatinine were analysed and eGFR was calculated. All medical records were reviewed. Major bleeding events, myocardial infarctions, strokes, arterial emboli, and deaths were recorded and classified.

    Results: After adjustment for age, no association between cystatin C, creatinine or eGFR and major bleeding was found. Cystatin C was independently associated with cardiovascular events (hazard ratio 1.50 (95% CI: 1.27-1.77)) and all-cause mortality (hazard ratio 1.62 (95% CI: 1.38-1.90)). Creatinine was only associated with all-cause mortality, while eGFR was not associated with any of the outcomes.

    Conclusions: Our findings underscore the superiority of cystatin C as a marker of cardiovascular risk compared to creatinine or eGFR. VKA-treated patients with increased cystatin C levels should be considered to be at an increased risk of cardiovascular events, and not bleeding complications.

  • 16.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lisbeth, Slunga Järvholm
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion2015In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 18, no 5, p. 578-588Article in journal (Refereed)
    Abstract [en]

    Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of the present study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near- and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.

  • 17.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stigsdotter Neely, Anna
    Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion: a randomized clinical trial2015In: International Convention of Psychological Science, Amsterdam, 2015Conference paper (Other academic)
    Abstract [en]

    The present study evaluated whether a computerized process-based cognitive training program improves cognitive function in patients with stress-related exhaustion (n=59). Results showed training effects that were generalizable beyond the specific training tasks, suggesting that cognitive training may be a viable part of the rehabilitation of stress-related exhaustion.

  • 18.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark..
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden..
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO – a randomized clinical trial2018In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 21, no 4, p. 279-291Article in journal (Refereed)
    Abstract [en]

    Stress-related exhaustion has been associated with selective and enduring cognitive impairments. However, little is known about how to address cognitive deficits in stress rehabilitation and how this influences stress recovery over time. The aim of this open-label, parallel randomized controlled trial (ClinicalTrials.gov: NCT03073772) was to investigate the long-term effects of 12 weeks cognitive or aerobic training on cognitive function, psychological health and work ability for patients diagnosed with exhaustion disorder (ED). One-hundred-and-thirty-two patients (111 women) participating in multimodal stress rehabilitation were randomized to receive additional cognitive training (n = 44), additional aerobic training (n = 47) or no additional training (n = 41). Treatment effects were assessed before, immediately after and one-year post intervention. The primary outcome was global cognitive function. Secondary outcomes included domain-specific cognition, self-reported burnout, depression, anxiety, fatigue and work ability, aerobic capacity and sick-leave levels. Intention-to-treat analysis revealed a small but lasting improvement in global cognitive functioning for the cognitive training group, paralleled by a large improvement on a trained updating task. The aerobic training group showed improvements in aerobic capacity and episodic memory immediately after training, but no long-term benefits. General improvements in psychological health and work ability were observed, with no difference between interventional groups. Our findings suggest that cognitive training may be a viable method to address cognitive impairments for patients with ED, whereas the effects of aerobic exercise on cognition may be more limited when performed during a restricted time period. The implications for clinical practice in supporting patients with ED to adhere to treatment are discussed.

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  • 19.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
    Neural activation in stress-related exhaustion: cross-sectional observations and interventional effects2017In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 269, p. 17-25Article in journal (Refereed)
    Abstract [en]

    The primary purpose of this study was to investigate the association between burnout and neural activation during working memory processing in patients with stress-related exhaustion. Additionally, we investigated the neural effects of cognitive training as part of stress rehabilitation. Fifty-five patients with clinical diagnosis of exhaustion disorder were administered the n-back task during fMRI scanning at baseline. Ten patients completed a 12-week cognitive training intervention, as an addition to stress rehabilitation. Eleven patients served as a treatment-as-usual control group. At baseline, burnout level was positively associated with neural activation in the rostral prefrontal cortex, the posterior parietal cortex and the striatum, primarily in the 2-back condition. Following stress rehabilitation, the striatal activity decreased as a function of improved levels of burnout. No significant association between burnout level and working memory performance was found, however, our findings indicate that frontostriatal neural responses related to working memory were modulated by burnout severity. We suggest that patients with high levels of burnout need to recruit additional cognitive resources to uphold task performance. Following cognitive training, increased neural activation was observed during 3-back in working memory-related regions, including the striatum, however, low sample size limits any firm conclusions.

  • 20.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Academic Unit for Psychiatry of Old Age, University of Melbourne, Australia.
    Stigsdotter Neely, Anna
    Department for Social and Psychological Studies, Karlstad University.
    Dunås, Tora
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
    Mental fatigue in stress-related exhaustion disorder: structural brain correlates, clinical characteristics and relations with cognitive functioning2020In: NeuroImage: Clinical, E-ISSN 2213-1582, Vol. 27, article id 102337Article in journal (Refereed)
    Abstract [en]

    Emerging evidence suggests that mental fatigue is a central component of the cognitive and clinical characteristics of stress-related exhaustion disorder (ED). Yet, the underlying mechanisms of mental fatigue in this patient group are poorly understood. The aim of this study was to investigate cortical and subcortical structural neural correlates of mental fatigue in patients with ED, and to explore the association between mental fatigue and cognitive functioning. Fifty-five patients with clinical ED diagnosis underwent magnetic resonance imaging. Mental fatigue was assessed using the Concentration subscale from the Checklist Individual Strength. Patients with high levels of mental fatigue (n = 30) had smaller caudate and putamen volumes compared to patients with low-moderate levels of mental fatigue (n = 25). No statistically significant differences in cortical thickness were observed between the groups. Mediation analysis showed that mental fatigue mediated the relationship between caudate volume and working memory; specifically, smaller caudate volume was associated with higher level of mental fatigue and mental fatigue was positively associated with working memory performance. Our findings demonstrate that the structural integrity of the striatum is of relevance for the subjective perception of mental fatigue in ED, while also highlighting the complex relationship between mental fatigue, cognitive performance and its neural underpinnings.

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  • 21.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stigsdotter Neely, Anna
    Institutionen för sociala och psykologiska studier, Karlstads Universitet.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Effects of a Process-based Cognitive Training Intervention for Patients With Stress-related Exhaustion - an fMRI study2016In: Cognitive Neuroscience Society: 2016 Annual Meeting Program, 2016, p. 161-161, article id D59Conference paper (Other academic)
  • 22. Nelson, Andreas
    et al.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stigsdotter Neely, Anna
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Subjective cognitive complaints and its associations to response inhibition and neural activation in patients with stress-related exhaustion disorder2023In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 26, no 1, article id 2188092Article in journal (Refereed)
    Abstract [en]

    Stress-related exhaustion is associated with cognitive deficits, measured subjectively using questionnaires targeting everyday slips and failures or more objectively as performance on cognitive tests. Yet, only weak associations between subjective and objective cognitive measures in this group has been presented, theorized to reflect recruitment of compensational resources during cognitive testing. This explorative study investigated how subjectively reported symptoms of cognitive functioning and burnout levels relate to performance as well as neural activation during a response inhibition task. To this end, 56 patients diagnosed with stress-related exhaustion disorder (ED; ICD-10 code F43.8A) completed functional magnetic resonance imaging (fMRI) using a Flanker paradigm. In order to investigate associations between neural activity and subjective cognitive complaints (SCCs) and burnout, respectively, scores on the Prospective and retrospective memory questionnaire (PRMQ) and the Shirom-Melamed burnout questionnaire (SMBQ) were added as covariates of interest to a general linear model at the whole-brain level. In agreement with previous research, the results showed that SCCs and burnout levels were largely unrelated to task performance. Moreover, we did not see any correlations between these self-report measures and altered neural activity in frontal brain regions. Instead, we observed an association between the PRMQ and increased neural activity in an occipitally situated cluster. We propose that this finding may reflect compensational processes at the level of basic visual attention which may go unnoticed in cognitive testing but are reflected in the experience of deficits in everyday cognitive functioning.

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  • 23. Nelson, Andreas
    et al.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Academic Unit for Psychiatry of Old Age, University of Melbourne, Australia.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Neely, Anna Stigsdotter
    Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study2021In: BMC Psychology, E-ISSN 2050-7283, Vol. 9, no 1, article id 84Article in journal (Refereed)
    Abstract [en]

    Background: Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress.

    Methods: We compared a group of patients with stress-related exhaustion disorder (n = 103, female = 88) with matched healthy controls (n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively.

    Results: Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance.

    Conclusion: Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation.

    Trial registration: Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017

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  • 24.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Höög, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Work situation and self-perceived economic situation as predictors of change in burnout: a prospective general population-based cohort study2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, no 329, p. 1-9Article in journal (Other academic)
    Abstract [en]

    Background: Sick leave rates due to mental and behavioural disorders have increased in Sweden during the last decades. The aim of this prospective study was to investigate changes in the level of burnout in a working subset of the general population and to identify how such changes relate to changes in work situation and self-perceived economic situation.

    Methods: A cohort of 1000 persons from a subset of the 2004 northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) general population survey was followed over a five-year period (2004–2009). In total, 623 persons (323 women and 300 men) were included in the analysis. Burnout levels were measured at baseline and follow-up using the Shirom Melamed Burnout Questionnaire. Risk factors were assessed at both measuring points.

    Results: In the whole study cohort, a small (−0.15) but statistically significant reduction in burnout level was found. No differences in change of burnout were found between men and women. Constant strain at work, an increased risk of unemployment, and a perceived worsening of economic situation during the study time period were related to an increased burnout level. An accumulation of these risk factors was associated with increased burnout level.

    Conclusions: Risk factors in work situation and self-perceived economy are related to changes in burnout level, and special attention should be directed towards persons exposed to multiple risk factors.

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  • 25.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Höög, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Work situation and self-perceived economic situation as predictors of change in burnout - a prospective general population-based cohort study2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 329Article in journal (Refereed)
    Abstract [en]

    Background: Sick leave rates due to mental and behavioural disorders have increased in Sweden during the last decades. The aim of this prospective study was to investigate changes in the level of burnout in a working subset of the general population and to identify how such changes relate to changes in work situation and self-perceived economic situation. Methods: A cohort of 1000 persons from a subset of the 2004 northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) general population survey was followed over a five-year period (2004-2009). In total, 623 persons (323 women and 300 men) were included in the analysis. Burnout levels were measured at baseline and follow-up using the Shirom Melamed Burnout Questionnaire. Risk factors were assessed at both measuring points. Results: In the whole study cohort, a small (-0.15) but statistically significant reduction in burnout level was found. No differences in change of burnout were found between men and women. Constant strain at work, an increased risk of unemployment, and a perceived worsening of economic situation during the study time period were related to an increased burnout level. An accumulation of these risk factors was associated with increased burnout level. Conclusions: Risk factors in work situation and self-perceived economy are related to changes in burnout level, and special attention should be directed towards persons exposed to multiple risk factors.

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  • 26.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Höög, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Slunga Birgander, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burnout, working conditions and gender: results from the northern Sweden MONICA Study2010In: BMC Public Health, E-ISSN 1471-2458, Vol. 10, no 326Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sick-leave because of mental and behavioural disorders has increased considerably in Sweden since the late nineties, and especially in women. The aim of this study was to assess the level of burnout in the general working population in northern Sweden and analyse it's relation to working conditions and gender.

    METHODS: In this cross-sectional study the survey from the MONICA-study (Monitoring of Trends and Determinants in Cardiovascular Disease) in northern Sweden 2004 was used. A burnout instrument, the Shirom Melamed Burnout Questionnaire (SMBQ), was incorporated in the original survey which was sent to a random sample of 2500 individuals with a response rate of 76%. After including only actively working people, aged 25-64 years, our study population consisted of 1000 participants (497 women and 503 men). ANOVA and multiple linear regression models were used.

    RESULTS: The prevalence of a high level of burnout (SMBQ >4.0) was 13%. Women had a higher level of burnout than men with the most pronounced difference in the age group 35-44 years. In both sexes the level of burnout decreased with age. Demand and control at work, and job insecurity were related to burnout. In women the level of education, socioeconomic position, work object, and working varying hours were of importance. Interaction effects were found between sex and work object, and sex and working hours. In a multiple regression analysis almost half of the gender difference could be explained by work related and life situational factors.

    CONCLUSIONS: Working life conditions contributed to the level of burnout in this actively working sample from the general population in northern Sweden. Especially in women, socioeconomic position was associated with burnout. The high level of burnout in women compared to men was partly explained by more unfavourable working conditions and life situational factors. Efforts to level out gender differences in burnout should probably focus on improving both working and socioeconomic conditions for women.

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    RBeusearrnch oartuiclte, working conditions and gender - results from the northern Sweden MONICA Study
  • 27.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Research and Development Department, Jämtland County Council, Östersund, Sweden.
    Höög, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Edlund, Curt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Slunga Birgander, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Work related factors and sick leave after rehabilitation in burnout patients: experiences from the REST-project2011In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

    Introduction The aim of this study was to investigate the impact of psychosocial working conditions and coping strategies at work on change in sick leave level for patients on long-term sick leave due to burnout.

    Methods A cohort sample of patients (n = 117) on long-term sick leave due to burnout was analyzed. The patients answered a questionnaire at baseline and sick leave information was collected from the Swedish Social Insurance Agency at baseline and at follow-up 2 years later. Two groups were formed depending on whether the patients had "improved" and reduced their sick leave level (56%) or if the sick leave level was "unchanged" (44%) at follow-up. The association between change in sick leave and predictors measuring psychosocial working conditions and coping strategies at work were analyzed using logistic regression.

    Results The predictor, low control at work, was associated with unchanged sick leave at follow-up. When background characteristics were taken into account, usage of covert coping towards supervisors and covert coping towards workmates, respectively, also predicted unchanged sick leave level. High overcommitment was of borderline significance and associated with a reduced sick leave level at follow-up.

    Conclusions Patients with burnout who have experienced low control at work and used covert coping towards supervisors and/or workmates have a higher risk of not reducing their sick leave after rehabilitation. The workplace may contribute to a reduction of sick leave lengths with a more flexible work environment and improvement in communication strategies for employees and supervisors.

  • 28.
    Norström, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Healthcare utilisation among patients with stress-induced exhaustion disorder treated with a multimodal rehabilitation programme: a longitudinal observational study2022In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 642Article in journal (Refereed)
    Abstract [en]

    Background: Stress-induced exhaustion disorder is a major challenge in Swedish working life. Despite its increase in prevalence, there is still limited knowledge about the effectiveness of different rehabilitation methods. In this study, we aim to describe the healthcare utilisation for patients with stress-induced exhaustion disorder before, during and after a multi-modal rehabilitation (MMR) programme, as well as the health-related quality of life, work ability, sick leave level and psychological measures, and their possible relations.

    Methods: In this longitudinal observational study, 53 patients who were part of an MMR programme at the Stress Rehabilitation Clinic participated with survey data, and among them 43 also contributed with healthcare data. Data were collected from one year before start of MMR to one year after the end of it. The patients also answered a questionnaire at the start of, end of and at a one-year follow-up of the MMR, which included questions about health-related quality of life, work ability, clinical burnout, sick leave level, anxiety and depression.

    Results: There was a statistically significant increase in healthcare consumption during MMR, if including visits to the Stress Rehabilitation Clinic, while it decreased if excluding such visits, when comparing with before and after MMR. During the follow-up period there was a non-statistically significant (p=0.11), but still rather large difference (15.4 compared with 12.0 visits per patient), in healthcare consumption in comparison with the period before MMR, when excluding follow-up visits at the Stress Rehabilitation Clinic. Health-related quality of life was rated as poor before MMR (mean 0.59). There was a statistically significant improvement, but values were still below normal at the end of follow-up (mean 0.70). In addition, the level of sick leave, the work ability and signs of clinical burnout improved statistically significantly after MMR, but were not fully normalised at the end of follow-up. Individual healthcare consumption was related to residual health problems.

    Conclusions: Patients with stress-induced exhaustion disorder have not reduced their healthcare consumption notably after MMR, and residual health problems remain for some patients. More studies are needed for a deeper understanding of the individual effectiveness of MMR, and also of its cost-effectiveness.

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  • 29.
    Pettersson-Strömbäck, Anita
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bodin Danielsson, Christina
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Öhrn, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Harder, Mette
    Umeå University, Faculty of Science and Technology, Umeå School of Architecture.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wahlström, Viktoria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slutrapport från AKTIKON-PROJEKTET i Örnsköldsviks kommun: Arbetsmiljö, fysisk aktivitet, hälsa och produktivitet i aktivitetsbaserad kontorsmiljö – en kontrollerad studie i Örnsköldsviks kommun2018Report (Other academic)
    Abstract [sv]

    Projektet Aktivitetsbaserat Kontor (AktiKon) har följt och utvärderat en förändringsprocess i Örnsköldsviks kommun där tjänstemännen i kommunen flyttade från cellkontor till antingen ett aktivitetsbaserat kontor (AB-kontor) eller ett cellkontor. Syftet med forskningsprojektet var att studera effekter på arbetsmiljö, fysisk aktivitet, hälsa och produktivitet i aktivitetsbaserad kontorsmiljö och kunna jämföra med fortsatt arbete i cellkontor. Mätningar med enkäter, fokusgruppsintervjuer, gåturer och observationer utfördes 6 mån före flytt och 6 respektive 18 månader efter flytt. Individuella intervjuer av personer med upplevd funktionsnedsättning utfördes ca 10 månader efter flytt. Rörelsemätningar utfördes vid fem olika tillfällen under flyttprocessen.

    I denna rapport har vi valt att redovisa enkätresultat från anställda som vi har kunnat följa över tid, d.v.s. individer där vi har resultat från enkät besvarad före flytt och från minst ett tillfälle efter flytt. Den ursprungliga studiepopulationen som studerades med denna metod bestod från början av 374 anställda och vid den sista uppföljningen, 18 månader efter flytt, av 152 anställda i AB-kontoret och 63 i cellkontoret. De två grupperna som flyttade till olika kontorsmiljöer var inte helt jämförbara. Exempelvis var det fler män och chefer som flyttade till AB-kontoret och yrkesgrupperna var inte heller lika, men alla som ingick i projektet var tjänstemän inom samma kommun.

    De som flyttade till AB-kontoret upplevde den nya kontorsmiljön som estetiskt tilltalande och luftkvaliteten god. De som flyttade till nya cellkontor hade utifrån kvalitativa intervjuer inte en lika positiv uppfattning vad gäller kontorets design och inredning.

    Arbetsbelastningen och olika typer av krav såg lika ut över tid för respektive grupp. Det var vid 18 månader efter flytt ingen skillnad jämfört med före flytt i hälsofrämjande arbetsfaktorer undersökta med WEMS-instrumentet (Work Experience Measurement Scale) för de som flyttat till AB-kontor. Det var inte heller någon skillnad över tid i jämförelse med de som flyttat till cellkontor. Datorstödet upplevdes mycket positivt av de som flyttade till AB-kontoret och de blev något mer nöjda än de som flyttade till cellkontor. Det fanns i AB-kontoret inte någon säker skillnad i upplevelse av samarbete mellan olika arbetsgrupper eller inom hela organisationen vid 18 månader efter flytt jämfört med utgångsläget och inte heller någon säker skillnad över tid jämfört med cellkontoret. De som flyttade till AB-kontor rapporterade efter flytten en ökad störning av ljud och besvär av bristande avskildhet. Man upplevde i genomsnitt en lägre produktivitet i AB-kontoret efter flytt och det fanns en skillnad mellan de två kontorstyperna över tid.

    Cheferna var generellt nöjda med att arbeta i AB-kontor och de upplevde inte någon minskad produktivitet vid övergång till AB-kontor. I genomsnitt blev det emellertid en minskad nöjdhet med kontorets utformning i gruppen som flyttade till AB-kontor. Nöjdheten med AB-kontoret varierade beroende på yrke och typ av arbetsuppgifter. De som hade mycket enskilt och koncentrationskrävande datorarbete upplevde mindre nöjdhet efter flytt och angav att de helst ville arbeta i cellkontor om de fick välja. De som arbetade mycket i grupp, behövde vara idérika och ofta diskuterade med kollegor föredrog att arbeta i AB-kontor. Bland dem som helst ville arbeta i cellkontor fanns det en ökad förekomst av problem med stress, långvarig utmattning och psykiska besvär.

    Det framkom ökade problem med koncentrationen hos de som flyttade till AB-kontor. Det fanns däremot inga säkra skillnader över tid mellan grupperna vad gäller skattning av allmän hälsa och förekomst av andra typer av besvär.

    Redan före flytten hade båda grupperna tillgång till höj- och sänkbara bord och det var vanligt att arbeta stående under en rätt stor del av arbetsdagen. Efter flytten ökade tiden i gående och antal steg något i AB-kontoret jämfört med cellkontoret. I AB-kontoret fanns tillgång till gå-band, men dessa användes endast av ett fåtal anställda. Den centralt belägna öppna trappan var omtyckt och användes mycket.

    Sammanfattningsvis visar studien att nöjdhet, preferens och produktivitet i AB-kontor varierar mycket beroende på vilka arbetsuppgifter man har. AB-kontoret fungerar särskilt bra för personer med ledningsuppdrag. För att AB-kontoret ska kunna fungera bra även för personer med funktionsnedsättning måste det finnas system för att fånga upp individuella problem och möjliggöra anpassningar vid behov. Detta gäller särskilt vid psykiska besvär och kognitiva svårigheter. Det är angeläget att det i AB-kontoret finns tillgång till stödytor och resurser i tillräcklig omfattning för alla de olika arbetsuppgifter som ska utföras.

    En viktig erfarenhet i projektet är betydelsen av att kunna beskriva den kontext som förändringen sker i. Genom att göra en processutvärdering har det funnits möjlighet att på ett adekvat sätt tolka och förstå de effekter som framkom vid övergång till AB-kontor.

    Framgångsfaktorer vid övergång till AB-kontor är noggrann kartläggning och analys före flytt, samverkan, delaktighet, överenskomna regler och förhållningssätt, och övergripande rutiner som inkluderar hela kontoret för det fortsatta arbetsmiljöarbetet.

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  • 30.
    Pettersson-Strömbäck, Anita
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Managers and coworkes perceptions of activity based work: a sub study of the aktikon project2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S149-S149Article in journal (Other academic)
  • 31. Rolfö, Linda
    et al.
    Jahncke, Helena
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Öhrn, Maria
    Babapour, Maral
    Predictors of Preference for the Activity-based Flexible Office2019In: Human Systems Engineering and Design: Proceedings of the 1st International Conference on Human Systems Engineering and Design (IHSED2018) / [ed] Tareq Ahram, Waldemar Karwowski, Redha Taiar, Springer, 2019, p. 546-552Conference paper (Refereed)
    Abstract [en]

    Activity-based Flexible Offices (A-FOs) are implemented with varying degree of success. Employees relocate from cell or open-plan offices, from different organizational backgrounds, varying design and implementation processes, and have different types of work tasks. This study aims at investigating whether preference for the A-FO correlate with these preconditions. The results from Chi-square tests and Spearman's non-parametric correlation of post-relocation questionnaires distributed to 11 A-FO sites, showed that a high preference for the A-FO correlated strongest with an A-FO preference prior to relocation, being a former open-plan office occupier and with frequent performance of innovation. Low preference for the A-FO correlated with frequent performance of concentration demanding tasks. Working with tasks with high confidentiality did not predict the preference ratings.

  • 32.
    Slunga, Lisbeth
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Serum lipoprotein(a) in relation to ischemic heart disease and associated risk factors1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Lipoprotein(a) (Lp(a)) consists of an LDL-like particle and the specific protein apo(a), which is very similar to plasminogen. Apo(a) contains repeated kringle structures and a serine protease domain, which cannot be activated by t-PA. Lp(a) is considered to be a predictor for atherosclerotic disease. It has been found incorporated in atherosclerotic plaques and inhibits in vitro fibrinolysis.

    Lp(a) was determined in 1527 randomly selected individuals participating in the Northern Sweden WHO-MONICA project. A weak but significant relation between Lp(a) and increasing age was found. Menopausal status was the strongest independent predictor of Lp(a) level in women. Fibrinogen was independently related to Lp(a) in both sexes. Only a minor fraction of Lp(a) variance could be explained for in a multiple regression model, which is in agreement with the contention that Lp(a) is highly genetically determined.

    Lp(a) was determined in 1571 patients investigated with coronary angiography because of suspected severe coronary artery disease (CAD). Patients with proven CAD at elective angiography had significantly higher Lp(a) than patients without significant CAD or healthy controls. Lp(a) was found to be an independent discriminator of CAD in both sexes.

    HLA-DR genotype 13 or 17 was found more frequently in 30 male patients with angiographic CAD at young age (< 50 years) than in 30 age matched controls. These genotypes were common in patients with high Lp(a) levels, which indicates that Lp(a) may be related to immunological processes.

    The reaction of Lp(a) was investigated in 32 patients with acute myocardial infarction (AMI). Lp(a) increased during the first week, but the response was comparatively weak. Individual Lp(a) responses were heterogeneous and no correlations to infarct size or changes in the acute phase proteins were found.

    In a randomized cross-over study on 36 hypercholesterolaemic patients treated with simvastatin/placebo during 12+12 weeks Lp(a) did not change significantly, but patients with high Lp(a) levels at baseline tended to develop further increased Lp(a).

    To conclude, Lp(a) was found to be an independent predictor of angiographic CAD in both men and women. Lp(a) levels are primarily genetically determined and only a small fraction of Lp(a) variance could be explained by other factors in this study. Lp(a) may be related to HLA DR types and immunological processes involved in atherosclerotic disease. Lp(a) increased slightly during the first week of AMI, but was not related to changes in the acute-phase proteins. The effective LDL-lowering agent simvastatin did not influence Lp(a) significantly.

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  • 33.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Nilsson, Leif
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Can rehabilitation in boreal forests help recovery from exhaustion disorder?: the randomised clinical trial ForRest2015In: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 30, no 8, p. 732-748Article in journal (Refereed)
    Abstract [en]

    Modern society is faced with increasing incidence of mental and behavioural disorders. The objective of this study was to evaluate whether visits to boreal forests can be utilised for rehabilitation from exhaustion disorder (ED). This randomised controlled trial comprised of a forest rehabilitation group (n = 35) and a waiting list group (control group) (n = 43) with subsequent cognitive behavioural rehabilitation (CBR) for all participants in both groups. The recovery from ED was compared between the forest rehabilitation and the control group at baseline, after the forest rehabilitation (3 months), and at the end of the CBR (1 year). Both groups had enhanced recovery from ED after the 3-month intervention period and at the end of the CBR (1 year), and there were no significant differences between the groups in terms of psychological health measures. Mental state, attention capacity and preferences for different forest environments were studied during the forest visits. Mental state was improved, but it showed some seasonal differences. A significant effect on attention capacity was found for single forest visits, but there was no effect found for the rehabilitation period as a whole. The most popular forest environments contained easily accessible, open and bright settings with visible water and/or shelter. Forest rehabilitation did not enhance the recovery from ED compared to the control group, but the participants’ well-being was improved after single forest visits.

  • 34.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Dolling, Ann
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Restorative effects of visits to urban and forest environments in patients with exhaustion disorder2014In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 13, no 2, p. 344-354Article in journal (Refereed)
    Abstract [en]

    This experimental study investigated differences in perceived restorativeness, mood, attention capacity and physiological reactions when visiting city and forest environments. Twenty female patients diagnosed with exhaustion disorder visited three different forest environments and one city environment in randomized order. They performed a standardized 90-min test procedure in each of these environments. Evaluation of the environments and psychological effects in mood were studied with self-administered questionnaires. Attention capacity was studied with Necker Cube Pattern Control task. Physiological responses were measured with regularly scheduled controls of heart rate and blood pressure, and a single test of heart rate recovery. Visits to the forest environments were perceived as significantly more restorative, enhancing mood and attention capacity compared to the city. This also applies to the results of heart rate and to some extent to the results of the diastolic blood pressure. The results from this experimental study support our hypothesis that short visits to forest environments enhance both psychological and physiological recovery and that visits to forest environments are likely to be beneficial when suffering from exhaustion disorder. 

  • 35.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundell, Ylva
    Brännström, Rigmor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Can the boreal forest be used for rehabilitation and recovery from stress-related exhaustion? A pilot study.2011In: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 26, no 3, p. 245-256Article in journal (Refereed)
    Abstract [en]

    It has been suggested that humans suffering from mental exhaustion recover better in environments that do not demand directed attention. Hence, we hypothesized that forests have restorative effects and examined whether the boreal forest in northern Sweden can be used for rehabilitation from stress-related exhaustion in a pilot study. Six participants suffering from stress-related exhaustion were offered visits twice a week, for 11 weeks, in six different forest settings: pine forest, mixed forest, spruce forest, forest by the lake, the forest with a small stream and rock outcrops. The participants chose one forest setting prior to each visit, and the mental state of each participant was evaluated before and after each visit. Interviews focusing on the experience of the forest were conducted after the 22 visits. Solitude and forest settings with light were identified as positive factors for recovery. Despite the limited amount of data, the results showed that the forest visits had significant positive effects on the participants' mental state. The interviews also indicated that the concept is suitable for use in larger randomized studies and that it is important to provide various forest settings to meet individual preferences of the participants and to offer the possibility of solitude.

  • 36.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Annchristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    "Nature's effect on my mind": patients' qualitative experiences of a forest-based rehabilitation programme2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-614Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate the personal experiences and perceived effects on mind from visits to forest environments in a subset of patients with severe exhaustion disorder (ED), who participated in a randomized controlled trial for evaluation of forest-based rehabilitation.

    Participants: A subsample of 19 patients with diagnosed ED, who completed the three-month forest-based rehabilitation programme in the ForRest project, was interviewed.

    Method: The forest-based rehabilitation consisted of repeated forest visits with the main objective of spending time in rest and solitude in a chosen forest setting. Semi-structured interviews were carried out and analysed using Grounded Theory.

    Result: A core category and five subcategories were set up to describe the patients' experiences and development during the forest-based rehabilitation. As patients mostly reported that they strove to achieve peace of mind during the forest visits, Striving for serenity was chosen to be the core category. At first the patients were frustrated when left alone with their own thoughts in an unfamiliar forest environment. They gradually became familiar with the forest environments and also found their favourite places where they experienced peace of mind. They were then able to rest and begin reflective thinking about their life situation, which led to ambitions to change it. The preferred forest environments were characterised by openness, light and a good view, and were felt to be undemanding, peaceful and stimulating.

    Conclusion: Visits to the forest provided favourite places for rest, were experienced as restorative, seemed to improved reflection and may have contributed to starting the coping process for these patients. However, forest visits, as the only treatment option, are not sufficient as rehabilitation from severe and long-term ED. We suggest that forest visits should be integrated with cognitive behavioural therapy to further improve the recovery and enhance coping in daily life for these patients.

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  • 37.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    "Nature's effect on my mind". Patients' experiences of nature based rehabilitation: a qualitative inquiry.2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-14Article in journal (Refereed)