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  • 1.
    Bohman, Tony
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Bottai, Matteo
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Björklund, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 4, article id e024557Article in journal (Refereed)
    Abstract [en]

    Objectives To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy. Design Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy. Participants and settings Eighty-nine women aged 31-65 years with non-specific chronic disabling neck pain from Gavle, Sweden. Measures The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique. Results Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively. Conclusion Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.

  • 2.
    Dantoft, Thomas M.
    et al.
    Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital, Gentofte, Denmark; Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark; Research Centre for Prevention and Health, Copenhagen, Denmark.
    Skovbjerg, Sine
    Research Centre for Prevention and Health, Copenhagen, Denmark.
    Andersson, Linus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Psychology, Umeå University, Umeå, Sweden.
    Claeson, Anna-Sara
    Department of Psychology, Umeå University, Umeå, Sweden.
    Engkilde, Kaare
    Department of Dermato-Allergology, National Allergy Research Center, Copenhagen University Hospital Gentofte, Denmark.
    Lind, Nina
    Department of Psychology, Umeå University, Umeå, Sweden; Department of Economics, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Nordin, Steven
    Department of Psychology, Umeå University, Umeå, Sweden.
    Hellgren, Lars I.
    Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark.
    Gene expression profiling in persons with multiple chemical sensitivity before and after a controlled n-butanol exposure session2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e013879Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure.

    DESIGN: Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure.

    SETTINGS: Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper.

    PARTICIPANTS: 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls.

    OUTCOME MEASURES: 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels.

    RESULTS: MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls.

    CONCLUSIONS: MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure.

  • 3.
    Dantoft, Thomas
    et al.
    Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital, Gentofte, Denmark; Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark; Research Centre for Prevention and Health, Copenhagen, Denmark.
    Skovbjerg, Sine
    Research Centre for Prevention and Health, Copenhagen, Denmark.
    Andersson, Linus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Psychology, Umeå University, Umeå, Sweden.
    Claeson, Anna-Sara
    Department of Psychology, Umeå University, Umeå, Sweden.
    Engkilde, Kaare
    Department of Dermato-Allergology, The National Allergy Research Center, Copenhagen University Hospital Gentofte, Denmark.
    Lind, Nina
    Department of Psychology, Umeå University, Umeå, Sweden; Department of Economics, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Nordin, Steven
    Department of Psychology, Umeå University, Umeå, Sweden.
    Hellgren, Lars I.
    Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark.
    Gene expression profiling in MCS before and upon a controlled symptom eliciting n-butanol exposure: a pilot study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e01387Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.

    The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure.

    Design Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure.

    Settings Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper.

    Participants 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls.

    Outcome measures 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels.

    Results MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls.

    Conclusions MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure

  • 4.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Holmström, Inger
    Mälardalens Högskola, Uppsala universitet.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

  • 5.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Is prolonged sitting at work associated with the time course of neck-shoulder pain?: A prospective study in Danish blue-collar workers2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012689Article in journal (Refereed)
    Abstract [en]

    Objectives

    This study aimed to determine the extent to which objectively measured sitting time at work is associated with the course of neck-shoulder pain across one year in blue-collar workers.

    Methods

    Data was analyzed from 625 blue-collar workers in the Danish DPHACTO cohort study (2012-2013). Objective data on sitting time were collected at baseline using accelerometry. Self-reported pain intensity (numeric rating scale 0-10) in the neck-shoulder region was registered for one year using repeated text messages (14 in total). Linear Mixed Models were used to determine the relationship between percent time in sitting at work and trajectories of neck-shoulder pain, with and without adjustment for demographic, occupational and lifestyle factors, and baseline pain intensity.

    Results

    More sitting time at work was associated with a faster decline in pain intensity over 12-months, as indicated by a statistically significant effect of sitting on pain trajectories in the crude (p=0.020) and fully adjusted models (p=0.027).

    Conclusion                             

    In blue-collar workers, more sitting time at work was associated with a favorable development of pain intensity over time. The relationship between sitting at work and pain needs further investigation before explicit recommendations and guidelines on sedentary behavior among blue-collar workers can be developed.

  • 6.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Dencker-Larsen, Sofie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Birk Jorgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nørregaard Rasmussen, Charlotte
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Are trajectories of neck-shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no e022006Article in journal (Refereed)
    Abstract [en]

    ObjectivesThe study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.

    MethodsThis longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0–10) over 1 year (14 waves in total). Simultaneously, selfreported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0–10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were usedas predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.

    ResultsSick leave increased and work ability decreased across all NSP trajectory classes (low, moderate, strong fluctuating and severe persistent pain intensity). In the adjusted model, the estimated number of days on sickleave was 1.5 days/month for severe persistent NSP compared with 0.1 days/month for low NSP (relativ risk=13.8, 95% CI 6.7 to 28.5). Similarly, work ability decreased markedly for severe persistent NSP (OR=12.9,95% CI 8.5 to 19.7; median 7.1) compared with low NSP (median 9.5).

    ConclusionSevere persistent NSP was associatedwith sick leave and poor work ability over 1 year amongworkers. Preventive strategies aiming at reducing severepersistent NSP among working populations are needed.

  • 7.
    Mathiassen, Svend Erik
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bolin, Malin
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Olofsdotter, Gunilla
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Johansson, Elin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Equal health at work? Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055Article in journal (Refereed)
  • 8.
    Monnier, Andreas
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, Regional Medical Service Mälardalen, Berga.
    Larsson, Helena
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, HR Centre, Stockholm.
    Djupsjöbacka, Mats
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Brodin, Lars-Åke
    Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Huddinge.
    Äng, Björn O
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Centre for Clinical Research Dalarna, Falun ; Karolinska University Hospital, Stockholm.
    Musculoskeletal pain and limitations in work ability in Swedish marines: a cross-sectional survey of prevalence and associated factors2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 10, article id e007943Article in journal (Refereed)
    Abstract [en]

    Objectives To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported.

    Design Population-based, cross-sectional survey.

    Participants There were 272 SAF marines from the main marine battalion in Sweden included in the study.

    Outcomes Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI.

    Results Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training ≤1 day/week (OR 5.3, 95% CI 1.7 to 16.8); body height ≤1.80 m (OR 5.0, 95% CI 1.6 to 15.1) and ≥1.86 m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and ≥1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities.

    Conclusions Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1 day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality.

  • 9.
    Monnier, Andreas
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Swedish Armed Forces, Military Academy Karlberg, Stockholm, Sweden.
    Larsson, Helena
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden.
    Nero, Håkan
    Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
    Djupsjöbacka, Mats
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Äng, Björn O.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research, Uppsala University, Falun, Sweden.
    A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e025150Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course.

    DESIGN: Prospective observational cohort study with weekly follow-ups.

    PARTICIPANTS: Fifty-three SwAF marines entering the training course.

    OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports.

    RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time.

    CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

  • 10.
    Patomella, Ann-Helen
    et al.
    Karolinska institutet.
    Guidetti, Susanne
    Karolinska institutet.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, Public Health Science. Karolinska institutet.
    Eriksson, Christina
    Karolinska institutet.
    Bergström, Aileen
    Karolinska institutet.
    Åkesson, Elisabet
    Karolinska institutet.
    Kottorp, Anders
    Karolinska institutet; Malmö högskola.
    Asaba, Eric
    Karolinska institutet.
    Primary prevention of stroke: randomised controlled pilot trial protocol on engaging everyday activities promoting health2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 11, article id e031984Article in journal (Refereed)
    Abstract [en]

    Introduction Stroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke.Methods and analysis The proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.Ethics and dissemination The study has been approved by the Regional Ethical Review Board in Stockholm, Sweden, being granted reference numbers 2015/834-31, 2016/2203-32 and 2019/01444. Study results will be disseminated through peer-review journals and presentations to mixed audiences at regional and international conferences.Trial registration number NCT03730701.

  • 11.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    Leo Swenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e015038Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.

    DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts.

    SETTING One anaesthetic clinic at two hospitals in Sweden.

    PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).

    RESULTS Patterns and five categories emerged: 1) Having different temporal foci during handover, 2) Insecurity when information is transferred from one team to another, 3) Striving to ensure quality of the handover, 4) Weighing the advantages and disadvantages of the bedside handover, and 5) Having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information, and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient, but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.

    CONCLUSIONS The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimize the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision-makers need to pay attention to the environment and infrastructure in postanaesthesia care.

  • 12.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Leo Swenne, Christine
    Uppsala University, Uppsala, Sweden, and Department of Anaesthesia, County Council of Gävleborg, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

    Design: A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

    Setting: Anaesthetic clinics at two hospitals in Sweden.

    Participants: All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and post anaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

    Intervention: Implementation of SBAR in an anaesthetic clinic.

    Primary and secondary outcomes: The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

    Results: In the intervention group, there were statistically significant improvements in the factors “Between-group communication accuracy” (p=0.039) and “Safety climate” (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

    Conclusions: Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

  • 13.
    Rashid, Mamunur
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Factors associated with return-to-work among people on work absence due to long-term neck or back pain: a narrative systematic review2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 6, article id e014939Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE:

    The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain.

    METHODS:

    A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category.

    RESULTS:

    Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW.

    CONCLUSIONS:

    Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

  • 14.
    Robinson, Yohan
    et al.
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Olerud, Claes
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Willander, Johan
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Psychology.
    Do biological disease-modifying antirheumatic drugs reduce the spinal fracture risk related to ankylosing spondylitis?: A longitudinal multiregistry matched cohort study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e016548Article in journal (Refereed)
    Abstract [en]

    Objectives: Ankylosing spondylitis (AS) is associated with an increased spinal fracture risk due to the loss of elasticity in spinal motion segments. With the introduction of biological disease-modifying antirheumatic drug (bDMARD) treatment for AS, the individual course of the disease has been ameliorated. This study aims to examine the association of bDMARD treatment and risk of spinal fracture.

    Design: Longitudinal population-based multiregistry observational matched cohort study.

    Setting: Swedish Patient Registry 1987-2014 and Swedish Prescribed Drugs Registry 2005-2014.

    Participants: Included were patients ≥18 years of age receiving treatment at a healthcare facility for the primary diagnosis of AS. About 1352 patients received more than one prescription of bDMARD from 2005 to 2014. An untreated control group was created by propensity score matching for age, sex, comorbidity, antirheumatic prescriptions and years with AS (n=1352).

    Main Outcome Measures: Spinal fracture-free survival.

    Results: No bDMARD treatment-related effect on spinal fracture-free survival was observed in the matched cohorts. Male gender (HR=2.54, 95% CI 1.48 to 4.36) and Charlson Comorbidity Index score (HR=3.02, 95% CI 1.59 to 5.75) contributed significantly to spinal fracture risk.

    Conclusion: bDMARD had no medium-term effect on the spinal fracture-free survival in patients with AS.

    Trial Registration Number: NCT02840695

  • 15.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Rissén, Dag
    Region Gävleborg.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Psychometric testing of a short form questionnaire for measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e025103Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

    Methods

    Questionnaire data was collected in three different contexts, in primary care via eight different multimodal rehabilitation teams, in specialised care via two different specialist care centres. The sample consisted of 116 participants, male (n=29) and female (n=87) with non-specific musculoskeletal disorders.

    Data was analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the Principal Component Analysis in present study, and the results attained in a previous study with a similar aim and design.

    Results

    The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had an only partly comparable result, compared to previous study.

    Conclusion

    The results of present study did not prove the suggested short form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

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