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  • 1.
    Alaie, Iman
    et al.
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Ssegonja, Richard
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Feldman, Inna
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Sampaio, Filipa
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Arinell, Hans
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Ramklint, Mia
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Päären, Aivar
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Olsson, Gunilla
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    von Knorring, Anne-Liis
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Bohman, Hannes
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Jonsson, Ulf
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed)
    Abstract [en]

    Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

    Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

    Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

    Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

  • 2.
    Arvidsson, Bo
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institute, Stockholm, Sweden.
    Rask, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Schwarcz, Erik
    Örebro University Hospital. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Reference data for bone mineral density in Swedish women using digital X-ray radiometry2013In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 16, no 2, p. 183-188Article in journal (Refereed)
    Abstract [en]

    During the last decade, digital X-ray radiometry (DXR) has been used to measure bone mineral density (BMD) in the metacarpal bones. The aim of this study was to establish Swedish reference material for bone mass in women, measured in the metacarpal bones with DXR, and compare these data with the data from the manufacturer. A sample of 1440 women aged 20-79yr living in Örebro County was randomly assigned from the population register. Microdose mammography was used (Sectra MDM L30; Sectra Imtec AB, Linköping, Sweden) to measure BMD. Cole's LMS method was used to calculate DXR. Six hundred sixty-nine (48.3%) women participated. Peak bone mass occurred at the age of 43.4yr with a BMD of 0.597g/cm(2) (standard deviation: 0.050). Our Swedish data correlated well with the manufacturer's material. Only among women aged 50-59yr did BMD differ, where the Swedish sample had lower values. The LMS method can be used to describe the DXR data and provide a more detailed picture of bone density distribution. DXR-BMD in Swedish women aged 20-79yr is equivalent to findings from other studies, showing the same distribution of BMD in most age groups except for ages 50-59yr.

  • 3.
    Duberg, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Örebro County Council, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Örebro County Council, Örebro, Sweden.
    Sunvisson, Helena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Influencing self-rated health among adolescent girls with dance intervention: a randomized controlled trial2013In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 167, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether dance intervention influenced self-rated health for adolescent girls with internalizing problems.

    Design: Randomized controlled intervention trial with follow-up measures at 8, 12, and 20 months after baseline.

    Setting: A Swedish city with a population of 130 000.

    Participants: Girls aged 13 to 18 years with internalizing problems, ie, stress and psychosomatic symptoms. A total of 59 girls were randomized to the intervention group and 53 were randomized to the control group.

    Intervention: The intervention comprised dance classes twice weekly during 8 months. Each dance class lasted 75 minutes and the focus was on the joy of movement, not on performance.

    Main Outcome Measures: Self-rated health was the primary outcome; secondary outcomes were adherence to and experience of the intervention.

    Results: The dance intervention group improved their self-rated health more than the control group at all follow-ups. At baseline, the mean score on a 5-point scale was 3.32 for the dance intervention group and 3.75 for the control group. The difference in mean change was 0.30 (95% CI, −0.01 to 0.61) at 8 months, 0.62 (95% CI, 0.25 to 0.99) at 12 months, and 0.40 (95% CI, 0.04 to 0.77) at 20 months. Among the girls in the intervention group, 67% had an attendance rate of 50% to 100%. A total of 91% of the girls rated the dance intervention as a positive experience.

    Conclusions: An 8-month dance intervention can improve self-rated health for adolescent girls with internalizing problems. The improvement remained a year after the intervention

  • 4.
    Duberg, Anna
    et al.
    Örebro University, School of Health Sciences.
    Jutengren, Göran
    University of Borås.
    Hagberg, Lars
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Dance Intervention for Adolescent Girls: Effects on Somatic Symptoms, Emotional Distress, and Use of Medication. A Randomized Controlled TrialManuscript (preprint) (Other academic)
  • 5.
    Duberg, Anna
    et al.
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Sunvisson, Helena
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    “I feel free”: Experiences of a Dance Intervention for Adolescent Girls with Internalizing ProblemsManuscript (preprint) (Other academic)
  • 6.
    Duberg, Anna
    et al.
    Örebro University, School of Health Sciences. University Healthcare Research Center, Region Örebro County, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Healthcare Research Center, Region Örebro County, Örebro, Sweden.
    Sunvisson, Helena
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    "I feel free": Experiences of a dance intervention for adolescent girls with internalizing problems2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 31946Article in journal (Refereed)
    Abstract [en]

    Adolescent girls today suffer from internalizing problems such as somatic symptoms and mental health problems at higher rates compared to those of previous decades, and effective interventions are warranted. The aim of this study was to explore the experiences of participating in an 8-month dance intervention. This qualitative study was embedded in a randomized controlled trial of a dance intervention for adolescent girls with internalizing problems. A total of 112 girls aged 13-18 were included in the study. The dance intervention group comprised 59 girls, 24 of whom were strategically chosen to be interviewed. Data were analyzed using qualitative content analysis with an inductive approach. The experiences of the dance intervention resulted in five generic categories: (1) An Oasis from Stress, which represents the fundamental basis of the intervention; (2) Supportive Togetherness, the setting; (3) Enjoyment and Empowerment, the immediate effect; (4) Finding Acceptance and Trust in Own Ability, the outcome; and (5) Dance as Emotional Expression, the use of the intervention. One main category emerged, Finding Embodied Self-Trust That Opens New Doors, which emphasizes the increased trust in the self and the ability to approach life with a sense of freedom and openness. The central understanding of the adolescent girls' experiences was that the dance intervention enriched and gave access to personal resources. With the non-judgmental atmosphere and supportive togetherness as a safe platform, the enjoyment and empowerment in dancing gave rise to acceptance, trust in ability, and emotional expression. Taken together, this increased self-trust and they discovered a new ability to "claim space." Findings from this study may provide practical information on designing future interventions for adolescent girls with internalizing problems.

  • 7.
    Duberg, Anna
    et al.
    Örebro University Hospital.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Vårdvetenskapligt forskningscentrum.
    Taube, Jill
    CEFAM, Stockholms läns landsting, Stockholm, Sverige.
    Dans kan ge unga skydd mot psykisk ohälsa2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 36, p. 1539-1541Article in journal (Refereed)
  • 8. Grahn Kronhed, Ann-Charlotte
    et al.
    Hallberg, Inger
    Ödkvist, Lars
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    Effect of training on health-related quality of life, pain and falls in osteoporotic women2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 154-165Article in journal (Refereed)
    Abstract [en]

    Physical inactivity is a risk factor for osteoporosis and fractures. The aim of the study was to see if supervised training would improve health-related quality of life (HRQL), reduce pain and falls in osteoporotic women. Women with established osteoporosis (n=124) were invited to a 1-year, follow-up study. Seventy-three women aged 60-81 years met the inclusion criteria and were randomized to an exercise (E) or control (C) group. A 4-month, supervised group training programme was designed. Participants were studied using HRQL questionnaires, clinical tests and dynamic posturography. Thirty-one women in the E-group and 34 women in the C-group completed the study. The E-group improved in six SF-36 domains and mental component summary (MCsum) index and also in worst pain intensity (p<0.01) after the supervised exercise training. Differences were found between the groups when comparing changes in four SF-36 domains, MCsum and worst pain (p=0.001). Physical activity level decreased in the E-group after the supervised period. Mean time to first fall occurred earlier in the C-group than in the E-group for the first 4 months but the trend did not last for the 1-year follow-up. The study suggests that supervised group training is beneficial for women with established osteoporosis.

  • 9. Håkanson, Margareta
    et al.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    Lindström, Ingalill
    Mattsson, Bengt
    The horse as the healer: a study of riding in patients with back pain2009In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 13, no 1, p. 43-52Article in journal (Refereed)
    Abstract [en]

    A total of 24 patients, considerably disabled in daily activities by back pain, participated in an Equine Assisted Therapy (EAT) programme. The patients also had several health problems in addition to their current pain. The programme emphasised the principles of body awareness. The study is aimed at investigating not only whether symptom reduction would be achieved, but also at identifying qualities of EAT that were particularly beneficial for the patients' well being. The study was performed according to action research principles. The treatment reduced the pain and lessened other symptoms. The EAT also had an influence on the patients' self-image and a positive chain of effects was observed. The consequences were described according to four dimensions; the dimension of body awareness, competence, emotion and environment. The dimensions were interrelated having the simultaneous influence of a transition process and symptom reduction towards health.

  • 10.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Andersson-Hagiwara, Magnus
    Borås University, Borås, Sweden.
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. University Health Care Research Center.
    The ambulance nurse experiences of non-conveying patients2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 1-2, p. 235-244Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.

    BACKGROUND: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.

    DESIGN: A qualitative interview study was conducted using an inductive research approach.

    METHODS: The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.

    RESULTS: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.

    CONCLUSION: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.

    RELEVANCE TO CLINICAL PRACTICE: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

  • 11.
    Karlberg-Traav, Malin
    et al.
    Örebro University, School of Health Sciences.
    Cronqvist, Agneta
    Ersta Sköndal University College, Stockholm, Sweden.
    Forsman, Henrietta
    Dalarna University, Falun, Sweden.
    Johansson, Gunilla
    Ersta Sköndal University College, Stockholm, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Leading for research: an intervention to facilitate research utilization2016In: Nordic Conference in Nursing Research: Methods and Networks for the future, 2016Conference paper (Refereed)
    Abstract [en]

    Background: Nurses working in hospital wards, have been reported as low users of research when organizing their clinical work. Two main factors that could influence the nurses research utilization have been identified; leadership and time for reflection.

    Aim: The overall aim was to evaluate an intervention organi- zed with the purpose of supporting nurse leaders to facilitate research utilization among clinically working nurses.

    Design and methods: Based on focus group interviews with nurse leaders, an educational intervention for nurse leaders was developed. The intervention was given to approximately one third of the nurse leaders at a university hospital. It con- sists of four educational workshops with themes like practical research support, nursing theory, leading for research and literature search strategies, and was performed over a half-year period. The focus of the intervention was to provide practical paths to stimulate research utilization and to create a reflective approach among the nurse leaders.

    We also provided the nurse leaders with a ”mentor of sci- ence”. Before and after the intervention a survey was sent to all nurses working on the hospital wards. The survey consisted of questions about the working climate and how they use research in their daily work.

    Results: Preliminary results from the focus groups indicates that the nurse leaders ask for external support, and “hands on help” so the intervention was designed to provide that. The pre-intervention survey was answered by 591 nurses and will be repeated approximately one year after the intervention is completed. 

  • 12.
    Kollén, Lena
    et al.
    Örebro University, School of Health and Medical Sciences.
    Frändin, Kerstin
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    Fagervik Olsén, Monika
    Örebro University, School of Health and Medical Sciences.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences.
    Benign Paroxysmal Positional Vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-oldsManuscript (preprint) (Other academic)
    Abstract [en]

    Background and aims: Dizziness is a common problem among the elderly. Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly Benign Paroxysmal Positional Vertigo (BPPV). The diagnosis of BPPV is made by history and findings in the Dix-Hallpike test. It can be difficult to perform the Dix-Hallpike test in elderly persons due to limited range of motion when extending the neck. In this study we used a side-lying test to stimulate the posterior semicircular canal while the head and neck were fully supported on the examination table. The aims were to investigate the prevalence of dizziness or impaired balance and BPPV in a 75-year old population. Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons performed side-lying, static balance and dynamic walking tests.

    Results: Subjective dizziness and/or impaired balance was found in 36% especially when walking outdoors. A significant gender difference was found with a higher prevalence in women (40%) compared to men (30%) (p<0.01). BPPV was found in 11%. This was significantly more common in women compared to men (p<0.01). Elderly persons with BPPV also showed significantly impaired balance ability in static and dynamic balance tests compared to age matched persons without BPPV(p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared to persons without BPPV (p<0.001).

    Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in elderly. The side-lying test is a good screening test for BPPV.

  • 13.
    Kollén, Lena
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden; Örebro University Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Frändin, Kerstin
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Fagevik Olsén, Monika
    Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Physiotherapy, Clinical of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Center, Örebro University Hospital, Institute for Disability Research, Örebro, Sweden.
    Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large populatioin of 75-year-olds2012In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 24, no 4, p. 317-323Article in journal (Refereed)
    Abstract [en]

    Background and aims: Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV.

    Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests.

    Results: Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared with persons without BPPV (p<0.001).

    Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in the elderly.

  • 14.
    Nilsson, Pia
    et al.
    Tandemkliniken, Tvååker Primary Health Care Centre, Varberg, Sweden; Research and Development Unit, Primary Health Care, General Practice and Public Health, Falkenberg, Sweden; Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Baigi, Amir
    Research and Development Unit, Primary Health Care, General Practice and Public Health, Falkenberg, Sweden; Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Swärd, Leif
    Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden .
    Möller, Margareta
    Centre for Caring Sciences, Örebro County Council, Örebro, Sweden; Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Månsson, Jörgen
    Research and Development Unit, Primary Health Care, General Practice and Public Health, Falkenberg, Sweden; Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID2012In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 5, p. 404-410Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years following treatment by a structured programme and if the number of recurrent episodes and sick leave days differed compared with a control group.

    Subjects: All of the patients were diagnosed by a physician with the diagnosis code M77.1 (lateral epicondylitis). The intervention group (n = 103) was treated by a physiotherapist and an occupational therapist with a home training programme that included ergonomic advice. Wrist supports and/or night bandages were also available. Controls (n = 194) were diversely treated by different professionals.

    Major findings: In the total study group (n = 297), 54% of the patients experienced pain and 55% experienced function loss after two years. The intervention group had less pain than patients treated with corticosteroid injections (p < 0.0001) or NSAIDs (p = 0.048) and experienced better function than those treated with corticosteroid injections (p = 0.002). The intervention group had a lower recurrence (p < 0.0001) and fewer sick leave days at the time of the visit to the health care centre (p = 0.005).

    Principal conclusions: A structured treatment programme was more effective than corticosteroid injections and NSAIDs. Patients did not require additional treatment or sick leave and had learned self-treatment of the disorder.

  • 15.
    Philipsson, Anna
    et al.
    Department of Community Medicine and Public health, Örebro County Council, Örebro, Sweden.
    Duberg, Anna
    Örebro University Hospital. Department of Community Medicine and Public health, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Community Medicine and Public health.
    Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems2013In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 11, no 1, p. 4-Article in journal (Refereed)
    Abstract [en]

    Background: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular formof exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of thisstudy was to assess the cost-effectiveness of a dance intervention in addition to usual school health services foradolescent girls with internalizing problems, compared with usual school health services alone.

    Methods: A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial wasperformed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13–18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n =59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usualschool health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs wereconsidered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measuredwith the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs forthe intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.

    Results: At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the controlgroup (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALYand the likelihood of cost-effectiveness was 95%.

    Conclusions: Intervention with dance twice weekly in addition to usual school health services may be consideredcost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.

  • 16.
    Philipsson, Anna
    et al.
    Örebro University, School of Health Sciences.
    Sandberg, Elin
    Örebro University, School of Medical Sciences.
    Högström, Sofie
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences.
    Ekstav, Lars
    Lorentzon Fagerberg, Ulrika
    Region Västmanland, Sweden.
    Mörelius, Evalotte
    Linköpings universitet, Linköping, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital.
    ”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS2019Conference paper (Refereed)
    Abstract [sv]

    Bakgrund och syfte

    Funktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.

    Metod

    En randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.

    Resultat/(Planerade studier)

    Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. 

    Konklusion

    Studien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.

  • 17. Skoglund, Ingmarie
    et al.
    Bjorkelund, Cecilia
    Mehlig, Kirsten
    Gunnarsson, Ronny
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    GPs' opinions of public and industrial information regarding drugs: a cross-sectional study2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, p. 204-Article in journal (Refereed)
    Abstract [en]

    Background: General Practitioners {GP} in Sweden prescribe more than 50% of all prescriptions. Scientific knowledge on the opinions of GPs regarding drug information has been sparse. Such knowledge could be valuable when designing evidence-based drug information to GPs. GPs' opinions on public- and industry-provided drug information are presented in this article. Methods: A cross-sectional study using a questionnaire was answered by 368 GPs at 97 primary-health care centres {PHCC}. The centres were invited to participate by eight out of 29 drug and therapeutic committees {DTCs}. A multilevel model was used to analyse associations between opinions of GPs regarding drug information and whether the GPs worked in public sector or in a private enterprise, their age, sex, and work experience. PHCC and geographical area were included as random effects. Results: About 85% of the GPs perceived they received too much information from the industry, that the quality of public information was high and useful, and that the main task of public authorities was to increase the GPs' knowledge of drugs. Female GPs valued information from public authorities to a much greater extent than male GPs. Out of the GPs, 93% considered the main task of the industry was to promote sales. Differences between the GPs' opinions between PHCCs were generally more visible than differences between areas. Conclusions: Some kind of incentives could be considered for PHCCs that actively reduce drug promotion from the industry. That female GPs valued information from public authorities to a much greater extent than male GPs should be taken into consideration when designing evidence-based drug information from public authorities to make implementation easier.

  • 18.
    Skoglund, Ingmarie
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Research and Development Unit, Primary Health Care and Dental Care, Southern Älvsborg County, Region Västra Götaland, Vänersborg, Sweden.
    Björkelund, Cecilia
    Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Petzold, Max
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gunnarsson, Ronny
    Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Douglas QLD, Australia.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether tailored evidence-based drug information (EBDI) to general practitioners (GPs) can change the proportion of ACE inhibitor prescriptions more effectively than EBDI provided as usual three and six months after the intervention.

    Design. Randomized controlled trial.

    Setting. GPs in southern Sweden working at primary health care centres (PHCCs) in seven drug and therapeutic committee areas.

    Intervention. EBDI tailored to motivational interviewing (MI) technique and focused on the benefit aspect was compared with EBDI provided as usual.

    Subjects. There were 408 GPs in the intervention group and 583 GPs in the control group.

    Main outcome measures. Change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and angiotensin receptor blockers, three and six months after the intervention.

    Results. The GPs' average proportions of prescribed ACE inhibitors increased in both groups. No statistically significant differences in the change of proportions were found between intervention and control groups. Information was provided to 29% of GPs in both groups.

    Conclusion. This study could not prove that specially tailored EBDI using MI implements guidelines more effectively than EBDI provided as usual.

  • 19.
    Ssegonja, Richard
    et al.
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Alaie, Iman
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Sampaio, Filipa
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Sarkadi, Anna
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden; Murdoch Children's Research Institute, Melbourne, Australia.
    Langenskiöld, Sophie
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    von Knorring, Anne-Liis
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Bohman, Hannes
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Jonsson, Ulf
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Feldman, Inna
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

    METHODS: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

    RESULTS: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

    LIMITATIONS: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

    CONCLUSIONS: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

  • 20. Virta, Lena
    et al.
    Mortensen, Mona
    Eriksson, Rikard
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    How many patients with subacromial impingement syndrome recover with physiotherapy?: A follow-up study of a supervised exercise programme2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 166-173Article in journal (Refereed)
    Abstract [en]

    This study was designed for patients with the diagnosis subacromial impingement syndrome who were on the waiting list for orthopaedic surgery. They were sent to physiotherapy for training before the operation. The aim of this study was to explore how large the proportion of patients was that did not need surgery when first treated with a supervised exercise programme. The programme emphasizes relearning of normal patterns of movement in arm elevation, reduction of mechanical subacromial stress, specific endurance training to increase nutrition of the collagen tissue and simple advice to prevent recurrence. Ninety-seven patients were included in this follow-up study, selected consecutively at the physiotherapy department. Seventy-two patients completed the training programme; 87% scored excellent or good results and 10 patients were operated on, one of them from the training group. No significant difference was seen in the number of treatments or final results related to age, sex or duration of symptoms. An average of 11 treatments during 8 weeks was required. The experience of improvement and good results from this study is a strong recommendation that the supervised exercise programme be the first treatment alternative for patients with impingement syndrome.

  • 21.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Center, Region Örebro, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro, Örebro, Sweden.
    Herlitz, Johan
    Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Care Sciences and Centre for Person-Centred Care, and Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, no 1, article id 252Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period.

    METHODS: One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire.

    RESULTS: Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures.

    CONCLUSION: Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.

    TRIAL REGISTRATION: EudraCT number 2008-004303-59 date of registration: 2008-10-24.

  • 22.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Sarenmalm, E.K.
    Herlitz, J.
    Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fracturesManuscript (preprint) (Other academic)
  • 23.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Centre, Region Örebro, Örebro, Sweden.
    Norlin, Rolf
    Capio Movement, Halmstad, Sweden; Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Herlitz, Johan
    The Centre of Prehospital Research in Western Sweden, University College of Borås, Sweden; The Centre of Prehospital Research in Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sarenmalm, Elisabeth Kenne
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro.
    Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial2019In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 33, p. 35-43Article in journal (Refereed)
    Abstract [en]

    Introduction: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.

    Methods: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.

    Results: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).

    Conclusions: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.

  • 24.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden .
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro County Council, Örebro, Sweden .
    Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden2010In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, Vol. 5, p. 67-Article in journal (Refereed)
    Abstract [en]

    Background: Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden.

    Methods: A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey.

    Results: The majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal.

    Conclusions: The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. However, the frequency and duration of exercises and recommendations for sternal precautions reinforced for the healing period differ between physiotherapists. This survey provides an initial insight into physiotherapy management in Sweden. Comparison with surveys in other countries is warranted to improve the physiotherapy management and postoperative recovery of the cardiac surgery patient.

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