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  • 1.
    Alaie, Iman
    et al.
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Philipson, 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, 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.
    Alaie, Iman
    et al.
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Ssegonja, Richard
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Philipson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Center.
    von Knorring, Anne-Liis
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Ramklint, Mia
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Bohman, Hannes
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Feldman, Inna
    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 Center.
    Jonsson, Ulf
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet,, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression, early psychiatric comorbidities, and adulthood welfare burden: a 25-year longitudinal cohort study2021In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, no 11, p. 1993-2004Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopathology on these associations.

    METHODS: This is a longitudinal cohort study of 539 participants assessed at age 16-17 using structured diagnostic interviews. An ongoing 25-year follow-up linked the cohort (n = 321 depressed; n = 218 nondepressed) to nationwide population-based registries. Outcomes included consecutive annual data on social transfer payments due to unemployment, work disability, and public assistance, spanning from age 18 to 40. Parameter estimations used the generalized estimating equations approach.

    RESULTS: Adolescent depression was associated with all forms of social transfer payments. The estimated overall payment per person and year was 938 USD (95% CI 551-1326) over and above the amount received by nondepressed controls. Persistent depressive disorder was associated with higher recipiency across all outcomes, whereas the pattern of findings was less clear for subthreshold and episodic major depression. Moreover, depressed adolescents presenting with comorbid anxiety and disruptive behavior disorders evidenced particularly high recipiency, exceeding the nondepressed controls with an estimated 1753 USD (95% CI 887-2620).

    CONCLUSION: Adolescent depression is associated with considerable public expenditures across early-to-middle adulthood, especially for those exposed to chronic/persistent depression and psychiatric comorbidities. This finding suggests that the clinical heterogeneity of early-life depression needs to be considered from a longer-term societal perspective.

  • 3.
    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.

  • 4.
    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

  • 5.
    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)
  • 6.
    Duberg, Anna
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Jutengren, Göran
    School of Health Sciences, University of Borås, Borås, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    The effects of a dance intervention on somatic symptoms and emotional distress in adolescent girls: A randomized controlled trial2020In: Journal of international medical research, ISSN 0300-0605, E-ISSN 1473-2300, Vol. 48, no 2, article id 300060520902610Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether a dance intervention for adolescent girls reduces stressrelated symptoms.

    Methods: This was a randomized controlled trial of an after-school intervention. Participants were 112 girls aged 13 to 18 years with stress-related somatic symptoms and emotional distress. The intervention comprised twice-weekly dance sessions for 8 months with a focus on enjoyment and socialization. A questionnaire was administered at baseline and after 8, 12 and 20 months. Participants rated the frequency with which they had experienced somatic symptoms and emotional distress during the previous 3 months.

    Results: After the intervention, there was a significantly greater reduction in somatic symptoms and emotional distress in the dance intervention group than in the control group. The difference in the mean score change on a 5-point scale was 0.26 (95% confidence interval [CI]: 0.04 to 0.47) for somatic symptoms and 0.30 (95% CI: 0.04 to 0.58) for emotional distress.

    Conclusion: Dance interventions may reduce somatic symptoms and emotional distress in adolescent girls, and may constitute a nonpharmacological complement to school health services. However, continued participation is needed for long-term sustainable results. Additional randomized studies are required to further evaluate the effect of this type of intervention in different settings.

  • 7.
    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.

  • 8.
    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)
  • 9.
    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)
  • 10.
    Duberg, Anna
    et al.
    Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Philipsson, A.
    Department of Community medicine and Public health, Örebro County Council, Örebro, Sweden.
    Hagberg, L.
    Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden; Department of Community medicine and Public health, Örebro County Council, Örebro, Sweden.
    Sunvisson, H.
    Örebro University, Örebro, Sweden.
    Möller, Margareta
    Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Adolescent girls with internalizing problems: Can dance intervention improve health? A randomized, controlled trial with cost-utility analysis2012In: Journal of Science and Medicine in Sport, ISSN 1440-2440, Vol. 15, no Suppl. 1, p. S345-S346, article id 837Article in journal (Other academic)
    Abstract [en]

    Introduction: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health are widespread. Dance is a popular form of exercise also known to increase a sense of self-control which can contribute to reduced stress. The purpose of this study was to investigate if dance intervention for adolescent girls with internalizing problems influenced self-rated health. A secondary aim was to assess the cost-effectiveness of the intervention in addition to usual school health services, compared with usual school health services alone.

    Methods: Randomized controlled intervention trial with follow-up measures of self-rated health at 8, 12 and 20 months after baseline. A total of 112 girls, 13–18 years old, with internalizing problems, i.e. stress and psychosomatic symptoms, were randomized to intervention group or control group. 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. Costs for the stakeholder of the intervention, treatment effect and healthcare costs were considered. Gained quality-adjusted life-years (QALY) were used to measure the effects. Quality of life (QOL) was measured with the Health Utility Index Mark 3 (HUI 3). Cost-effectiveness ratios were based on the changes in QALY and net costs for the intervention group compared with the control group. Net monetary benefit (NMB) was also calculated.

    Results: A year after baseline 65% of the girls in the intervention group and 32% of the girls in the control group had increased their self-rated health. The differences in change score between groups were significant at all follow-ups. After 8-months U = 895.5 (P = .037), after 12-months U = 680.0 (P = .001), and after 20-months U = 801 (P = .022).

    Cost effectiveness showed that after 20 months, QOL had increased by 0.083 units more in the intervention group than in the control group (P = .04), translating to 0.095 gained QALY. The cost-effectiveness ratio was $7187.4 and the NMB was $3846.0 (Willingness to pay $50 000 for a gained QALY).

    Discussion: This study suggests that an 8-month dance intervention can improve self-rated health for adolescent girls with internalizing problems. The improvement remained a year after the intervention. The intervention in addition to usual school health services showed cost-effectiveness compared with usual school health services alone. The cost-effectiveness ratio was far below the recommended threshold value.

  • 11. 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.

  • 12. 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.

  • 13.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Cente.
    Andersson-Hagiwara, Magnus
    Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Gjøvik, Norway.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center; Department of Surgery.
    Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden2020In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, no 1, article id 61Article in journal (Refereed)
    Abstract [en]

    Background: There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data.

    Methods: A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients' medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test.

    Results: Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women.

    Conclusions: Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

  • 14.
    Höglund, Erik S.
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Andersson-Hagiwara, Magnus
    Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research University of Borås, Sweden.
    Möller, Margareta H.L.
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Ohlsson-Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Sweden; Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden .
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Sweden; Faculty of Medicine and Health Sciences, Department of Health Sciences in Gjøvik, NTNU – Norwegian University of Science and Technology, Gjøvik, Norway.
    Am I ill enough?: Experiences of patients non-conveyed by an ambulance serviceManuscript (preprint) (Other academic)
  • 15.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Sweden; Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU 10 – Norwegian University of Science and Technology, Gjøvik, Norway.
    Andersson-Hagiwara, Magnus
    Faculty of Caring Science, Centre for Prehospital Research, Work Life and Social Welfare, University of Borås, Sweden .
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Ohlsson-Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Outcomes in patients not conveyed by emergency medical services (EMS): A one-year prospective studyManuscript (preprint) (Other academic)
  • 16.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Gjøvik, Norway.
    Andersson-Hagiwara, Magnus
    Faculty of Caring Science, Centre for Prehospital Research, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Ohlsson-Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Surgery.
    Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study2022In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12-51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed.

    AIM: The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients.

    METHODS: This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year.

    RESULTS: The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision.

    CONCLUSIONS: Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm.

  • 17.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Schröder, Agneta
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway.
    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.

  • 18.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Hagiwara, Magnus
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Ambulance nurses experiences of non-conveying patients to another level of care2018Conference paper (Refereed)
  • 19.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Hagiwara, Magnus
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Hänvisning till annan vårdnivå: En prehospital patientsäkerhetsstudie2018Conference paper (Refereed)
  • 20.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Hagiwara, Magnus
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital.
    The ambulance nurse experiences of non-conveying patients2018Conference paper (Refereed)
  • 21.
    Högström, Sofie
    et al.
    Örebro University, School of Health Sciences.
    Philipson, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Ekstav, Lars
    Region Örebro län, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fagerberg, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Falk, Elin
    Uppsala university, Uppsala, Sweden .
    Möller, Margareta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Sandberg, Elin
    Lund university, Lund, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Dance and Yoga Reduced Functional Abdominal Pain in Young Girls: A Randomized Controlled Trial2021Conference paper (Refereed)
  • 22.
    Högström, Sofie
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Philipson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Ekstav, Lars
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fagerberg, Ulrika
    Department of Pediatrics, Center for Clinical Research, Västmanland Hospital, Västerås, Uppsala University, Sweden.
    Falk, Elin
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Sandberg, Elin
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences. Department of Pediatrics.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Dance and yoga reduced functional abdominal pain in young girls: A randomized controlled trial2021In: Örebro University’s Nobel Day Festivities: Book of abstracts, 2021 / [ed] Johanna Hulldin, Örebro University , 2021, p. 13-13Conference paper (Refereed)
  • 23.
    Högström, Sofie
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Philipson, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Ekstav, Lars
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fagerberg, Ulrika L.
    Department of Pediatrics, Center for Clinical Research, Västmanland Hospital, Västerås, Uppsala University, Uppsala, Sweden; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Falk, Elin
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Child and adolescent psychiatry, Uppsala university hospital, Uppsala, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Sandberg, Elin
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Center for primary health care research, Department of clinical sciences, Lund University, Malmö, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences. Department of Pediatrics.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Dance and Yoga Reduced Functional Abdominal Pain in Young Girls: A Randomized Controlled Trial2022In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 26, no 2, p. 336-348Article in journal (Refereed)
    Abstract [en]

    Background: Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio-respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain.

    Objectives: The aim with this study was to evaluate the effects of a dance and yoga intervention on maximum abdominal pain in 9- to 13-year- old girls with FAPDs.

    Methods: This study was a prospective randomised controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale–Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes.

    Results: Dance and yoga were superior to standard healthcare alone, with a medium to high between-group effect size and significantly greater pain reduction (b = −1.29, p = 0.002) at the end of the intervention.

    Conclusions: An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9- to 13-year-old girls with FAPDs.

    Significance:  FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group. 

  • 24.
    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. 

  • 25.
    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.

  • 26.
    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 population 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.

  • 27.
    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.

  • 28.
    Norén, Paulina
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Ohlsson-Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Psychometric evaluation of the WHODAS 2.0 and prevalence of disability in a Swedish general population2023In: Journal of patient-reported outcomes, E-ISSN 2509-8020, Vol. 7, no 1, article id 36Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a generic questionnaire that captures health and disability-related functioning information corresponding to six major life domains: Cognition, Mobility, Self-care, Getting along, Life activities, and Participation. The WHODAS 2.0 is used in a wide range of international clinical and research settings. A psychometric evaluation of WHODAS 2.0, Swedish version, in the general population is lacking, together with national reference data to enable interpretation and comparison. This study aims to evaluate the psychometric properties of the Swedish 36-item version of WHODAS 2.0 and describe the prevalence of disability in a Swedish general population.

    METHODS: A cross-sectional survey was performed. Internal consistency reliability was assessed with Cronbach's alpha. The construct validity was evaluated with item-total correlation, Pearson's correlation between the WHODAS 2.0 domains and the RAND-36 subscales, analysis of known groups by one-way ANOVA, and analysis of the factor structure by confirmatory factor analysis.

    RESULTS: Three thousand four hundred and eighty two adults aged 19-103 years (response rate 43%) participated. Significantly higher degrees of disability were reported by the oldest age group (≥ 80 years), adults with a low level of education, and those on sick leave. Cronbach's alpha was from 0.84 to 0.95 for the domain scores and 0.97 for the total score. The item-scale convergent validity was satisfactory, and the item-scale discriminant validity was acceptable except for the item about sexual activity. The data partially supported the factor structure, with borderline fit indices.

    CONCLUSION: The psychometric properties of the self-administered Swedish 36-item version of the WHODAS 2.0 are comparable to those of other language versions of the instrument. Data of the prevalence of disability in Swedish general population enables normative comparisons of WHODAS 2.0 scores of individuals and groups within clinical practice. The instrument has certain limitations that could be improved on in a future revision. The test-retest reliability and responsiveness of the Swedish version of WHODAS 2.0 for different somatic patient populations remain to be evaluated.

  • 29.
    Norén, Paulina
    et al.
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Tests of scaling assumptions and reference data for the Swedish RAND-36: the Mid-Swed Health Survey2020Conference paper (Refereed)
  • 30.
    Ohlsson Nevo, Emma
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. School of Health Sciences, Department of Surgery, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Norén, Paulina
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    The Swedish RAND-36: psychometric characteristics and reference data from the Mid-Swed Health Survey2021In: Journal of patient-reported outcomes, E-ISSN 2509-8020, Vol. 5, no 1, article id 66Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to evaluate data quality, scaling properties, and reliability of the Swedish RAND-36 in a general population sample and to present reference data for the Swedish population.

    METHODS: Testing of data quality, scaling assumptions and reliability followed methods recommended for the International Quality of Life Assessment Project, previously used for psychometric testing of SF-36 and RAND-36. Data were collected via regular mail for a random stratified sample of the general population in a Swedish county. Weighted means for RAND-36 scores were used and differences by sex, age, education, and occupational groups were tested.

    RESULTS: The response rate was 42%, and the sample comprised 3432 persons (45% men, 55% women) with a median age of 56.9 years. The internal consistency reliability was satisfactory, with Cronbach's alphas > 0.80 for all eight scales. The percentage of missing items was low, ranging between 1.3% and 3.2%. No floor effects (≥15%) were noted, while ceiling effects were observed for physical functioning, role-functioning/physical, pain, role-functioning/emotional, and social functioning. Item-scale correlations were satisfactory (r ≥ 0.40). Correlations among the physical health scales were strong (range 0.58-0.68) as were the correlations among the mental health scales (range 0.58-0.73). Men reported significantly better health-related quality of life (HRQoL) on all scales, although the gender differences were small. Comparisons among age groups showed approximately equal scores among those 20-29, 30-39, and 40-49 years, while significant decreases in physical health were observed in the older age groups. Substantially worse physical health scores were observed in the oldest age group (80+). Significant differences among age groups were noted also for the mental health scales; however, better energy/fatigue and emotional well-being scores were seen in the older age groups, except for the oldest (80+). Those with university education reported significantly better scores on all scales compared to those with mandatory education.

    CONCLUSIONS: The study suggests that the Swedish version of RAND-36 is an acceptable and reliable instrument for measuring HRQoL in the general population. The study provides reference data that can be used for norm-based comparisons.

  • 31.
    PERJÉS, B.B.
    et al.
    Doctoral School of Health Sciences, Faculty of Health Sciences, University, Hungary.
    PREMUSZ, V.
    Doctoral School of Health Sciences, Faculty of Health Sciences, University, Hungary.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    NAGY, A.
    Hungarian Society of Sports Medicine, Budapest, Hungary, Hungary.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital.
    HOW CAN DANCE INTERVENTION BECOME A WAY OFSTRESSMANAGEMENT BETWEEN YOUNG GIRLS?2017In: European Journal of Sports Medicine, E-ISSN 1792-4979, Vol. 5, no Sup. 1, p. 85-86, article id A52Article in journal (Refereed)
  • 32.
    Philipson, A.
    et al.
    Örebro University, School of Health Sciences. Örebro University, Örebro, Sweden.
    Alaie, I.
    Uppsala Univ, Uppsala, Sweden..
    Ssegonja, R.
    Uppsala Univ, Uppsala, Sweden..
    Möller, M.
    Örebro University, School of Health Sciences. Örebro University, Örebro, Sweden.
    Hagberg, L.
    Örebro University, School of Health Sciences. Örebro University Hospital. Örebro University, Örebro, Sweden.
    Jonsson, U.
    Uppsala Univ, Uppsala, Sweden..
    ASSOCIATION OF ADOLESCENT DEPRESSION WITH EARNINGS IN ADULTHOOD2019In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 22, p. S685-S685Article in journal (Refereed)
  • 33.
    Philipson, Anna
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Alaie, Iman
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Ssegonja, Richard
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Imberg, Henrik
    Statistiska Konsultgruppen, Gothenburg, Sweden; Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden.
    Copeland, William
    Vermont Center for Children, Youth and Families in the Department of Psychiatry, University of Vermont Medical Center, Burlington, VT, USA.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Jonsson, Ulf
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression and subsequent earnings across early to middle adulthood: a 25-year longitudinal cohort study2020In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 2045-7979, Vol. 29, article id e123Article in journal (Refereed)
    Abstract [en]

    AIMS: The few available studies on early-onset depression and future earnings offer ambiguous findings, and potential sources of heterogeneity are poorly understood. We examined the differences in adult earnings of males and females with and without a history of depressive disorder in adolescence, with specific focuses on (1) future earnings in clinical subtypes of adolescent depression; (2) the growth and distribution of earnings over time within these subgroups and (3) the mediating role of subsequent depressive episodes occurring in early adulthood.

    METHODS: Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort study initiated in Uppsala, Sweden, in the early 1990s. Comprehensive diagnostic assessments were conducted at age 16-17 and in follow-up interviews 15 years later, while consecutive data on earnings for the years 1996 to 2016 (ages 20-40) were drawn from population-based registries. The current study included participants with a history of persistent depressive disorder (PDD) (n = 175), episodic major depressive disorder (MDD) (n = 82), subthreshold depression (n = 64) or no depression (n = 218) in adolescence. The association of adolescent depression with earnings in adulthood was analysed using generalised estimating equations. Estimates were adjusted for major child and adolescent psychiatric comorbidities and parental socioeconomic status. The indirect (mediated) effect of depression in early adulthood (ages 19-30) on earnings in mid-adulthood (31-40) was estimated in mediation analysis. The study followed the 'STrengthening the Reporting of OBservational studies in Epidemiology' (STROBE) guidelines.

    RESULTS: Earnings across early to middle adulthood were lower for participants with a history of a PDD in adolescence than for their non-depressed peers, with an adjusted ratio of mean earnings of 0.85 (0.77-0.95) for females and 0.76 (0.60-0.95) for males. The differences were consistent over time, and more pronounced in the lower percentiles of the earnings distributions. The association was partially mediated by recurrent depression in early adulthood (48% in total; 61% for females, 29% for males). No reduction in earnings was observed among participants with episodic MDD in adolescence, while results for subthreshold depression were inconclusive.

    CONCLUSIONS: Our findings suggest that future earnings of adolescents with depressive disorders are contingent on the duration and natural long-term course of early-onset depression, emphasising the need for timely and effective interventions to avoid loss of human capital.

  • 34.
    Philipson, Anna
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Högström, Sofie
    Örebro University, School of Health Sciences. University Health Care Research Center, Universitetssjukhuset Örebro, Örebro, Sweden.
    Lindholm, Lars
    Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Universitetssjukhuset Örebro, Örebro, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    The Cost-Effectiveness of a Dance and Yoga Intervention for Girls with Functional Abdominal Pain Disorders2023In: PharmacoEconomics - open, ISSN 2509-4262, no 7, p. 321-335Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Functional abdominal pain disorders (FAPDs) affect children worldwide, being more prevalent among girls. The individual and societal burdens of the disease are substantial, and evidence-based interventions are needed. Non-pharmacological treatments have generally produced promising results, with dance and yoga specifically having potential as an effective treatment option. Beside efficacy, the cost-effectiveness of interventions is important when prioritizing and allocating public resources.

    OBJECTIVE: This study evaluated the cost-effectiveness of an 8-month dance and yoga intervention for girls with functional abdominal pain or irritable bowel syndrome, based on a randomized control trial called 'Just in TIME'.

    METHODS: The intervention, performed in Sweden, was studied using a decision analysis tool, i.e., a decision tree within the trial followed by a Markov model with a time horizon of 10 years. The base case considered healthcare costs as well as productivity losses, measuring the effects in gained quality-adjusted life-years (QALYs) and presenting an incremental cost-effectiveness ratio (ICER).

    RESULTS: The base case results show that the intervention, compared with current practice, was the dominant strategy from both the 12-month and long-term perspectives. The sensitivity analyses indicated that the long-term, but not the short-term, findings were robust for different assumptions and changes in parameter estimates, resulting in ICERs similar to those of the base case scenario.

    CONCLUSIONS: Offering dance and yoga to young girls with FAPDs generates small QALY gains and monetary savings compared with standard healthcare and is likely cost-effective. These findings make a valuable contribution to an area where evidence-based and cost-effective treatment interventions are needed.

    CLINICAL TRIALS REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02920268; Name: Just in TIME-Intervention With Dance and Yoga for Girls With Recurrent Abdominal Pain.

  • 35.
    Philipson, Anna
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Högström, Sofie
    Örebro University, School of Health Sciences. University Health Care Research Center, Universitetssjukhuset Örebro, Örebro.
    Lindholm, Lars
    Umeå University, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Universitetssjukhuset Örebro .
    Ryen, Linda
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    The cost-effectiveness of a dance and yoga intervention for girls with functional abdominal pain disordersManuscript (preprint) (Other academic)
  • 36.
    Philipson, Anna
    et al.
    Örebro University, School of Health Sciences.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences. Department of Paediatrics.
    Ekstav, Lars
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fagerberg, Ulrika
    Centre for Clinical Research, Västmanland Hospital Västerås, Uppsala University, Uppsala, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Mörelius, Evalotte
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital.
    An Intervention With Dance and Yoga for Girls With Functional Abdominal Pain Disorders (Just in TIME): Protocol for a Randomized Controlled Trial2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 12, article id e19748Article in journal (Refereed)
    Abstract [en]

    Background: Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus.

    Objective: This study aims to evaluate the effects of a dance and yoga intervention among girls aged 9 to 13 years with FAPDs.

    Methods: The study is a prospective randomized controlled trial among girls aged 9 to 13 years with functional abdominal pain, irritable bowel syndrome, or both. The target sample size was 150 girls randomized into 2 arms: an intervention arm that receives dance and yoga sessions twice weekly for 8 months and a control arm that receives standard care. Outcomes will be measured at baseline and after 4, 8, 12, and 24 months, and long-term follow-up will be conducted 5 years from baseline. Questionnaires, interviews, and biomarker measures, such as cortisol in saliva and fecal microbiota, will be used. The primary outcome is the proportion of girls in each group with reduced pain, as measured by the faces pain scale-revised in a pain diary, immediately after the intervention. Secondary outcomes are gastrointestinal symptoms, general health, mental health, stress, and physical activity. The study also includes qualitative evaluations and health economic analyses. This study was approved by the Regional Ethical Review Board in Uppsala (No. 2016/082 1-2).

    Results: Data collection began in October 2016. The intervention has been performed in 3 periods from 2016 through 2019. The final 5-year follow-up is anticipated to be completed by fall 2023.

    Conclusions: Cost-effective and easily accessible interventions are warranted to reduce the negative consequences arising from FAPDs in young girls. Physical activity is an effective strategy, but intervention studies are needed to better understand what types of activities facilitate regular participation in this target group. The Just in TIME (Try, Identify, Move, and Enjoy) study will provide insights regarding the effectiveness of dance and yoga and is anticipated to contribute to the challenging work ofreducing the burden of FAPDs for young girls.

  • 37.
    Philipsson, Anna
    et al.
    Department of Community Medicine and Public health, Örebro County Council, Örebro, Sweden.
    Duberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. 2Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    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, 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.

  • 38.
    Philipsson, Anna
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    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”.

  • 39.
    Poikonen, Hanna
    et al.
    Professorship for Learning Sciences and Higher Education, Department of Humanities, Social and Political Sciences, ETH Zurich, Switzerland; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Eriksson Crommert, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Lund, Majja
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Msghina, Mussie
    Örebro University, School of Medical Sciences.
    InMotion – Mixed physical exercise with creative movement as an intervention for people with schizophrenia2023Conference paper (Refereed)
    Abstract [en]

    Schizophrenia (SCZ) is among the world’s top ten causes of long-term disability (World Health Organization, 2004). The major symptoms of SCZ include hallucinations, delusions, affective flattening, and cognitive impairment, and their treatment with antipsychotic medications is far from optimal.Creative and body awareness training (dance/movement therapy, body psychotherapy) and physical training (aerobic and strength training) improve SCZ symptoms (e.g Martin et al., 2016, 2017; Girdler et al., 2019; Millman et a., 2021). In our novel intervention, we bring together creativity and self-awareness with physical training. The 12-week 24-session intervention with 30 participants (Figure 1) includes components like visualization, cardio and strength training, and social interaction. We will measure the impact with standardized clinical questionnaires, EEG-fNIRS, motion capture, and cognitive, affective, and physical tests. We expect our intervention to improve the quality of life and negative symptoms of SCZ by balancing the brain functions and bodily state related to self-awareness, social interaction, and physical fitness. In my talk, I will cover brain dysfunctions related to self-awareness in SCZ (Ferri et al., 2012; Ebisch et al., 2013) and describe the scientific rationale for each component included in our novel intervention (e.g. Lee et al., 2015; Firth et al., 2017).

  • 40.
    Poikonen, Hanna
    et al.
    Professorship for Learning Sciences and Higher Education, Department of Humanities, Social and Political Sciences, Swiss Federal Institute of Technology Zurich (ETH Zürich), Zürich, Switzerland; 2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Eriksson Crommert, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Lund, Majja
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; .
    Msghina, Mussie
    Örebro University, School of Medical Sciences. Department of Psychiatry, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    “InMotion”—Mixed physical exercise program with creative movement as an intervention for adults with schizophrenia: study protocol for a randomized controlled trial2023In: Frontiers in Human Neuroscience, E-ISSN 1662-5161, Vol. 17, article id 1192729Article in journal (Refereed)
    Abstract [en]

    Background: Schizophrenia is among the world’s top 10 causes of long-term disability with symptoms that lead to major problems in social and occupational functioning, and in self-care. Therefore, it is important to investigate the efficacy of complementary treatment options for conventionally used antipsychotic medication, such as physical training, and psychosocial interventions.

    Objective: To combine aerobic and strength training with cognitive, emotional and social stimulation in one intervention for people with schizophrenia and test the feasibility and effects of this intervention.

    Methods: The study is a mixed-method randomized controlled trial to evaluate the effects of a 12-week intervention for adults with schizophrenia. The treatment group (30 participants) will receive the intervention in addition to standard care and the control group (30 participants) only standard care. The intervention consists of 24 biweekly sessions with a duration of 60 min. The pre-test (weeks from 4 to 2 prior to the intervention) and post-test (week 12) include clinical measure (PANSS), quality of life, social performance, movement quantity, brain function and eye tracking measures. In addition, a treatment subgroup of 12–15 participants and their family member or other next of kin will complete a qualitative interview as a part of their post-test. Two follow-up tests, including clinical, quality of life, brain function and eye tracking will be made at 6 and 12 months from the completion of the intervention to both study groups. The primary outcome is change in negative symptoms. Secondary outcome measures include general and positive symptoms, quality of life, social performance, movement quantity, brain function and eye tracking. Explorative outcome includes patient and family member or other next of kin interview.

    Results: Pilot data was collected by June 2023 and the main data collection will begin in September 2023. The final follow-up is anticipated to be completed by 2026.

    Conclusion: The InMotion study will provide new knowledge on the feasibility, efficacy, and experiences of a novel intervention for adults with schizophrenia. The hypothesis is that regular participation in the intervention will reduce clinical symptoms, normalize physiological measures such as brain activation, and contribute to new active habits for the participants.

  • 41.
    Sandberg, Elin
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Appelros, Peter
    University Health Care Research Center, Region Örebro County, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Duberg, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Dance intervention for adolescent girls: Effects on daytime tiredness, alertness and school satisfaction. A randomized controlled trial2021In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 26, p. 505-514Article in journal (Refereed)
    Abstract [en]

    Introduction: Daytime tiredness is a risk factor for poor health and well-being in the short and long term and is often associated with sleep problems, stress-related mental health complaints and decreased school functioning. This study investigates the effect of an 8 month dance intervention study on daytime tiredness, alertness, sleep duration, sleep quality and school satisfaction.

    Methods: Randomized controlled intervention study that included a total of 112 girls aged 13-18 years old with stress-related mental health problems. Dance intervention with focus on enjoyment were performed semiweekly for 8 months. Questionnaire-based measurements regarding self-reported daytime tiredness, alertness, school satisfaction, sleep duration and quality were evaluated at baseline and at 8-, 12- and 20- month follow-ups.

    Results: Daytime tiredness decreased significantly in the dance group compared to control group at all follow-ups. Alertness increased significant within the dance group, but there were no significant difference compared to the controls. Significant improvements were found in all sleep quality items within the dance group, between groups only one significant result was found. No conclusive changes in sleep duration were observed. School satisfaction increased significantly in the dance intervention group; however, its significance compared to that of the control group faded after adjustment for differences between groups at baseline.

    Conclusions: This study suggests that a dance intervention focusing on enjoyment can be effective in decreasing daytime tiredness. This study also adds to the growing body of evidence for the benefits of using nonpharmacological interventions to decrease stress-related problems among adolescents.

  • 42. 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, 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.

  • 43.
    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.

  • 44.
    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.
    Philipson, 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.

  • 45. 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.

  • 46.
    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.

  • 47.
    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)
  • 48.
    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, and School of Health Sciences, Örebro University, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro.
    Sarenmalm, Elisabeth Kenne
    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, Sweden.
    Herlitz, Johan
    Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden.
    Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures2020In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 49, article id 100825Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain management needs to be comprehensively investigated in patients with hip fractures, as it represents a fast-growing challenge to emergency care. The purpose of this study was to describe reported pain in patients with suspected hip fractures in a prehospital setting.

    METHODS: In this observational study, 1,426 patients with a suspected hip fracture were included. Dynamic and static pain were assessed on the arrival of the emergency medical services (EMS) and on hospital admission using the Numerical Rating Scale (NRS), if feasible, and the Behaviour Rating Scale (BRS), if not.

    RESULTS: On EMS arrival, the median dynamic NRS pain score was eight and 84% of the patients had severe or moderate dynamic pain according to the BRS. On admission to hospital, the median dynamic NRS pain score was reduced to five and 45% of the patients had reduced dynamic pain according to the BRS. Among all patients, the NRS was judged to be feasible and was therefore used in 36%. Furthermore, there was an association between the decrease in pain and the increase in the number of administered medications, as well as the duration of prehospital care.

    CONCLUSIONS: Patients with suspected hip fractures suffered substantial pain on EMS arrival. Only half experienced a reduction in pain on hospital admission and only 75% received pain-relieving medication.

  • 49.
    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.

  • 50.
    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, E-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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