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Söderberg D, Bonn SE, Sjöblom L, Dahlgren A, Muli I, Amer-Wåhlin I, Bertilson BC, Farrokhnia N, Hvitfeldt H, Taloyan M, Hägglund M, Trolle Lagerros Y. Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden. Telemed J E Health 2024; 30:1289-1296. [PMID: 38394275 DOI: 10.1089/tmj.2023.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65-69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19-0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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Affiliation(s)
- Daniel Söderberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Anna Dahlgren
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Irene Muli
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Bo C Bertilson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hvitfeldt
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Hägglund
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden
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Öster K, Tucker P, Söderström M, Dahlgren A. Pros and cons of quick returns-a cross-sectional survey among Swedish nurses and nurse assistants. Ind Health 2023; 61:379-392. [PMID: 35896350 PMCID: PMC10542474 DOI: 10.2486/indhealth.2022-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Short rest (<11h) between evening and day shifts-known as quick returns (QRs)-impede recovery and may impair health. Nevertheless, QRs remain popular among some shift workers. This study explores nurses' and nurse assistants' perceptions of the merits and demerits of QRs from individual and organizational perspectives. Participants were recruited from eleven wards at two Swedish hospitals as part of a larger quasi-experimental intervention study. The majority (79%) had influence over their work schedules. Frequency distributions of responses are presented. Ninety six undertook a baseline survey regarding recovery, tolerance and work performance in relation to QRs. A majority experienced difficulties unwinding before bedtime (76%), insufficient sleep (80%), and daytime fatigue (72%). A third experienced an increased risk of errors and mistakes. However, QRs appeared to facilitate taking reports from patients and planning work, as this task was more often rated as 'very easy' following a QR compared to other shift combinations. Tolerance of QRs varied substantially. In conclusion, QRs seem to benefit continuity in work processes, but may do so at the expense of recovery and safety. Wards planning to reduce QRs-through participatory or fixed schedule models-should consider impacts on work processes.
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Affiliation(s)
- Kristin Öster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institute, Sweden
| | - Philip Tucker
- School of Psychology, Swansea University, United Kingdom
- Stress Research Institute, Stockholm University, Sweden
| | - Marie Söderström
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institute, Sweden
| | - Anna Dahlgren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institute, Sweden
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3
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Ran C, Jennysdotter Olofsgård F, Steinberg A, Sjöstrand C, Waldenlind E, Dahlgren A, Belin AC. Patients with cluster headache show signs of insomnia and sleep related stress: results from an actigraphy and self-assessed sleep study. J Headache Pain 2023; 24:114. [PMID: 37596555 PMCID: PMC10439595 DOI: 10.1186/s10194-023-01650-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cluster headache (CH) is a primary headache disorder which is characterized by circadian timing of headache attacks, usually at nighttime, in around two thirds of patients. Patients with CH often report sleep difficulties, though it is unknown whether this is a cause or a consequence of nightly headache attacks. OBJECTIVE In this case-control study we have assessed sleep quality in study participants with CH in cluster bout respectively in remission, compared to a control group of neurologically healthy individuals to investigate the potential connection between sleep and CH. METHODS Fifty study participants with CH and 42 controls were recruited for sleep assessment. Sleep was recorded using MotionWatch 8 actigraphs (CamNTech) for a period of two weeks. Study participants were instructed to wear the unit during rest and sleep and to fill out a sleep diary daily through the two-weeks period. RESULTS Results from actigraphy recordings and sleep diaries suggested that patients with CH spend longer time in bed than controls (CH 8.1 hours vs. Controls 7.7 hours, p=0.03), but do not sleep more than controls (CH 6.7 hours vs. controls 6.5 hours, p=0.3). In addition, CH patients reported increased sleep latency (p=0.003), particularly during, but not restricted to, cluster bouts. Study participants with CH further reported higher levels of stress at bedtime (p=0.01), and they felt less well rested than controls (p=0.001). CONCLUSION Our analysis suggests that sleep is negatively affected in CH both in cluster bout and in remission, manifesting in symptoms consistent with insomnia such as prolonged sleep latency and increased time in bed.
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Affiliation(s)
- Caroline Ran
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Danderyd Hospital, Stockholm, Sweden
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Dahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Carmine Belin
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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4
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 2.3: descriptions of effects should clearly reflect the size of the effects. J R Soc Med 2023; 116:113-115. [PMID: 36453853 PMCID: PMC10041623 DOI: 10.1177/01410768221140739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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5
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Sjöblom L, Bonn SE, Alexandrou C, Dahlgren A, Eke H, Trolle Lagerros Y. Dietary habits after a physical activity mHealth intervention: a randomized controlled trial. BMC Nutr 2023; 9:23. [PMID: 36732788 PMCID: PMC9893597 DOI: 10.1186/s40795-023-00682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A healthy diet and a sufficient amount of physical activity are important factors to reduce complications of type 2 diabetes. Diet and physical activity are associated behaviours. Individuals who are physically active have also been shown to have healthier eating habits than sedentary individuals. We aimed to evaluate the indirect effect of a smartphone-based physical activity intervention on dietary habits in patients with type 2 diabetes. METHODS We performed analyses of secondary outcomes in a randomized controlled trial. The active intervention was use of a smartphone application to promote physical activity during 12 weeks. Dietary intake was assessed at baseline and after three months using a validated semi-quantitative food frequency questionnaire comprising 94 items. We analysed changes in the intake of fruit and vegetables, snacks, fibre, whole grains, vitamin C, saturated fat, unsaturated fat and total energy. We also assessed overall dietary habits using a dietary index developed by the Swedish National Board of Health and Welfare. Results were compared between the intervention and control group, as well as stratified by sex within the study groups. Paired t-tests and analysis of covariance were performed. RESULTS A total of 181 patients were recruited to the DiaCert-study, whereof 146 patients had complete dietary data and were included in the analyses. Women in the intervention group had a higher fruit and vegetable intake (p = 0.008) and a higher dietary index (p = 0.007), at three-months compared to women in the control group. They had increased their daily intake of fruit and vegetables by on average 87.4 g/day (p = 0.04) and improved their dietary index by on average 0.8 points (p = 0.01) from baseline to follow-up. No effect was found in men. CONCLUSIONS Women, but not men, receiving a smartphone-based physical activity intervention improved their total intake of fruit and vegetables. The transfer effect, i.e. an intervention aimed at promoting one health behavior that facilitates changes in other health behaviors, may differ between the sexes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03053336; 15/02/2017.
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Affiliation(s)
- Linnea Sjöblom
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden ,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Stephanie Erika Bonn
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Christina Alexandrou
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Anna Dahlgren
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden ,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Helén Eke
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden ,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- grid.4714.60000 0004 1937 0626Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden ,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 2.2: reviews of the effects of treatments should be fair. J R Soc Med 2023; 116:76-78. [PMID: 36453870 PMCID: PMC9944237 DOI: 10.1177/01410768221140738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 2.1: comparisons of treatments should be fair. J R Soc Med 2023; 116:21-26. [PMID: 36453850 PMCID: PMC9909114 DOI: 10.1177/01410768221140733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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8
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices: 1.4. Trust based on the source of a claim alone can be misleading. J R Soc Med 2022; 115:479-481. [PMID: 36349971 PMCID: PMC9747893 DOI: 10.1177/01410768221135537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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9
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 2.4: Descriptions of effects should reflect the risk of being misled by the play of chance. J R Soc Med 2022; 116:144-147. [PMID: 36453856 PMCID: PMC10164267 DOI: 10.1177/01410768221140750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- AD Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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10
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 3.2: expected advantages should outweigh expected disadvantages. J R Soc Med 2022:1410768221140786. [PMID: 36453865 DOI: 10.1177/01410768221140786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 3.1: evidence should be relevant. J R Soc Med 2022:1410768221140768. [PMID: 36453844 DOI: 10.1177/01410768221140768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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12
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices: 1.3. Seemingly logical assumptions about treatments can be misleading. J R Soc Med 2022; 115:448-450. [PMID: 36349961 PMCID: PMC9723814 DOI: 10.1177/01410768221135536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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13
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Bonn SE, Christenson A, Eke H, Sjöblom L, Dahlgren A, Trolle Lagerros Y. Does eating behaviour among adolescents and young adults seeking obesity treatment differ depending on sex, body composition, and parental country of birth? BMC Public Health 2022; 22:1895. [PMID: 36221108 PMCID: PMC9552712 DOI: 10.1186/s12889-022-14297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents and young adults around the world experience high rates of weight gain. The underlying eating behaviours that may lead to overconsumption of energy are complex and can depend on a number of factors. The aim of this study was to explore if eating behaviour among adolescents and young adults referred to specialized obesity treatment differed depending on sex, body composition, and parental country of birth. METHODS Adolescents and young adults aged 16-25 years, referred for obesity treatment in 2018-2021 were included in the study. Eating behaviour was assessed using the Three Factor Eating Questionnaire, comprising domains of uncontrolled-, emotional- and cognitive restraint eating. Student's t-test was used to compare differences in eating behaviour scores between males and females, and between those having at least one parent born in a Nordic country and those with both parents born outside the Nordic countries. Associations between BMI, waist circumference, and body fat percentage, and eating behaviour as the dependent variable, were examined using linear regression. RESULTS A total of 463 participants, mean age 21 years and mean BMI 41.3 kg/m2, were included in the analysis. Females scored statistically significantly higher than males on emotional eating (45.8 vs. 35.4, p = 0.002) and cognitive restraint eating (45.4 vs. 39.2, p = 0.009). Participants with at least one parent born in a Nordic country reported a statistically significantly lower score of uncontrolled eating (45.7 vs. 51.3, p = 0.02) compared to participants with both parents born outside the Nordic countries. Further, there were statistically significant inverse associations between cognitive restraint eating scores and BMI (β=-0.64, 95%CI: -0.97 to -0.31), waist circumference (β=-0.44, 95%CI: -0.61 to -0.27) and body fat percentage (β=-0.57, 95%CI: -1.01 to -0.14) in models adjusted for age, sex, smoking, and civil status. CONCLUSION Our findings suggest that sex and parental country of birth may influence eating behaviours among adolescents and young adults referred for specialist obesity treatment. We also found that cognitive restraint eating decreased with increasing BMI, waist circumference, and body fat percentage. This indicates that there may be an inverse association between the ability to restrain oneself from eating and gaining weight, however, the direction of the association must be investigated further. Increased knowledge about eating behaviours may be valuable in the clinical setting.
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Affiliation(s)
- Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.
| | - Anne Christenson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Helén Eke
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Anna Dahlgren
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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14
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 1.2: Seemingly logical assumptions about research can be misleading. J R Soc Med 2022; 115:408-411. [PMID: 36342050 PMCID: PMC9720283 DOI: 10.1177/01410768221135497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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15
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 1.1: assumptions that treatments are safe or effective can be misleading. J R Soc Med 2022; 115:354-359. [PMID: 36321676 PMCID: PMC9634226 DOI: 10.1177/01410768221120491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
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16
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Dahlgren A, Tucker P, Epstein M, Gustavsson P, Söderström M. Randomised control trial of a proactive intervention supporting recovery in relation to stress and irregular work hours: effects on sleep, burn-out, fatigue and somatic symptoms. Occup Environ Med 2022; 79:460-468. [PMID: 35074887 PMCID: PMC9209685 DOI: 10.1136/oemed-2021-107789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022]
Abstract
Objectives To examine if a proactive recovery intervention for newly graduated registered nurses (RNs) could prevent the development of sleep problems, burn-out, fatigue or somatic symptoms. Methods The study was a randomised control trial with parallel design. Newly graduated RNs with less than 12 months’ work experience were eligible to participate. 461 RNs from 8 hospitals in Sweden were invited, of which 207 signed up. These were randomised to either intervention or control groups. After adjustments, 99 RNs were included in the intervention group (mean age 27.5 years, 84.7% women) and 108 in the control group (mean age 27.0 years, 90.7% women). 82 RNs in the intervention group attended a group-administered recovery programme, involving three group sessions with 2 weeks between each session, focusing on proactive strategies for sleep and recovery in relation to work stress and shift work. Effects on sleep, burn-out, fatigue and somatic symptoms were measured by questionnaires at baseline, postintervention and at 6 months follow-up. Results Preventive effect was seen on somatic symptoms for the intervention group. Also, the intervention group showed less burn-out and fatigue symptoms at postintervention. However, these latter effects did not persist at follow-up. Participants used many of the strategies from the programme. Conclusions A proactive, group-administered recovery programme could be helpful in strengthening recovery and preventing negative health consequences for newly graduated RNs. Trial registration number NCT04246736.
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Affiliation(s)
- Anna Dahlgren
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Philip Tucker
- Department of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Stockholm University Stress Research Institute, Stockholm, Sweden
| | - Majken Epstein
- Liljeholmens akademiska vårdcentral/Academic Primary Healthcare Center Liljeholmen, Stockholm, Sweden
| | - Petter Gustavsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Marie Söderström
- Department of Psychology, Karolinska Institutet Department of Clinical Neuroscience, Stockholm, Sweden
- Stressmottagningen, Stockholm, Sweden
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Hansson K, Dahlgren A. Open research data repositories: Practices, norms, and metadata for sharing images. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Karin Hansson
- Department of Culture and Aesthetics Stockholm University Stockholm Sweden
| | - Anna Dahlgren
- Department of Culture and Aesthetics Stockholm University Stockholm Sweden
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18
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Bujacz A, Rudman A, Gustavsson P, Dahlgren A, Tucker P. Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis. J Nurs Manag 2021; 29:2603-2610. [PMID: 34309949 DOI: 10.1111/jonm.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to identify profiles of working conditions to which nurses were exposed to over time and investigate how changes in working conditions relate to shiftworking and health. BACKGROUND Previous studies rarely addressed the issue of working conditions development over long periods and the effects of such development on nurses' health. METHODS Data from a national cohort of nurses in Sweden (N = 2936) were analysed using a person-centred analytical approach-latent profile and latent transition analysis. RESULTS Nurses report better psychosocial working conditions as they progress into mid-career. Shiftworking nurses experience poorer working conditions than their dayworking counterparts and tend to move from shiftwork to daywork as they progress into mid-career. In mid-career, nurses in work environments characterized by low autonomy and support tend to report poorer health outcomes. CONCLUSION Current analyses suggest that shiftworking nurses are particularly in need of interventions that address poor work environments. Not only do they experience more negative psychosocial working conditions than their dayworking counterparts, but they do so while having to contend with demanding schedules. IMPLICATIONS FOR NURSING MANAGEMENT The findings highlight that organisational interventions should target different aspects of the work environment for nurses in diverse stages of their careers.
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Affiliation(s)
- Aleksandra Bujacz
- Behavioral Informatics Team, Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Dahlgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Philip Tucker
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Psychology Department, Swansea University, Swansea, UK
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19
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Dahlgren A, Sjöblom L, Eke H, Bonn SE, Trolle Lagerros Y. Screen time and physical activity in children and adolescents aged 10-15 years. PLoS One 2021; 16:e0254255. [PMID: 34242329 PMCID: PMC8270173 DOI: 10.1371/journal.pone.0254255] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Previous research studies have demonstrated a relationship between low levels of physical activity and high amounts of screen time in children and adolescents. However, this is usually based on self-reported data. Therefore, the aim of this cross-sectional study was to investigate the association between objectively measured smartphone screen time and physical activity among children and adolescents aged 10–15 years. Methods During seven consecutive days, we objectively assessed smartphone screen time, using the SCRIIN smartphone application, and physical activity, using the SCRIIN activity tracker, in children and adolescents recruited from two schools in Stockholm County, Sweden. Moreover, the children/adolescents and their parents responded to a questionnaire, obtaining among other things: self-reported screen time, physical activity, sleep and health-related quality of life. Results A total of 121 children and adolescents (mean age: 12.1 ± 1.5) were included in the study. Objectively measured smartphone screen time was 161.2 ± 81.1 min/day. Mean physical activity, measured with the SCRIIN activity tracker, was 32.6 ± 16.5 active min/day. Minutes of screen time and physical activity did not differ between the children and adolescents from the two schools, despite located in different socioeconomic areas. Further, we found no association between smartphone screen time and physical activity. However, girls aged 14–15 years, had more smartphone screen time (p<0.01) and were significantly more physically active (p<0.01) than girls aged 10–12 years. In addition, boys reported more than five times more time spent on computer and video games than girls did. Conclusion Smartphone screen time was not associated with physical activity level among children and adolescents aged 10–15 years.
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Affiliation(s)
- Anna Dahlgren
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Linnea Sjöblom
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Helén Eke
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Stephanie E Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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20
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Dahlgren A, Tucker P, Bujacz A, Frögéli E, Rudman A, Gustavsson P. Intensive longitudinal study of newly graduated nurses' quick returns and self-rated stress. Scand J Work Environ Health 2021; 47:404-407. [PMID: 33929547 PMCID: PMC8259702 DOI: 10.5271/sjweh.3962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Little is known about the relationship between quick returns (QR) – shift combinations that result in inter-shift rest periods <11 hours) and stress. The current study examined whether variations in the frequency of QR, both between and within individuals, were associated with changes in self-rated stress. Methods: A questionnaire was sent weekly to newly graduated nurses during the first 12 weeks of work. Stress was measured with four items from the Stress-Energy Questionnaire on a scale from 1 “not at all” to 5 “very much” [mean 2.65, standard deviation (SD) 1.08]. Shifts worked in the past week were reported and QR were identified by evening-morning shift combinations (mean 0.98, SD 0.90 per week). In total, 350 persons were included in the analysis (3556 observations). Data were analyzed with a multilevel residual dynamic structural equation model (RDSEM) using Bayesian estimation procedures. Results: There was no between-person effect of QR on stress averaged across measurement occasions (0.181, 95% CI -0.060–0.415). However, there was a small within-person effect of QR (0.031, 95% CI 0.001–0.062), meaning that more QR during a given week, compared to that person’s average, was associated with an increase in their level of stress during that week. Conclusions: Nurses were likely to report increased stress during weeks in which they worked more QR. Intervention studies are needed to determine whether the relationship is causal.
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Affiliation(s)
- Anna Dahlgren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institute, Nobelsväg 9, 171 65 Solna, Sweden.
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21
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Donnelly CG, Bellone RR, Hales EN, Nguyen A, Katzman SA, Dujovne GA, Knickelbein KE, Avila F, Kalbfleisch TS, Giulotto E, Kingsley NB, Tanaka J, Esdaile E, Peng S, Dahlgren A, Fuller A, Mienaltowski MJ, Raudsepp T, Affolter VK, Petersen JL, Finno CJ. Generation of a Biobank From Two Adult Thoroughbred Stallions for the Functional Annotation of Animal Genomes Initiative. Front Genet 2021; 12:650305. [PMID: 33763124 PMCID: PMC7982670 DOI: 10.3389/fgene.2021.650305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022] Open
Abstract
Following the successful creation of a biobank from two adult Thoroughbred mares, this study aimed to recapitulate sample collection in two adult Thoroughbred stallions as part of the Functional Annotation of the Animal Genome (FAANG) initiative. Both stallions underwent thorough physical, lameness, neurologic, and ophthalmic (including electroretinography) examinations prior to humane euthanasia. Epididymal sperm was recovered from both stallions immediately postmortem and cryopreserved. Aseptically collected full thickness skin biopsies were used to isolate, culture and cryopreserve dermal fibroblasts. Serum, plasma, cerebrospinal fluid, urine, and gastrointestinal content from various locations were collected and cryopreserved. Under guidance of a board-certified veterinary anatomic pathologist, 102 representative tissue samples were collected from both horses. Whole tissue samples were flash-frozen and prioritized tissues had nuclei isolated and cryopreserved. Spatially contemporaneous samples of each tissue were submitted for histologic examination. Antemortem and gross pathologic examination revealed mild abnormalities in both stallions. One stallion (ECA_UCD_AH3) had unilateral thoracic limb lameness and bilateral chorioretinal scars. The second stallion (ECA_UCD_AH4) had subtle symmetrical pelvic limb ataxia, symmetrical prostatomegally, and moderate gastrointestinal nematodiasis. DNA from each was whole-genome sequenced and genotyped using the GGP Equine 70K SNP array. The genomic resources and banked biological samples from these animals augments the existing resource available to the equine genomics community. Importantly we may now improve the resolution of tissue-specific gene regulation as affected by sex, as well as add sex-specific tissues and gametes.
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Affiliation(s)
- Callum G Donnelly
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Rebecca R Bellone
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.,Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Erin N Hales
- Morris Animal Foundation, Denver, CO, United States
| | - Annee Nguyen
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Scott A Katzman
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Ghislaine A Dujovne
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Kelly E Knickelbein
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Felipe Avila
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Ted S Kalbfleisch
- Gluck Equine Research Center, University of Kentucky, Lexington, KY, United States
| | - Elena Giulotto
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Nicole B Kingsley
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Jocelyn Tanaka
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Elizabeth Esdaile
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Sichong Peng
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Anna Dahlgren
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Anna Fuller
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Michael J Mienaltowski
- Department of Animal Science, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, United States
| | - Terje Raudsepp
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - Verena K Affolter
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Jessica L Petersen
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Carrie J Finno
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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22
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Trolle Lagerros Y, Dahlgren A, Sjöblom L, Bonn SE. Digital Support for Healthier Eating Habits Among Patients With Type 2 Diabetes: Protocol for a Randomized Clinical Trial Within Primary Care (HAPPY Trial). JMIR Res Protoc 2020; 9:e24422. [PMID: 33196448 PMCID: PMC7704281 DOI: 10.2196/24422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite the large impact that dietary habits have in the management of diabetes, few tools for supporting healthy eating habits are available for persons with diabetes. Objective The aim of this randomized clinical trial is to evaluate the effect of a 12-week, mobile health (mHealth), app-based intervention promoting healthy eating habits among patients with type 2 diabetes. Methods The HAPPY (Healthy eating using APP technologY) trial is a randomized clinical trial with two arms aiming to include 200 patients, 18 years of age or older, with type 2 diabetes. Both women and men are eligible for inclusion. Study participants are randomized 1:1 to an intervention group, where they are instructed to use a smartphone app promoting healthy eating, or to a control group, where they receive standard primary care only, for a period of 12 weeks. Each week a new topic (eg, vegetable intake) is introduced via the app. After an introduction text, the user is given a topic-related activity to perform (eg, eat one additional serving of vegetables per day during that week). The app records daily progress and sends automatic reminders or feedback to the user. Dietary intake, body composition, clinical variables, and biomarkers are measured at baseline and at 3- and 6-month follow-ups. An extensive web-based questionnaire comprising several validated questionnaires assessing a number of lifestyle factors is distributed via email at baseline and at 3-, 6-, and 12-month follow-ups; lifestyle factors include, for example, sleep, physical activity, eating behavior, and health-related quality of life. The effect of the intervention on dietary intake (primary outcome) and on glycated hemoglobin and blood lipid levels, body composition, blood pressure, other lifestyle factors, and overall health (secondary outcomes) will be assessed. Results Data collection is ongoing. Recruitment of participants started in January 2019. Findings from the study are expected to be published by the end of 2021. Conclusions Technology development provides new ways to promote and support long-term adherence to healthier eating habits. mHealth-based approaches allow for real-time interaction and the delivery of an intervention at any time. Further, focusing on overall diet allows the user to apply new knowledge to current eating patterns, creating an individualized approach. In this study, we evaluate the effect of using a new smartphone app promoting healthy eating habits on dietary intake, clinical markers, and lifestyle factors among patients with type 2 diabetes. Trial Registration ClinicalTrials.gov NCT03784612; https://clinicaltrials.gov/ct2/show/NCT03784612 International Registered Report Identifier (IRRID) DERR1-10.2196/24422
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Affiliation(s)
- Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Anna Dahlgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
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23
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Rudman A, Arborelius L, Dahlgren A, Finnes A, Gustavsson P. Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. EClinicalMedicine 2020; 27:100565. [PMID: 33150328 PMCID: PMC7599295 DOI: 10.1016/j.eclinm.2020.100565] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Burnout is common among nurses and midwives. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation. METHODS Symptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden's nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2474 nurses (62%) consented to participate at follow-up. Burnout was measured using items from the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up. FINDINGS The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression. INTERPRETATION The results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses' careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs). FUNDING AFA Insurance Grant [number 150284].
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Affiliation(s)
- Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Solna, Stockholm SE-171 65, Sweden
| | - Lotta Arborelius
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Solna, Stockholm SE-171 65, Sweden
| | - Anna Dahlgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Solna, Stockholm SE-171 65, Sweden
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Solna, Stockholm SE-171 65, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Solna, Stockholm SE-171 65, Sweden
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24
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Hellström A, Kassaye Tessma M, Flink M, Dahlgren A, Schildmeijer K, Ekstedt M. Validation of the patient activation measure in patients at discharge from hospitals and at distance from hospital care in Sweden. BMC Public Health 2019; 19:1701. [PMID: 31856796 PMCID: PMC6921492 DOI: 10.1186/s12889-019-8025-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background The Patient Activation Measure (PAM) is a recognized measure of how active patients are in their care, and has been translated into several languages and cultural contexts. Patient activity, self-care, and health literacy have become increasingly important aspects of health care, and thus reliable measures of these are needed. However, a Swedish translation of PAM is currently lacking. The aim of the study was to translate and assess the validity and reliability of the Swedish PAM-13. Methods A self-report questionnaire was handed out to 521 patients at ten medical, geriatric, and surgical wards, and one Virtual Health Room. The Rasch model was employed, using the partial credit model, to assess the functioning of the PAM scale, item fit, targeting, unidimensionality, local independence, differential item functioning (DIF), and person-separation index. Evidence of substantive, content, structural, and external validity was examined. Results Of the 521 patients who were consecutively handed a questionnaire, 248 consented to participate, yielding a response rate of 47.6%. The average measure for each category advanced monotonically. The difficulty of the PAM items ranged from − 1.55 to 1.26. The infit and outfit values for the individual items were acceptable. Items 1, 2, and 4 showed disordered thresholds. The mean person location was 1.48 (SD = 1.66). The person-item map revealed that there were no item representations at the top of the scale. The evidence for unidimensionality was ambiguous and response dependency was seen in some items. DIF was found for age. The person separation index was 0.85. Conclusion The Swedish PAM-13 was reliable, but was not conclusively found to represent one underlying construct. It seems that the Swedish PAM-13 lacks strong evidence for substantive, content, and structural validity. Although valid and reliable measures of ability for activation in self-care among patients are highly warranted, we recommend further development of PAM-13 before application in everyday clinical care.
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Affiliation(s)
- Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
| | - Mesfin Kassaye Tessma
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Flink
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Dahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
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25
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Bookbinder L, Finno CJ, Firshman AM, Katzman SA, Burns E, Peterson J, Dahlgren A, Ming‐Whitfield B, Glessner S, Borer‐Matsui A, Valberg SJ. Impact of alpha-tocopherol deficiency and supplementation on sacrocaudalis and gluteal muscle fiber histopathology and morphology in horses. J Vet Intern Med 2019; 33:2770-2779. [PMID: 31660648 PMCID: PMC6872615 DOI: 10.1111/jvim.15643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/02/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A subset of horses deficient in alpha-tocopherol (α-TP) develop muscle atrophy and vitamin E-responsive myopathy (VEM) characterized by mitochondrial alterations in the sacrocaudalis dorsalis medialis muscle (SC). OBJECTIVES To quantify muscle histopathologic abnormalities in subclinical α-TP deficient horses before and after α-TP supplementation and compare with retrospective (r)VEM cases. ANIMALS Prospective study; 16 healthy α-TP-deficient Quarter Horses. Retrospective study; 10 retrospective vitamin E-responsive myopathy (rVEM) cases . METHODS Blood, SC, and gluteus medius (GM) biopsy specimens were obtained before (day 0) and 56 days after 5000 IU/450 kg horse/day PO water dispersible liquid α-TP (n = 8) or control (n = 8). Muscle fiber morphology and mitochondrial alterations were compared in samples from days 0 and 56 and in rVEM cases. RESULTS Mitochondrial alterations more common than our reference range (<2.5% affected fibers) were present in 3/8 control and 4/8 treatment horses on day 0 in SC but not in GM (mean, 2.2; range, 0%-10% of fibers). Supplementation with α-TP for 56 days did not change the percentage of fibers with mitochondrial alterations or anguloid atrophy, or fiber size in GM or SC. Clinical rVEM horses had significantly more mitochondrial alterations (rVEM SC, 13% ± 7%; GM, 3% ± 2%) and anguloid atrophy compared to subclinical day 0 horses. CONCLUSIONS AND CLINICAL IMPORTANCE Clinically normal α-TP-deficient horses can have mitochondrial alterations in the SC that are less severe than in atrophied VEM cases and do not resolve after 56 days of α-TP supplementation. Preventing α-TP deficiency may be of long-term importance for mitochondrial viability.
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Affiliation(s)
- Lauren Bookbinder
- McPhail Equine Performance Center, Department of Large Animal Clinical SciencesMichigan State UniversityEast LansingMichigan
| | - Carrie J. Finno
- Department of Population Health and ReproductionUniversity of California DavisDavisCalifornia
| | - Anna M. Firshman
- Department of Veterinary Population Medicine, College of Veterinary MedicineUniversity of MinnesotaSt PaulMinnesota
| | - Scott A. Katzman
- Department of Surgical and Radiological SciencesUniversity of California DavisDavisCalifornia
| | - Erin Burns
- Department of Population Health and ReproductionUniversity of California DavisDavisCalifornia
| | - Janel Peterson
- Department of Population Health and ReproductionUniversity of California DavisDavisCalifornia
| | - Anna Dahlgren
- Department of Population Health and ReproductionUniversity of California DavisDavisCalifornia
| | - Brittni Ming‐Whitfield
- Department of Population Health and ReproductionUniversity of California DavisDavisCalifornia
| | - Shelby Glessner
- McPhail Equine Performance Center, Department of Large Animal Clinical SciencesMichigan State UniversityEast LansingMichigan
| | - Amanda Borer‐Matsui
- McPhail Equine Performance Center, Department of Large Animal Clinical SciencesMichigan State UniversityEast LansingMichigan
| | - Stephanie J. Valberg
- McPhail Equine Performance Center, Department of Large Animal Clinical SciencesMichigan State UniversityEast LansingMichigan
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26
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Epstein M, Söderström M, Jirwe M, Tucker P, Dahlgren A. Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork. J Clin Nurs 2019; 29:184-194. [PMID: 31609523 DOI: 10.1111/jocn.15076] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/30/2019] [Accepted: 09/29/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. BACKGROUND For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. DESIGN AND METHODS Semi-structured interviews were conducted with nurses (N = 11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. RESULTS Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. CONCLUSION The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.
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Affiliation(s)
- Majken Epstein
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marie Söderström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stressmottagningen/Stress clinic, Stockholm, Sweden
| | - Maria Jirwe
- Department for health promoting science, Sophiahemmet University, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Philip Tucker
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Psychology, Swansea University, Swansea, UK
| | - Anna Dahlgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Dahlgren A, Epstein M, Söderström M, Tucker P. Nurses' strategies for managing sleep when starting shift work – implications for interventions targeting sleep behaviours in a shift work population. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dahlgren A, Tucker P, Gustavsson P, Rudman A. Quick returns and night work as predictors of sleep quality, fatigue, work–family balance and satisfaction with work hours. Chronobiol Int 2016; 33:759-67. [DOI: 10.3109/07420528.2016.1167725] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Dahlgren
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden, and
| | - Philip Tucker
- Stress Research Institute, Stockholm University, Stockholm, Sweden, and
- Department of Psychology, Swansea University, Swansea, UK
| | - Petter Gustavsson
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Ann Rudman
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
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Ekstedt M, Dahlgren A. [Safe care also in the home: a future challenge]. Lakartidningen 2015; 112:DFI7. [PMID: 26010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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van Leeuwen WMA, Kircher A, Dahlgren A, Lützhöft M, Barnett M, Kecklund G, Åkerstedt T. Sleep, Sleepiness, and Neurobehavioral Performance While on Watch in a Simulated 4 Hours on/8 Hours off Maritime Watch System. Chronobiol Int 2013; 30:1108-15. [DOI: 10.3109/07420528.2013.800874] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bredenberg S, Dahlgren A, Mattsson S. Evaluation of a sieve classification method for characterization of low-dose interactive mixtures. Pharm Dev Technol 2012; 18:1366-71. [PMID: 22998104 DOI: 10.3109/10837450.2012.717949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study investigated a sieve classification method for evaluating carrier materials and particle size fractions, which could be a valuable tool in the early development of pharmaceutical dosage forms containing low-dose interactive mixtures. When developing new products based on interactive mixtures, it is essential to ensure that the drug particles are successfully deagglomerated and have adhered to the carrier particles. In this study, the effect on the demixing potential (DP) of low-dose interactive mixtures was assessed for various carrier particle sizes and surface textures. The model drug used was sodium salicylate and the tested carriers were lactose, mannitol, and isomalt. The results showed that the lowest DPs, i.e. the most mechanically stable mixtures, were obtained with lactose. Furthermore, for interactive mixtures, small carrier particles and/or a narrow carrier particle size range are essential for obtaining a low DP and high homogeneity. Calculation of the DP provided a reliable estimate of the quality of the low-dose interactive mixtures used in this study.
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Bergström I, Dahlgren A, Kronhed ACG, Forss A, Karlsson S, Qvist N. [Women strengthened by exercise. Experiences of a back muscle exercise program in vertebral fracture]. Lakartidningen 2012; 109:1616-1618. [PMID: 23077771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Brown M, Tucker P, Rapport F, Hutchings H, Dahlgren A, Davies G, Ebden P. The impact of shift patterns on junior doctors' perceptions of fatigue, training, work/life balance and the role of social support. Qual Saf Health Care 2011; 19:e36. [PMID: 21127102 PMCID: PMC3002836 DOI: 10.1136/qshc.2008.030734] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The organisation of junior doctors' work hours has been radically altered following the partial implementation of the European Working Time Directive. Poorly designed shift schedules cause excessive disruption to shift workers' circadian rhythms. METHOD Interviews and focus groups were used to explore perceptions among junior doctors and hospital managers regarding the impact of the European Working Time Directive on patient care and doctors' well-being. RESULTS Four main themes were identified. Under "Doctors shift rotas", doctors deliberated the merits and demerits of working seven nights in row. They also discussed the impact on fatigue of long sequences of day shifts. "Education and training" focused on concerns about reduced on-the-job learning opportunities under the new working time arrangements and also about the difficulties of finding time and energy to study. "Work/life balance" reflected the conflict between the positive aspects of working on-call or at night and the impact on life outside work. "Social support structures" focused on the role of morale and team spirit. Good support structures in the work place counteracted and compensated for the effects of negative role stressors, and arduous and unsocial work schedules. CONCLUSIONS The impact of junior doctors' work schedules is influenced by the nature of specific shift sequences, educational considerations, issues of work/life balance and by social support systems. Poorly designed shift rotas can have negative impacts on junior doctors' professional performance and educational training, with implications for clinical practice, patient care and the welfare of junior doctors.
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Affiliation(s)
- M Brown
- Department of Psychology, Swansea University, Swansea, UK
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Abstract
BACKGROUND Today many merchant ships sail with only two nautical officers, working a shift schedule of 6 hr on and 6 hr off. There are concerns that such a shift schedule is related to fatigue. However, little data exist from onboard studies of seafarers. METHODS Data were collected on board 13 ships. Fifteen participants worked on a 6-on, 6-off watch system and another 15 on a 4-on, 8-off watch system. Electrooculography, actigraphy, diaries, and reaction time tests were used to measure the effects of shift system on fatigue and sleep. RESULTS AND CONCLUSIONS Sleepiness was higher during the night shift in the 6-on, 6-off system. Moreover, sleepiness increased more during the watch in the 6-on, 6-off system compared to the 4-on, 8-off system. There was a trend toward shorter sleep episodes in the 6-on, 6-off system and sleep was more often split into two episodes.
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Tucker P, Brown M, Dahlgren A, Davies G, Ebden P, Folkard S, Hutchings H, Åkerstedt T. The impact of junior doctors' worktime arrangements on their fatigue and well-being. Scand J Work Environ Health 2010; 36:458-465. [PMID: 20414629 DOI: 10.5271/sjweh.2985] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Many doctors report working excessively demanding schedules that comply with the European Working Time Directive (EWTD). We compared groups of junior doctors working on different schedules in order to identify which features of schedule design most negatively affected their fatigue and well-being in recent weeks. METHODS Completed by 336 doctors, the questionnaires focused on the respondents' personal circumstances, work situation, work schedules, sleep, and perceptions of fatigue, work-life balance and psychological strain. RESULTS Working 7 consecutive nights was associated with greater accumulated fatigue and greater work-life interference, compared with working just 3 or 4 nights. Having only 1 rest day after working nights was associated with increased fatigue. Working a weekend on-call between 2 consecutive working weeks was associated with increased work-life interference. Working frequent on-calls (either on weekends or during the week) was associated with increased work-life interference and psychological strain. Inter-shift intervals of <10 hours were associated with shorter periods of sleep and increased fatigue. The number of hours worked per week was positively associated with work-life interference and fatigue on night shifts. CONCLUSION The current findings identify parameters, in addition to those specified in the EWTD, for designing schedules that limit their impact on doctors' fatigue and well-being.
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Affiliation(s)
- Philip Tucker
- Department of Psychology, Swansea University, Swansea SA2 8PP, United Kingdom.
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Dahlgren A, Kecklund G, Theorell T, Åkerstedt T. Day-to-day variation in saliva cortisol—Relation with sleep, stress and self-rated health. Biol Psychol 2009; 82:149-55. [DOI: 10.1016/j.biopsycho.2009.07.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/05/2009] [Accepted: 07/05/2009] [Indexed: 10/20/2022]
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Abstract
The objectives of this study were to explore individual differences associated with diverse reactions in cortisol secretion under different stress levels. This study was part of a larger project concerning working hours and health. Thirty-four white-collar workers participated under two different conditions; one work week with a high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. Based on the morning cortisol concentration during a workday subjects were divided into two groups. One group consisted of subjects whose morning level of cortisol increased in response to the high-stress week, compared to their morning levels in the low-stress condition (Group 1). The other group consisted of subjects whose morning cortisol response was the opposite, with a lower level under the high stress condition (Group 2). Subjects wore actiwatches, completed a sleep diary, and rated their sleepiness and stress for one work week in each condition, i.e., high and low stress. Saliva samples for measures of cortisol were collected on a Wednesday. Group 2 reported higher workload, fatigue, and exhaustion during both weeks. Since there were no differences in perceived stress, neither within nor between groups, the data indicate that there are other factors influencing morning cortisol. The results suggest that one component modulating the cortisol response might be the level of exhaustion, probably related to work overload. Higher levels of stress in exhausted individuals might suppress morning cortisol levels.
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Affiliation(s)
- Anna Dahlgren
- National Institute for Psychosocial Medicine, Stockholm, Sweden.
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Dahlgren A, Zethelius B, Jensevik K, Syvänen AC, Berne C. Variants of the TCF7L2 gene are associated with beta cell dysfunction and confer an increased risk of type 2 diabetes mellitus in the ULSAM cohort of Swedish elderly men. Diabetologia 2007; 50:1852. [PMID: 17618413 DOI: 10.1007/s00125-007-0746-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
Abstract
AIMS/HYPOTHESIS In a population-based cohort of elderly men with well-defined phenotypes and biochemical markers related to type 2 diabetes mellitus, we analysed two single nucleotide polymorphisms (SNPs), rs7903146 and rs12255372, in the transcription factor 7-like 2 gene (TCF7L2), which are associated with an increased risk of type 2 diabetes mellitus. MATERIALS AND METHODS The 1,142 subjects were from the population-based Uppsala Longitudinal Study of Adult Men cohort study (see http://www.pubcare.uu.se/ULSAM/, last accessed in May 2007). Insulin sensitivity was assessed using a euglycaemic-hyperinsulinaemic clamp; fasting intact and 32-33 split proinsulin, immunoreactive insulin and specific insulin were measured in plasma samples. The SNPs rs7903146 and rs12255372 were genotyped using a fluorescent homogeneous single base extension assay. The SNP genotypes were analysed against diabetes prevalence at age 70 using logistic regression and against quantitative biochemical measures using linear regression analysis. RESULTS We replicated the association with type 2 diabetes mellitus for both SNPs in this cohort of elderly males. The highest significant odds ratio (2.15, 95% CI 1.20-3.85) was found for SNP rs7903146. The odds ratio for SNP rs12255372 was 1.69 (95% CI 1.20-2.39). Both TCF7L2 SNPs were found to be significantly associated with plasma proinsulin when adjusting for insulin sensitivity, both in the whole cohort and when the diabetic subjects were excluded. Analysis for fasting plasma insulin or insulin sensitivity did not give significant results. CONCLUSIONS/INTERPRETATION The association between the risk alleles of the two SNPs studied and levels of proinsulin in plasma, identified when adjusting for insulin sensitivity using euglycaemic-hyperinsulinaemic clamp measurements in this study, is an important novel finding.
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Affiliation(s)
- A Dahlgren
- Molecular Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - B Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - K Jensevik
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - A-C Syvänen
- Molecular Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - C Berne
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
- Department of Medical Sciences, University Hospital, S-751 85, Uppsala, Sweden.
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Dahlgren A, Karlsson AK, Lundgren-Nilsson Å, Fridén J, Claesson L. Erratum: Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein–Bell ADL Scale. Spinal Cord 2007. [DOI: 10.1038/sj.sc.3102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dahlgren A, Karlsson AK, Lundgren-Nilsson A, Fridén J, Claesson L. Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale. Spinal Cord 2006; 45:475-84. [PMID: 17117173 DOI: 10.1038/sj.sc.3101993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.
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Affiliation(s)
- A Dahlgren
- Department of Clinical Neuro Science and Rehabilitation, The Sahlgrenska Academy at Göteborg University, Institute of Neuro Science and Physiology, Göteborg University, Goteborg, Sweden
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Dahlgren A, Kecklund G, Akerstedt T. Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study. Scand J Work Environ Health 2006; 32:318-27. [PMID: 16932830 DOI: 10.5271/sjweh.1016] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Previous studies of long workhours and their effects on stress, sleep, and health show inconclusive results. This inconclusiveness may be partly due to methodological problems such as the use of between-group designs or comparisons before and after reorganizations. In addition, stress is usually a confounder. A within-person design was used to examine the effects of working 8- or 12-hour shifts in the absence of additional stress. METHODS In an experimental field study, 16 white-collar workers [9 women, mean age 45.9 (SD 15) years] undertook one workweek with normal workhours (8 hours) and 1 week of overtime with 4 extra hours of regular worktasks (12 hours). The participants wore actigraphs, rated sleepiness (Karolinska Sleepiness Scale) and stress throughout the day, and rated workload and how exhausted they felt. Saliva samples were collected on Mondays and Thursdays for cortisol analysis. On these days, ambulatory heart rate and blood pressure were also measured for 24 hours. RESULTS Overtime was associated with higher levels of exhaustion. Sleepiness showed a significant interaction between conditions, with higher levels at the end of the workweek featuring overtime. Total sleep time was shorter in the overtime week. There were no significant differences between ratings of stress and workload. Cortisol showed a circadian variation but no main effect of condition. CONCLUSIONS One week of overtime work with a moderate workload produced no main effects on physiological stress markers. Nevertheless, sleep was negatively affected, with shorter sleeps during overtime work and greater problems with fatigue and sleepiness.
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Affiliation(s)
- Anna Dahlgren
- National Institute for Psychosocial Medicine, PO Box 230, S-171 77 Stockholm, Sweden.
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Dahlgren A, Kecklund G, Akerstedt T. Different levels of work-related stress and the effects on sleep, fatigue and cortisol. Scand J Work Environ Health 2005; 31:277-85. [PMID: 16161710 DOI: 10.5271/sjweh.883] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of the study was to relate different levels of work stress to measures of sleep and the diurnal pattern of salivary cortisol and subjective sleepiness. METHODS Thirty-four white-collar workers participated under two different conditions. One workweek with a relatively high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. The workers wore activity monitors, filled out a sleep diary, gave saliva samples (for cortisol), and rated their sleepiness and stress during one workday and one free day. RESULTS During the week with stress the number of workhours increased and total sleep time decreased. Sleepiness showed a significant interaction between weeks and time of day, with particularly high levels towards the evenings of the stress week. Cortisol also showed a significant interaction, with a more flattened pattern, probably due to increased evening levels during the stress week. Stress (restlessness) at bedtime was significantly increased during the stress week. CONCLUSIONS The results demonstrate that a workweek with a high workload and much stress increases sleepiness and workhours, impairs sleep, and affects the pattern of diurnal cortisol secretion.
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Affiliation(s)
- Anna Dahlgren
- National Institute for Psychosocial Medicine, Stockholm, Sweden.
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Kecklund G, Ekstedt M, Akerstedt T, Dahlgren A, Samuelson B. The effects of double-shifts (15.5 hours) on sleep, fatigue and health. J Hum Ergol (Tokyo) 2001; 30:53-8. [PMID: 14564858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The aim of the present study was to investigate how "double-shifts" (15.5 hours) affects sleep, fatigue and self-rated health. The study was carried out on male construction workers of which 80% were long-distance commuters. The schedule involved two work periods and each work period involved two double shifts in a row. The subjects filled in a sleep/wake diary at 8 times across a year and a questionnaire at 3 times. They also wore an actigraph during one shift cycle. The results showed that sleepiness, and to a certain extent, mental fatigue increased during double shifts and accumulated across days. The short rest time (8.5 hours) between days caused insufficient sleep and approximately 5.5 hours of sleep was obtained between double shifts. Questionnaire data showed that complaints of insufficient sleep, exhaustion on awakening and pain symptoms increased across the year. It was concluded that a shift system involving double shifts has a negative effect on fatigue, recovery and health-related well-being.
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Affiliation(s)
- G Kecklund
- National Institute for Psychosocial Factors and Health, Karolinska Institutet, Stockholm, Sweden
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Abstract
Release factors (RF) 1 and 2 trigger the hydrolysis of the peptide from the peptidyl-tRNA during translation termination. RF1 binds to the ribosome in response to the stop codons UAG and UAA, whereas RF2 recognizes UAA and UGA. RF1 and RF2 have been shown to bind to several ribosomal proteins. To study this interaction in vivo, prfA1, a mutant form of RF1 has been used. A strain with the prfA1 mutation is temperature sensitive (Ts) for growth at 42 degrees C and shows an increased misreading of UAG and UAA. In this work we show that a point mutation in ribosomal protein S4 can, on the one hand, make the RF1 mutant strain Ts(+); on the other hand, this mutation increases the misreading of UAG, but not UAA, caused by prfA1. The S4 mutant allele, rpsD101, is a missense mutation (Tyr51 to Asp), which makes the cell cold sensitive. The behaviour of rpsD101 was compared to the well-studied S4 alleles rpsD12, rpsD14, and rpsD16. These three mutations all confer both a Ts (44 degrees C) phenotype and show a ribosomal ambiguity phenotype, which rpsD101 does not. The three alleles were sequenced and shown to be truncations of the S4 protein. None of the three mutations could compensate for the Ts phenotype caused by the prfA1 mutation. Hence, rpsD101 differs in all studied characteristics from the three above mentioned S4 mutants. Because rpsD101 can compensate for the Ts phenotype caused by prfA1 but enhances the misreading of UAG and not UAA, we suggest that S4 influences the interaction of RF1 with the decoding center of the ribosome and that the Ts phenotype is not a consequence of increased readthrough.
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Affiliation(s)
- A Dahlgren
- Department of Microbiology, Stockholm University, 106 91, Stockholm, Sweden
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Abstract
The posterior deltoid muscle was used to replace lost elbow extension in 11 patients with C5 or C6 level tetraplegia. During surgery stainless steel sutures were inserted into the donor muscle, graft, and tendon insertion sites. Over the succeeding time periods (1 month to 2 years) the distances between the various markers were measured. Significant tendon elongation of 23.1 +/- 4.8 mm (mean +/- SEM; n = 6) was observed in patients receiving traditional postoperative care. To reduce the tendon elongation observed, a specially designed armrest was developed and applied the first postoperative day. The armrest was designed to maintain the elbow in 20 degrees flexion and to prevent shoulder adduction. The addition of this armrest to the traditional postoperative protocol resulted in a dramatic decrease of tendon elongation to only 8.4 +/- 3.0 mm (n = 5). Elongation occurred within the first 6 postoperative weeks in the armrest group; in the nonprotected group, elongation continued for several additional months. The majority of the elongation in both groups occurred in the proximal portion of the tendon-graft-tendon unit. Although this study did not explicitly measure strength, we conclude that preventing excessive muscle length change is required to protect repair sites in posterior deltoid to triceps transfer. (J Hand Surg 2000; 25A:144-149.
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Affiliation(s)
- J Fridén
- Department of Hand Surgery and Spinal Unit, Sahlgrenska University Hospital, Göteborg, Sweden
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Abstract
BACKGROUND AND METHODS The antibacterial activity of originally devised and synthesized organobismuth compounds was tested against fresh clinical isolates of Helicobacter pylori and compared with clinically well-established inorganic bismuth salts currently used in triple antibacterial treatment to eradicate H. pylori. The test conditions in vitro were standard for determination of minimum inhibitory concentrations (MICs). RESULTS Organic compounds with covalently bound bismuth showed stronger and more consistent antibacterial activity than inorganic bismuth salts. Whereas the most active among the standard therapeutic inorganic compounds showed MICs against the test organisms of 4-8 mg/l (bismuth salicylate) and 0.5-64 mg/l, the most active neosynthesized organic substance, tris(2.6-dimethylphenyl)-bismuthine, consistently showed an MIC of 4 mg/l against all bacterial strains. CONCLUSIONS The new line of organobismuth compounds might offer a therapeutic potential against the bacteria causing peptic ulcer disease.
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Affiliation(s)
- A Dahlgren
- Dept. of Medicinal Chemistry, School of Pharmacy, University of Oslo, Norway
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Abstract
Slipping on ice or snow during winter caused 3.5 injuries per 1000 inhabitants per year in the Umeå health district; the injury rate was highest among the elderly. Most injured were elderly women, but also many young men in the age group 20-29 years were injured. Half of all injuries were fractures; for women 50 years and over two-thirds were fractures, mostly of an upper extremity. The 'cost' of medical care of these slipping injuries was almost the same as the 'cost' of all traffic injuries in the area during the same time. Injury reducing measures, such as more effective snow clearing, sand and salt spreading in strategic areas, better slip preventive aids on shoes, and 'padding' of older women, would reduce the injuries and their consequences.
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Affiliation(s)
- U Björnstig
- Department of Surgery, University of Umeå, Sweden
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48
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Björnstig U, Björnstig J, Dahlgren A. [Young men and old women fall most often on slippery ice and snow]. Lakartidningen 1995; 92:1597-601. [PMID: 7715285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lassus A, Dahlgren A, Linnavuori K. Genivir (DIP-253) 1% cream versus placebo cream in the treatment of recurrent genital herpes: a double-blind study. Int J STD AIDS 1990; 1:18-20. [PMID: 2099194 DOI: 10.1177/095646249000100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A total of 100 heterosexual adults of either sex with frequent episodes of recurrent genital herpes were allocated to treatment with either Genivir (DIP-253) 1% cream or placebo cream. All patients had genital herpes previously verified by a positive viral culture. The study was carried out as a double-blind parallel group trial. Fifty patients were allocated to each of the two treatment groups. The treatment was initiated within 24 hours after the first sign of a recurrence, and at the pretreatment examination all patients had developed typical lesions with blisters and/or sores. At baseline a sample for herpes virus culture and typing was obtained. The creams were applied four times daily for five days. Follow-up examinations were carried out on days 1, 2, 4 and if needed on days 7, 10 and 14. The major factor used for assessment of efficacy was the time to complete healing of all lesions. Duration of pruritus and pain were also recorded. In the group of patients treated with Genivir cream the time to complete healing was 3.3 days and in the placebo group 6.1 days. The difference was statistically significant (P less than 0.001). The mean duration of pain was 1.3 days in the Genivir group and 2.5 days in the placebo group: this difference also reached significance (P less than 0.01). The duration of pruritus was about the same in both groups. The active agent in Genivir, DIP-253, is a heterocyclic aromatic complex with confirmed anti-herpetic activity and with evidence of a local immunomodulatory effect. It was concluded that the efficacy of topical application of DIP-253 may be due to combined antiviral and immunomodulatory activities.
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Affiliation(s)
- A Lassus
- Outpatient Department for Venereal Diseases, University Central Hospital, Helsinki, Finland
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Dahlgren A. [Focus on education (5). Education in terminal care in the university]. Sykepleien 1986; 73:15-8. [PMID: 3641450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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