Search

Introduction: Children gain increased health and wellbeing by participating in physical activity (PA). In children and adolescents with cerebral palsy who are non-ambulant (children with CP-NA), levels of PA have been indicated to be lower compared to children and adolescents without physical disabilities. However, research on PA in children with CP-NA is limited. Therefore, this study aims to evaluate objectively assessed PA over the course of one year when using ActiGraph GT3X accelerometer in children with CP-NA. Participants and methods: Accelerometer data were retrieved from 32 children with CP-NA (4 - 17 years) in Region Skane, Sweden. Participants wore the ActiGraph GT3X accelerometer all waking hours for up to four periods of seven consecutive days over a year. Statistically sensitivity analyses were run to explore differences in PA between subtypes of cerebral palsy and GMFCS level IV and V. Results: In total 481 days and 85 periods of valid accelerometer data were obtained. Light PA was statically significantly higher for children with dyskinetic CP-NA compared to spastic CP-NA (median (IQR) 57 (37.42-88.1) vs. 34.42 (20.42-55.96), p = <0.001). Light PA (median (IQR) 57 (36.67-88.5) vs. 25.42 (17-38.75), p = <0.001) and moderate to vigorous PA (median (IQR) 1.83 (1-4.17) vs. 1.67 (0.67-2), p = <0.001) were statically significantly higher for children with CP-NA GMFCS level IV compared to level V. Conclusion: Preliminary results indicate differences in PA levels between subtype of cerebral palsy and GMFCS level. Further analyses to explore potential differences in PA over the year will be run.

Purpose: To investigate acute and long-term changes in hormonal and inflammatory biomarkers in nonambulant children with cerebral palsy in response to dynamic standing exercise. Methods: Fourteen children with severe cerebral palsy were recruited. Anthropometrics and body composition measures were obtained. Physical activity levels before the study were assessed using hip-worn accelerometry. All children underwent a 30-minute dynamic standing exercise using the Innowalk standing aid. Respiratory data during exercise were collected using indirect calorimetry. Blood samples were collected before and after exercise. Blood samples were also obtained after two 16-week exercise protocols, in a resting state. Hormonal and inflammatory metabolites were measured from blood serum/plasma, and acute and long-term changes in biomarker levels were assessed using Wilcoxon signed-rank tests. Results: Of the 14 children at baseline, all had slightly/moderately/severely elevated C-reactive protein and cortisol levels. C-reactive protein levels were decreased following a 30-minute bout of dynamic standing (before exercise: 53 mg/L [interquartile range: 40-201]; after exercise: 39 mg/L [interquartile range: 20-107]; P = .04). Conclusions: We show that several hormonal and inflammatory biomarkers are dysregulated in children with cerebral palsy. Our preliminary results from a small, but deep-phenotyped prospective cohort indicate acute and long-term alterations of several biomarkers in response to exercise. ©2023 The Authors.

INTRODUCTION: The aging population is a challenge for the healthcare system that must identify strategies that meet their needs. Practicing patient-centered care has been shown beneficial for this patient-group. The effect of patient-centered care is called patient-centered outcomes and can be appraised using outcomes measurements. OBJECTIVES: The main aim was to review and map existing knowledge related to patient-centered outcomes and patient-centered outcomes measurements for older people, as well as identify key-concepts and knowledge-gaps. The research questions were: How can patient-centered outcomes for older people be measured, and which patient-centered outcomes matters the most for the older people? STUDY DESIGN: Scoping review. METHODS: Search for relevant publications in electronical databases, grey literature databases and websites from year 2000 to 2021. Two reviewers independently screened titles and abstracts, followed by full text review and extraction of data using a data extraction framework. RESULTS: Eighteen studies were included, of which six with involvement of patients and/or experts in the process on determine the outcomes. Outcomes that matter the most to older people was interpreted as: access to- and experience of care, autonomy and control, cognition, daily living, emotional health, falls, general health, medications, overall survival, pain, participation in decision making, physical function, physical health, place of death, social role function, symptom burden, and time spent in hospital. The most frequently mentioned/used outcomes measurements tools were the Adult Social Care Outcomes Toolkit (ASCOT), EQ-5D, Gait Speed, Katz- ADL index, Patient Health Questionnaire (PHQ9), SF/RAND-36 and 4-Item Screening Zarit Burden Interview. CONCLUSIONS: Few studies have investigated the older people's opinion of what matters the most to them, which forms a knowledge-gap in the field. Future research should focus on providing older people a stronge

Cerebral palsy is the most common physical disability in childhood, affecting approximately 1.6 out of every 1000 live births (23). In addition to a movement disorder and affected muscle tone, many children experience problems with pain, osteoporosis, epilepsy, intellectual, communicational, and behavioral impairments (25,33), and a higher risk of developing health problems related to decreased physical activity in adulthood, such as cardiovascular disease. The degree of motor impairment in cerebral palsy is extremely variable and classified in the 5-level Gross Motor Function Classification System–Expanded & Revised (GMFCS–E&R) scale (28). Children with severe cerebral palsy (GMFCS–E&R IV–V) who cannot stand or walk independently have been shown to have low physical activity levels (18,20). Standard care in Sweden includes daily static supported standing for 30 to 90 minutes to improve bone density, range of motion, and reduce spasticity (27). Compared with sitting and laying down, children with cerebral palsy have increased energy expenditure and muscle activity when they perform static supported standing (39). Robotic walking aids have been used to facilitate walking among ambulant children with cerebral palsy, demonstrating higher walking speed and distance (3). The effects of robotic walking (defined as dynamic standing exercise) on blood-borne biomarkers for nonambulant children with cerebral palsy are largely unknown. Innowalk, a motorized assistive device made by Made for Movement in Norway, offers whole-body exercise through assisted and repetitive movements of the lower extremities in an upright weight-bearing position. In a previous study, we compared static and dynamic standing for 20 children with cerebral palsy (17,36). The results showed that dynamic standing exercise improved passive range of motion and spasticity in the hip, and overall health-related quality of life. Another study involving 46 patients showed that dynamic standing impro, PURPOSE: To investigate acute and long-term changes in hormonal and inflammatory biomarkers in nonambulant children with cerebral palsy in response to dynamic standing exercise.METHODS: Fourteen children with severe cerebral palsy were recruited. Anthropometrics and body composition measures were obtained. Physical activity levels before the study were assessed using hip-worn accelerometry. All children underwent a 30-minute dynamic standing exercise using the Innowalk standing aid. Respiratory data during exercise were collected using indirect calorimetry. Blood samples were collected before and after exercise. Blood samples were also obtained after two 16-week exercise protocols, in a resting state. Hormonal and inflammatory metabolites were measured from blood serum/plasma, and acute and long-term changes in biomarker levels were assessed using Wilcoxon signed-rank tests.RESULTS: Of the 14 children at baseline, all had slightly/moderately/severely elevated C-reactive protein and cortisol levels. C-reactive protein levels were decreased following a 30-minute bout of dynamic standing (before exercise: 53 mg/L [interquartile range: 40-201]; after exercise: 39 mg/L [interquartile range: 20-107]; P = .04).CONCLUSIONS: We show that several hormonal and inflammatory biomarkers are dysregulated in children with cerebral palsy. Our preliminary results from a small, but deep-phenotyped prospective cohort indicate acute and long-term alterations of several biomarkers in response to exercise.

Introduction: Manipulation of medicines is often necessary in the paediatric setting due to lack of medicines suitable for paediatric patients. There are previous short-term frequency studies in different paediatric settings, but no long-term studies and no comparison between two different years in the same setting. In 2007 the Paediatric Regulation was implemented in Europe to stimulate drug companies to develop more information around medicines for children and new dosage forms suitable for paediatric patients. An alternative to manipulation of medicines is to use extemporaneous preparations in correct strengths. Aim: The overall research aim of this thesis was to study how and to what extent manipulation of medicines is being done and its effect on dosing accuracy in paediatric care. A specific aim was to compare the use of extemporaneous preparations in two different years. Methods: The setting for three of the four studies was a large paediatric university hospital in Sweden, and the fourth study was performed at a hospital pharmacy. Data for paper I and IV were extracted from a large registry containing material regarding patient data, care, and medicines from the hospital electronic health record, TakeCare. In Paper I data regarding all solid oral and rectal administrations where a part of a solid dosage form needed to be administered were counted. Comparisons were then made between the included study years 2009 and 2019 and between inpatients and patients at the emergency department. Semi-structured interviews with registered nurses and pharmacists were performed in Paper II. All interviews were audio recorded, transcribed verbatim, and analysed qualitatively using content analysis. In Paper III five different brands of tablets were split into halves and quarters. The resulting parts were then weighed and compared with expected weight, according to criteria in the European Pharmacopoeia and the United States Pharmacopoeia. The frequency of patients with at l

This is a registry-based study with the aim of describing and comparing the frequency of manipulations of solid oral and rectal medicines in 2009 and 2019 at inpatient units and an emergency department in a paediatric hospital within a Swedish university hospital. All patients aged 1 month-18 years with oral or rectal administrations were included. In total, 140,791 oral and rectal administrations were included in 2009, and 167,945 oral and rectal administrations were included in 2019. The frequency of patients receiving at least one manipulated oral medicine decreased between the study years, both in inpatient units and in the emergency department (from 19% to 17%, p = 0.0029 and from 11% to 5%, p < 0.0001, respectively). The frequency of patients receiving a manipulated rectal medicine also decreased between the study years, both in inpatient units and in the emergency department (from 22% to 10%, p < 0.0001 and from 35% to 7% 2019, p < 0.0001, respectively). The results show a decrease in the manipulation of both oral and rectal medicines to paediatric patients in 2019 compared to 2009. Even though this implies a safer practice, there is still a pronounced lack of child-friendly dosage forms and suitable strengths enabling the safe administration of medicines to sick children.

AIM: Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients. METHODS: Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis. RESULTS: Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment. CONCLUSION: Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.

Syftet med studien var att öka kunskapen om hur speciallärare och lärare beskriver att de samarbetar gällande de elever som bedöms vara i svårigheter och därmed riskerar att inte nå kunskapsmålen i årskurs tre i ämnet svenska. Studien är relevant eftersom det finns behov av mer kunskap om professioners samarbete, proaktivt arbetssätt, god lärandemiljö och tidiga insatser för läs- och skrivinlärning. Det finns således behov av mer svensk forskning som uppmärksammar hur lärare och speciallärare stöttar och samarbetar kring detta utifrån sina professioner. Även Skolinspektionens rapport som pekar på att Läsa-, skriva-, räknagarantin i nuläget riskerar att huvudsakligen drivas av lärare synliggör det här behovet. Studien är kvalitativ och empirin samlades in genom semistrukturerade intervjuer med speciallärare och lärare. Som metod för att analysera intervjuerna användes innehållsanalys. Resultaten av intervjusvaren visar att speciallärare och lärare beskriver att samarbetet mellan dem byggs på dialog, samsyn, tät kontakt, flexibilitet och gemensam problemlösning. Speciallärarna och lärarna beskriver att de har samtal där de ofta reflekterar tillsammans och diskuterar. Hinder som framkom var tid och lärare beskriver att speciallärare har många arbetsuppgifter att hinna med. Resultaten visar även att organisationen på skolorna möjliggör ett samarbete och en diskussion mellan speciallärare och lärare gällande lärandemiljön. Vad gäller utformandet av lärandemiljön framkommer det att respondenterna tycker att det är viktigt med lugn och ro, variation i klassrummet både vad gäller möbler och placeringar och även i material som även behöver vara anpassat efter elevernas nivå och behov. En tydligt inarbetad struktur i klassrummet framhålls samt ett förebyggande arbetssätt för att ge elever goda förutsättningar i undervisningen och att göra elever delaktiga i sin undervisningssituation. Motivationshöjande inslag och lustfyllt lärande är viktiga inslag för att gynna elevers inl

Introduction: Transcranial Doppler sonography (TCD) is a non-invasive tool for measuring cerebrovascular hemodynamics. Studies have reported alterations in cerebrovascular hemodynamics in normal aging, mild cognitive impairment (MCI) and dementia, as well as in different etiologies of dementia. This systematic review and meta-analysis was designed to investigate the relationship between cerebral blood velocity (CBv) and pulsatility index (PI) in the middle cerebral artery (MCA) in persons with MCI and dementia. Methods: A systematic literature search was conducted in Pubmed, Embase, Cochrane Library, Epistemonikos, PsychINFO, and CINAHL. The search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After screening of 33439 articles, 86 were reviewed in full-text, and 35 fulfilled the inclusion criteria. Results: CBv was significantly lower and PI significantly higher in MCA in vascular dementia (VaD) and Alzheimer's disease (AD) compared to cognitively normal (CN) older persons. Also, CBv was lower in MCI compared to CN. There were no significant differences in CBv in MCA in AD compared with VaD, although PI was higher in VaD compared to AD. Conclusion: Alterations in cerebrovascular hemodynamics are seen in AD, VaD and MCI. While PI was slightly higher in VaD compared to AD, the reduction in CBv appears to be equally pronounced across neurodegenerative and vascular etiologies of dementia., The study was funded by: 1) Örebro University School of Medical Sciences, Örebro, Sweden; 2) Central Hospital Karlstad, Karlstad, Sweden.

Background Physical exercise is an important treatment for individuals with axial spondyloarthritis (axSpA). Although high-intensity training (HIT) has been shown to reduce disease symptoms and risk of comorbidity without exacerbating disease activity (1), compliance tends to decrease over time. Increased knowledge is needed on how to optimize and tailor individual exercise programs for continued regular exercising and improved health. Objective To study the effects of HIT on aerobic capacity, body composition, disease activity, physical function, health status and fatigue in individuals with axSpA after a 12-week intervention supported by digital coaching. Methods Twenty-two individuals (women, n=12), recruited from two rheumatology clinics in southern Sweden, were randomized to a HIT intervention group (HG; n=11) or a control group (CG; n=11). The HG completed three HIT sessions/week, including two interval training sessions (4x4 min), in self-selected activities for 12 weeks. The individuals in the HG were individually coached and had regular support from a physical therapist primarily by digital coaching. The CG continued exercising as usual. Assessment of aerobic capacity (VO2max), body composition (BMI and visceral fat area [cm2]), disease activity (CRP [µg/ml], BASDAI, 0-10 best-worst), physical function (BASFI, 0-10 best-worst), health status (EQ5D, 0-1 worst-best, ASAS health index [ASAS-HI], 0-17 best-worst), and fatigue (fatigue severity scale [FFS], 0-7 best-worst) were sampled at baseline and after 12 weeks. Mean and standard deviation (SD) were used for descriptive statistics. Repeated measures analysis of variance (ANOVA) was used to investigate effect of group (HG*CG) and time (PRE*POST), with a post-hoc analysis using t-tests when ANOVA indicated a significant difference in main effects or interactions. A significance level of p≤0.05 was used. Fisher´s exact test was used to study the effects over time for CRP (as dichotomized variable, > or

Shapes of Sounds is a publication that gathers reflections from and documentation of three sound art projects undertaken at Kungl. Konsthögskolan/Royal Institute of Art, by Ami Kohara, Johanna Mårtensson and Rossana Mercado-Rojas during 2018-2019. The publication includes QR-codes that enable access to the sound works and other material via Vimeo.

Bakgrund: Ensamhet och social isolering är ett ökande folkhälsoproblem som många arbetsterapeuter möter i sin yrkesutövning. Det finns arbetsterapeutiska interventioner som stödjer social delaktighet för att motverka ensamhet och isolering bland äldre. En aktuell sammanställning av kunskapsläget som belyser vad den nyaste forskningen visar att arbetsterapeutiska interventioner kan bidra med för att öka social delaktighet för gruppen äldre utan inriktning mot specifika skador och sjukdomar saknas dock. Syfte: Att sammanställa kunskapsläget om hur arbetsterapeutiska interventioner kan öka social delaktighet och minska ensamhet och social isolering hos äldre (60+). Metod: Litteraturöversikt med induktiv ansats. Databaserna CINAHL, PsycINFO samt PubMed användes vid datainsamling. Tolv artiklar inkluderades och innehållet analyserades med manifest innehållsanalys. Resultat: Tio olika arbetsterapeutiska interventioner i olika former och på olika platser identifierades. Majoriteten inkluderade gruppträffar, men även en individuell intervention identifierades. Innehållsanalysen resulterade i tre huvudkategorier som sammanfattar hur de arbetsterapeutiska interventionerna ökade social delaktighet hos äldre genom ökad tillhörighet, meningsfulla aktiviteter och främjande miljö. Slutsats: Resultatet visar att arbetsterapeutiska interventioner kan bidra till att öka social delaktighet hos äldre. Arbetsterapeuter skulle kunna adressera ohälsosam ensamhet och social isolering i större utsträckning än idag genom arbete på olika samhällsnivåer., Background: Loneliness and social isolation is an increasing public health problem that many occupational therapists meet within their clinical practice. There are occupational therapy interventions supporting social participation to counteract loneliness and isolation amongst older adults. However, an overview of the latest research findings of occupational therapy interventions’ contributions for an increased social participation in older adults without focusing on specific injuries or illnesses is lacking. Aim: To make an overview of how occupational therapy interventions can increase social participation and decrease loneliness and social isolation in older adults (60+). Method: A literature review with an inductive approach. The databases CINAHL, PsycINFO and PubMed were used for data collection. Twelve articles were included, and a manifest content analysis was used. Results: Ten different occupational therapy interventions in different forms and in different places were identified. The majority included group meetings, but there was also an individual intervention. The content analysis resulted in three categories summarizing how the occupational therapy interventions increased social participation in older adults through increased belonging, meaningful occupations and promotive environment. Conclusion: The results show that occupational therapy interventions can increase social participation in older adults. Occupational therapists could address the unhealthy loneliness and social isolation more than what is done today through work at different societal levels.