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Porserud, A., Aly, M., Nygren-Bonnier, M. & Hagströmer, M. (2023). Association between early mobilisation after abdominal cancer surgery and postoperative complications. European Journal of Surgical Oncology, 49(9), Article ID 106943.
Open this publication in new window or tab >>Association between early mobilisation after abdominal cancer surgery and postoperative complications
2023 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 9, article id 106943Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Postoperative complications and readmission to hospital after major cancer surgery are common. Early mobilisation in hospital is thought to reduce complications, and patients are recommended to mobilise for at least 2 h on the day of surgery, and thereafter at least 6 h per day. Evidence for early mobilisation is limited and therefore also how early mobilisation may influence the development of postoperative complications. The aim of this study was to evaluate the association between early mobilisation after abdominal cancer surgery and readmission to hospital due to postoperative complications.

MATERIAL AND METHODS: Adult patients who had abdominal cancer surgery due to ovarian, colorectal, or urinary bladder cancer between January 2017 and May 2018 were included in the study. Exposure was set to the mean number of steps taken over the first three postoperative days, measured with an activity monitor. Primary outcome was readmission to hospital within 30 days after discharge, and secondary outcome was severity of complications. Data were obtained from medical records. Logistic regression was used to investigate the association between exposure and outcomes.

RESULTS: Of 133 patients included in the study, 25 were readmitted to the hospital within 30 days after discharge. The analysis showed no association between early mobilisation and readmission or severity of complications.

CONCLUSION: Early mobilisation does not seem to increase the odds of readmission, nor the severity of complications. This study contributes to the limited research on the association between early mobilisation and postoperative complications after abdominal cancer surgery.

Keywords
Activity monitor, Colorectal cancer, Ovarian cancer, Readmission, Steps, Urinary bladder cancer
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:shh:diva-4970 (URN)10.1016/j.ejso.2023.05.018 (DOI)37296020 (PubMedID)
Available from: 2023-06-19 Created: 2023-06-19 Last updated: 2023-12-21Bibliographically approved
Kullenberg, H., Rossen, J., Johansson, U.-B., Hagströmer, M., Nyström, T., Kumlin, M. & Svedberg, M. (2023). Correlations between insulin-degrading enzyme and metabolic markers in patients diagnosed with type 2 diabetes, Alzheimer's disease, and healthy controls: A comparative study. Endocrine
Open this publication in new window or tab >>Correlations between insulin-degrading enzyme and metabolic markers in patients diagnosed with type 2 diabetes, Alzheimer's disease, and healthy controls: A comparative study
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2023 (English)In: Endocrine, ISSN 1355-008X, E-ISSN 1559-0100Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: This study aimed to explore correlations between insulin-degrading enzyme (IDE) and markers of metabolic function in a group of patients diagnosed with type 2 diabetes mellitus (T2DM) or Alzheimer's disease (AD) and metabolically healthy volunteers.

METHOD: We included 120 individuals (47 with T2DM, 9 with AD, and 64 healthy controls). Serum levels of IDE were measured with commercial kits for ELISA. Differences in IDE levels between groups were analyzed with non-parametric ANCOVA, and correlations were analyzed with Spearman's rank correlations. We also investigated the influence of age, sex, and the use of insulin on the correlation using a non-parametric version of partial correlation.

RESULTS: Patients diagnosed with T2DM had higher IDE levels than patients diagnosed with AD and healthy controls after adjustment for age and sex. IDE was increasingly associated with body mass index (BMI), fasting blood glucose, C-peptide, hemoglobin A1c (HbA1c), insulin resistance, and triglycerides. In stratified analyses, we found a decreasing partial correlation between IDE and HbA1c in patients diagnosed with AD and a decreasing partial correlation between IDE and C-peptide in healthy controls. In patients diagnosed with T2DM, we found no partial correlations.

CONCLUSION: These results indicate that IDE is essential in metabolic function and might reflect metabolic status, although it is not yet a biomarker that can be utilized in clinical practice. Further research on IDE in human blood may provide crucial insights into the full function of the enzyme.

Keywords
Alzheimer’s disease, Insulin resistance, Insulin-degrading enzyme, Metabolic disorder, Serum, Type 2 diabetes mellitus
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:shh:diva-5079 (URN)10.1007/s12020-023-03603-4 (DOI)37980298 (PubMedID)
Available from: 2023-11-23 Created: 2023-11-23 Last updated: 2023-11-23Bibliographically approved
Jakobsson, M., Hagströmer, M., Lotzke, H., von Rosen, P. & Lundberg, M. (2023). Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder. BMC Musculoskeletal Disorders, 24, Article ID 874.
Open this publication in new window or tab >>Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder
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2023 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, article id 874Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery.

METHODS: Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders.

RESULTS: Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points.

CONCLUSIONS: Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.

Keywords
Accelerometer, Kinesiophobia, Movement behaviour, Pain catastrophising, Physical activity, Postoperative outcomes, Predictors, Self-efficacy, Spine Surgery
National Category
Physiotherapy
Identifiers
urn:nbn:se:shh:diva-5077 (URN)10.1186/s12891-023-06980-z (DOI)37950235 (PubMedID)
Available from: 2023-11-23 Created: 2023-11-23 Last updated: 2024-01-17Bibliographically approved
Thurfjell, Å., Sandlund, C., Adami, J., Hasseltröm, J., Hagströmer, M. & Lundh, L. (2023). General practitioners' experiences of Phosphatidylethanol in treatment of hypertension: A qualitative study. BJGP Open, 7(4), Article ID BJGPO.2023.0037.
Open this publication in new window or tab >>General practitioners' experiences of Phosphatidylethanol in treatment of hypertension: A qualitative study
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2023 (English)In: BJGP Open, ISSN 2398-3795, Vol. 7, no 4, article id BJGPO.2023.0037Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hazardous alcohol use increases the risk of hypertension but is underdetected in primary health care patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last two to three weeks of alcohol consumption, is increasing in Swedish primary health care, but studies from that context are scarce or missing.

AIM: Explore general practitioners' (GPs') experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension.

DESIGN & SETTING: A qualitative study of GPs (n=12) experienced in using PEth in hypertension management who were recruited at Swedish primary health care centres in 2021.

METHOD: The GPs participated in five focus groups interviews. A questioning route was used. The interviews were audio recorded, transcribed verbatim, and analysed with inductive qualitative content analysis.

RESULTS: The overall theme I don't hesitate anymore reflects the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred and that the positive effects of PEth predominated in the findings. The theme is underpinned by four sub-themes: serving as an eyeopener, improving the dialogue, using with care, and learning by doing.

CONCLUSION: PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in primary health care. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.

Keywords
Alcohol drinking, Glycerophospholipids, Hypertension, Primary health care, Qualitative study
National Category
Substance Abuse
Identifiers
urn:nbn:se:shh:diva-5008 (URN)10.3399/BJGPO.2023.0037 (DOI)37463721 (PubMedID)
Available from: 2023-09-13 Created: 2023-09-13 Last updated: 2023-12-21Bibliographically approved
Larsson, K., Hagströmer, M., Rossen, J., Johansson, U.-B. & Norman, Å. (2023). Health care professionals' experiences of supporting persons with metabolic risk factors to increase their physical activity level: A qualitative study in primary care. Scandinavian Journal of Primary Health Care, 41(2), 116-131
Open this publication in new window or tab >>Health care professionals' experiences of supporting persons with metabolic risk factors to increase their physical activity level: A qualitative study in primary care
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2023 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 2, p. 116-131Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals' within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity.

DESIGN: A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach.

SETTING: Primary health care in five Swedish healthcare regions.

SUBJECTS: Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants.

RESULTS: Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: 'Patient readiness for change', 'Supporting the process of change', 'The professional role', and 'The organisation of primary care'.

CONCLUSION: The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors.KEY POINTSHealth care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity.Barriers and facilitators to support the patients should be addressed at several levels within primary care.The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change.

Keywords
Barriers, Sweden, Facilitators, Health care professionals, Physical activity, Primary care
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4903 (URN)10.1080/02813432.2023.2187668 (DOI)36927270 (PubMedID)
Available from: 2023-05-17 Created: 2023-05-17 Last updated: 2023-09-06Bibliographically approved
Woldamanuel, Y., Rossen, J., Andermo, S., Bergman, P., Åberg, L., Hagströmer, M. & Johansson, U.-B. (2023). Perspectives on promoting physical activity using eHealth in primary care by health care professionals and individuals with prediabetes and type 2 diabetes: Qualitative study. JMIR Diabetes, 8, Article ID e39474.
Open this publication in new window or tab >>Perspectives on promoting physical activity using eHealth in primary care by health care professionals and individuals with prediabetes and type 2 diabetes: Qualitative study
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2023 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 8, article id e39474Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The trend of an exponential increase in prediabetes and type 2 diabetes (T2D) is projected to continue rising worldwide. Physical activity could help prevent T2D and the progression and complications of the disease. Therefore, we need to create opportunities for individuals to acquire the necessary knowledge and skills to self-manage their chronic condition through physical activity. eHealth is a potential resource that could facilitate self-management and thus improve population health. However, there is limited research on users' perception of eHealth in promoting physical activity in primary care settings.

OBJECTIVE: This study aims to explore the perspectives of health care professionals and individuals with prediabetes and T2D on eHealth to promote physical activity in primary care.

METHODS: A qualitative approach was applied using focus group discussions among individuals with prediabetes or T2D (14 participants in four groups) and health care professionals (10 participants in two groups). The discussions were audio-recorded and transcribed verbatim. Qualitative content analysis was used inductively to code the data.

RESULTS: Three main categories emerged: utility, adoption process, and accountability. The utility of eHealth was described as a motivational, entertaining, and stimulating tool. Registration of daily medical measurements and lifestyle parameters in a cohesive digital platform was recognized as a potential resource for strengthening self-management skills. The adoption process includes eHealth to increase the accessibility of care and personalize the support of physical activity. However, participants stated that digital technology might only suit some and could increase health care providers' administrative burden. Accountability refers to the knowledge and skills to optimize eHealth and ensure data integrity and security.

CONCLUSIONS: People with prediabetes and T2D and health care professionals positively viewed an integration of eHealth technology in primary care to promote physical activity. A cohesive platform using personal metrics, goal-setting, and social support to promote physical activity was suggested. This study identified eHealth illiteracy, inequality, privacy, confidentiality, and an increased workload on health care professionals as factors of concern when integrating eHealth into primary care. Continuous development of eHealth competence was reported as necessary to optimize the implementation of eHealth technology in primary care.

Keywords
eHealth, Focus groups, Health care professionals, Physical activity, Prediabetes, Primary care, Qualitative research, Self-management, Type 2 diabetes
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4760 (URN)10.2196/39474 (DOI)36662555 (PubMedID)
Available from: 2023-03-20 Created: 2023-03-20 Last updated: 2023-03-20Bibliographically approved
Larsson, K., von Rosen, P., Rossen, J., Johansson, U.-B. & Hagströmer, M. (2023). Relative time in physical activity and sedentary behaviour across a 2-year pedometer-based intervention in people with prediabetes or type 2 diabetes: A secondary analysis of a randomised controlled trial. Journal of Activity, Sedentary and Sleep Behaviors, 2(1), Article ID 10.
Open this publication in new window or tab >>Relative time in physical activity and sedentary behaviour across a 2-year pedometer-based intervention in people with prediabetes or type 2 diabetes: A secondary analysis of a randomised controlled trial
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2023 (English)In: Journal of Activity, Sedentary and Sleep Behaviors, E-ISSN 2731-4391, Vol. 2, no 1, article id 10Article in journal (Refereed) Published
Abstract [en]

Background: People with prediabetes or type 2 diabetes (T2D) need to be physically active, including moderate-to-vigorous intensity physical activity (MVPA) and light-intensity physical activity (LIPA) and reduce time in sedentary behaviour (SB). Few studies have evaluated the effect of randomised controlled trials taking all movement behaviours into account. This study aimed to investigate the effects of a 2-year pedometer-based intervention in people with prediabetes or T2D on relative time in movement behaviours.

Methods: Secondary analysis of longitudinal data on individuals with prediabetes or T2D from a three-armed randomised controlled trial, the Sophia Step Study, was conducted. The three groups were (1) a multi‑component group (self‑monitoring of steps with a pedometer plus counselling), (2) a single‑component group (self‑monitoring of steps with a pedometer, without counselling), and (3) a standard care group (control). The three behaviours MVPA, LIPA and SB during waking hours were measured with an ActiGraph GT1M accelerometer at baseline, 6, 12, 18 and 24 months. Relative time in MVPA, LIPA and SB for each participant at each time point was calculated and used as outcome measures. Linear mixed models assessed the effect of the intervention over time.

Results: In total 184 participants with mean (SD) age 64.3 (7.6) years and 41% female was included. In the multi-component group, compared to the control group, a significant group-by-time interaction effect for relative time in all three behaviours was found at 6 and 18 months and for MVPA and SB at 24 months. In the single-component group, compared to the control group, an effect occurred in the MVPA and SB behaviours at 6 months and MVPA and LIPA at 24 months. The estimated marginal means ranged from 0.9 to 1.5% of more MVPA, 1.9–3.9% of less LIPA and from 0.5% of less SB to 1.7 more SB in the intervention groups compared to the control group.

Conclusions: The findings show a beneficial effect on all behaviours over time in the two intervention groups compared to the control group. A more pronounced effect occurred in the multi-component intervention compared to the single-component intervention, implicating the importance of counselling in pedometer-based interventions.

Trial registration ClinicalTrials.gov, NCT02374788

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4993 (URN)10.1186/s44167-023-00020-w (DOI)
Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2023-09-06Bibliographically approved
Larsson, K., Hagströmer, M., Rossen, J., Johansson, U.-B. & Norman, Å. (2022). Experiences of supporting persons with metabolic risk factors to increase physical activity level. In: : . Paper presented at The International 23rd Puijo Symposium, Kuopio, Finland, 27-30 juni 2022.
Open this publication in new window or tab >>Experiences of supporting persons with metabolic risk factors to increase physical activity level
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2022 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4618 (URN)
Conference
The International 23rd Puijo Symposium, Kuopio, Finland, 27-30 juni 2022
Available from: 2022-10-14 Created: 2022-10-14 Last updated: 2022-10-14Bibliographically approved
Kullenberg, H., Rossen, J., Johansson, U.-B., Hagströmer, M., Nyström, T., Kumlin, M. & Svedberg, M. (2022). Increased levels of insulin-degrading enzyme in patients with type 2 diabetes mellitus. Endocrine, 77(3), 561-565
Open this publication in new window or tab >>Increased levels of insulin-degrading enzyme in patients with type 2 diabetes mellitus
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2022 (English)In: Endocrine, ISSN 1355-008X, E-ISSN 1559-0100, Vol. 77, no 3, p. 561-565Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Decreasing levels of serum insulin-degrading enzyme (IDE) have been associated with an increased risk for Alzheimer´s disease (AD) in patients with type 2 diabetes mellitus (T2DM). Research on serum IDE levels in patients with T2DM is sparse and the aim of this study was to explore serum levels of IDE in patients with T2DM.

METHOD: Blood serum samples were obtained from a biobank. Samples from subjects with T2DM and without metabolic disease were divided into subgroups; lifestyle treatment (n = 10), oral antidiabetic treatment (n = 17), insulin treatment (n = 20) and metabolically healthy controls (n = 18). Serum levels of IDE were analysed using specific ELISA assays.

RESULTS: Serum levels of IDE were elevated in subjects with T2DM compared to metabolically healthy individuals (p = 0.033). No significant differences were detected between treatment subgroups.

CONCLUSION: The present study indicates that patients with T2DM have increased serum IDE levels, compared to metabolically healthy individuals. However, for IDE to be clinically useful as a biomarker, its full function and possible use needs to be further elucidated in larger studies showing reproducible outcomes.

Keywords
Insulin resistance, Insulin-degrading enzyme, Type 2 diabetes mellitus
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:shh:diva-4539 (URN)10.1007/s12020-022-03123-7 (DOI)35751775 (PubMedID)
Available from: 2022-12-14 Created: 2022-12-14 Last updated: 2023-11-06Bibliographically approved
Porserud, A., Lundberg, M., Eriksson, J., Nygren Bonnier, M. & Hagströmer, M. (2022). Like I said, I would not have likely gotten up otherwise: Patient experiences of using an Activity Board after abdominal cancer surgery.. Disability and Rehabilitation
Open this publication in new window or tab >>Like I said, I would not have likely gotten up otherwise: Patient experiences of using an Activity Board after abdominal cancer surgery.
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2022 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Most patients treated in a hospital setting are fully or partially immobilised. The Activity Board (Träningstavlan® Phystec) is a useful tool to enhance mobilisation after major abdominal cancer surgery. Knowledge of patient experiences of the mobilisation tool is crucial in implementing the Activity Board in health care. This study aimed to describe patient experiences of using the Activity Board after surgery for abdominal cancer.

MATERIALS AND METHODS: Semi-structured face-to-face interviews were conducted in 15 patients who underwent abdominal surgery due to colorectal, ovarian or urinary bladder cancer. All 15 patients (mean age 67.7 years, range 40-86) used the Activity Board postoperatively. The interviews were transcribed verbatim and analysed according to inductive content analysis.

RESULTS: The overarching theme that emerged from the interviews was that "enabling participation facilitates empowerment over rehabilitation". Three categories supported the theme: prerequisites for using the Activity Board, the value of using supportive behavioural techniques, and the possibility to influence the patients' care.

CONCLUSIONS: These findings suggest that the Activity Board could be a viable tool that activates the person-centred postoperative rehabilitation process by cooperating with the medical team at the hospital ward.Implications for rehabilitationPatients who are in hospital due to cancer surgery are often immobilised, which increases the risk of complications.The Activity Board can stimulate the patients to participate in the rehabilitation process in a more active way.The Activity Board can be used to improve and clarify the person-centred approach in hospital settings.

Keywords
Behaviour change techniques, Hospital, Mobilisation, Physical activity, Postoperative, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4362 (URN)10.1080/09638288.2022.2048097 (DOI)35275766 (PubMedID)
Available from: 2022-03-31 Created: 2022-03-31 Last updated: 2022-03-31Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-4607-8677

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