<p>Bio‐analytical results are influenced by in vivo factors like genetic, pharmacological and physiological conditions and in vitro factors like specimen composition, sample additives and storage conditions. The knowledge of stability of a drug and its major metabolites in biological matrices is very important in forensic cases for the interpretation of analytical results. Many drugs are unstable and undergo degradation during storage.</p><p>Zopiclone is a short‐acting hypnotic drug, introduced as a treatment for insomnia in the 1980s. However, this drug is also subject to abuse and can be found in samples from drug‐impaired drivers, recreational drug users and forensic autopsy cases. Zopiclone is analyzed in biological materials using different analytical methods. It is unstable in certain solvents and depending on storage conditions unstable in biological fluids. The aim of this thesis was to investigate the stability of zopiclone in human whole blood and to compare stability between authentic and spiked samples. Interpretation of zopiclone concentrations in whole blood is important in forensic toxicology. The following investigations were performed to study the stability of zopiclone in both spiked and authentic human blood.</p><p>First, different stability tests were performed. Spiked blood samples were stored at –20°C, 5°C and 20°C and the degradation of zopiclone was investigated in long‐ and short‐term stability. Authentic and spiked blood samples were stored at 5°C and differences in zopiclone stability were studied. Processed sample stability and effect of freeze/thaw cycles were also evaluated.</p><p>Second, influence of pre‐analytical conditions on the interpretation of zopiclone concentrations in whole blood was investigated. Nine volunteers participated in the study. Whole blood was obtained before and after oral administration of 2 x 5 mg Imovane®. Aliquots of authentic and spiked blood were stored under different conditions and zopiclone stability was evaluated. In this study, the influence from physiological factors such as drug interactions, matrix composition and plasma protein levels were minimized.</p><p>Analyses of zopiclone were performed by gas chromatography with nitrogen phosphorous detection and zopiclone concentrations were measured at selected time intervals. Degradation product of zopiclone was identified using liquid chromatography‐tandem mass spectrometry.</p><p>The first study showed that zopiclone degrades in human blood depending on time and temperature and may not be detected after long‐term storage. The degradation product 2‐amino‐5‐chloropyridine was identified following zopiclone degradation. The best storage condition was at –20°C even for short storage times, because freeze‐thaw had no influence on the results. In butyl acetate extracts, zopiclone was stable for at least two days when kept in the autosampler. However, in blood samples stored at 20°C a rapid decrease in concentration, was noticed. This rapid degradation at ambient temperature can cause an underestimation of the true concentration and consequently flaw the interpretation.</p><p>The second study showed no stability differences between authentic and spiked blood but confirmed the poor stability in whole blood at ambient temperature. The results showed that zopiclone was stable for less than 1 day at 20°C, less than 2 weeks at 5°C, but stable for 3 months at –20°C. This study, demonstrates the importance of controlling pre‐analytical conditions from sampling to analysis to avoid misinterpretation of toxicological results.</p>

<p>Bakgrund: Helkroppsvibration är en relativt ny träningsform, där mekaniska vibrationer överförs till kroppen via en vibrerande platta. Effekten har undersökts främst på idrottare och vuxna med skiftande diagnoser. Det finns lite forskning om effekten på barn/ungdomar med cerebral pares (CP).</p><p><strong>Syfte: </strong>Att prova helkroppsvibration som träningsmetod för barn och ungdomar med cerebral pares. Vetenskapliga frågeställningar. Har helkroppsvibration någon effekt på muskelstyrka, spasticitet, ledrörlighet och grovmotorisk förmåga hos barn och ungdomar med cerebral pares? Vidare ville vi undersöka om effekten varierade mellan olika grupper av barn/ungdomar och om träningstiden påverkade resultatet.<strong> </strong></p><p><p><strong>Metod: </strong>I denna före - efter studie deltog 41 barn/ungdomar (ålder 7-19, 14 flickor och 27 pojkar). Alla tränade enligt samma protokoll, 6 set två gånger i veckan under fem veckor, i samma utgångsställning och samma frekvens, 30 Hz. Träningstiden bestämdes till 70 % av maxtiden de orkade stå på vibrationsplattan. En baslinje med 3 mätningar gjordes före/efter interventionen. Mätningarna och bedömningarna var muskelstyrka, spasticitet och passiv ledrörlighet i nedre extremiteterna samt grovmotorisk förmåga.</p></p><p><p><strong>Resultat: </strong>Mätdata beräkning dels för hela gruppen och för, GMFCS nivå I-II (31st, ålder 7-19) och GMFCS nivå III-IV (9st, ålder 9-18). Muskelstyrkan ökade signifikant i samtliga muskelgrupper över hela mätperioden. För hela gruppen ökade muskelstyrkan signifikant i en av sex muskelgrupper direkt efter interventionen och i tre av sex muskelgrupper efter sex månader. För GMFCS nivå I-II ökade den grovmotoriska förmågan och muskelstyrkan signifikant i fyra av sex muskelgrupper direkt efter interventionen. Efter 6 månader fanns en signifikant ökad muskelstyrka i fyra av sex muskelgrupper. GMFCS nivå III-IV fick en signifikant ökad muskelstyrka i höger höftextension vid uppföljningen efter sex månader. Inga signifikanta förändringar av spasticiteten eller ledrörligheten förekom.</p></p><p><p><strong>Konklusion: </strong>Helkroppsvibration kan prövas för att öka muskelstyrka och den grovmotorisk förmåga hos barn/ungdomar med CP med GMFCS nivå I-II äldre än 7 år. Barnen/ungdomarna i GMFCS nivå III-IV hade ingen större effekt av helkroppsvibration enligt det protokoll som användes.</p></p>

<p><strong>Background:</strong> Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.</p><p><strong>Aims:</strong> The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.</p><p>Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.</p><p><strong>Results:</strong> In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.</p><p><strong>Conclusions: </strong>The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.</p>

<p>Introduction: The exact causes of Exercise Induced Arterial Hypoxemia (EIAH) are not yet known. Earlier studies on the ergogenic effects of NaHCO3 have neglected to investigate the occurrence of EIAH among their subject, something that could explain the conflicting results, EIAH cannot be over looked since reportedly 50% of well trained athletes experience EIAH. One possible ergogenic effect of NaHCO3 would be to attenuate EIAH through an increase in blood pH in a subject. This has been shown previously by means of intravenous infusion during maximal rowing.</p><p>Aim: The aim of the study was to examine the effect of oral intake of NaHCO3 on EIAH and performance in trained cyclists.</p><p>Method: Seven male cyclists (age 23.7 (22-27) years, VO2peak 64 (60-72) ml min-1 (kg body mass) -1 volunteered for the study. The subjects performed two maximal exercise tests to exhaustion 48 hours apart in a counter balanced cross over double blind fashion. Subjects received 0.3 g kg BW-1 CaCO3 and 0.3 g kg BW-1 NaHCO3 in the placebo and bicarbonate trial respectively.</p><p>Free flowing arterialized capillary blood was sampled at rest and exhaustion and analyzed for pH, O2 Saturation, pO2, pCO2, and blood lactate. Ventilatory variables were measured continuously throughout the test V'O2, V’CO2, V'E, V'E/VO2, RER and HR. In addition pulse oximetry was used to evaluate O2 saturation.</p><p>Results/Discussion: At rest pH and PCO2 was elevated (p<0.05) in the bicarbonate trial compared to the placebo trial. At exhaustion in the bicarbonate trial pH, blood lactate, RER, was significantly elevated (p<0.05) when compared to the placebo trial. O2 saturation from blood samples at exhaustion in the bicarbonate trial showed a trend towards improving (p=0.061). No difference was seen between the two trials in PO2, VO2peak, V'Emax, HRmax or performance. During exercise, bicarbonate ingestion increased blood pH but did not improve arterial saturation or performance. The increase in blood pH achieved by ingestion of bicarbonate was not as large as the increase achieved by intravenous infusion in another study. Even with the larger increase in blood pH in those studies, there was only a small improvement in performance. One possible explanation for the performance improvement with bicarbonate infusion in that study was a reduced ventilation that could effect respiratory muscle work and thereby work capacity. The bicarbonate ingestion in the present study did not reduce ventilation. This could possible be achieved with higher doses of NaHCO3, which would most likely result in increased frequency of gastrointestinal distress among subjects.</p>

No description available.

<p>INTRODUKTION</p><p>En av de mest vanligt förekommande vårdåtgärder som utförs på mekaniskt ventilerade patienter</p><p>är endotrakeal sugning. För att undvika syrgasbrist i samband med detta, är det vanligt att några</p><p>minuter innan sugning öka syrgashalten, preoxygenering. Höga syrgaskoncentrationer kan vara</p><p>skadligt och bland annat orsaka atelektaser, vilka försämrar gasutbytet i lungan. En fysiologisk</p><p>reaktion på atelektasbildning är att strypa åt blodförsörjningen till den aktuella lungvävnaden</p><p>med förhöjt blodtryck i lungan som följd. Syftet med studien var att undersöka om preoxygenering</p><p>samt lungrekrytering med varierade syrgaskoncentrationer påverkar hemodynamik, lungmekanik</p><p>och lungvolymer.</p><p>METOD</p><p>Sex grisar, under anestesi med mekanisk kontrollerad ventilation, preoxygenerades med 100 %</p><p>eller 60 % O2 under 5 minuter. Därefter genomfördes en endotrakeal sugning. Efter sugning gavs</p><p>ett stort andetag, en ”suck” innehållande 21 %, 60 % eller 100 % O2 med 15 cm H2O tryck över</p><p>inställt ventilationstryck. Detta gjordes i 3 protokoll av 4. Mätningar av hemodynamik, lungmekanik</p><p>och lungvolymer gjordes. Som kontrollgrupp gjordes ingen lungrekrytering i ett av</p><p>protokollen.</p><p>RESULTAT</p><p>Ett förhöjt medelpulmonellt tryck sågs i det protokoll där lungan inte rekryterades efter sugning,</p><p>29±3 mmHg jämfört med baslinjevärde 22±2 mmHg (p<0.05). Tydliga skillnader förelåg i</p><p>lungans compliance mellan rekryterad lunga, 22±1 (100 % O2), 21±3 (21 % O2), 21±3 (60 % O2)</p><p>eller inte rekryterad lunga (13±1 mL/cmH2O) efter sugning (p<0.001). Signifikanta skillnader</p><p>sågs även i lungvolym i jämförelse av rekryterad och icke rekryterad lunga, andetagsvolym</p><p>(p<0.001) och EELV (p<0.05).</p><p>KONKLUSION</p><p>Koncentrationen av syrgas i samband med endotrakeal sugning har i denna experimentella studie</p><p>ingen påverkan på hemodynamik, lungmekanik och lungvolymer förutsatt att lungan blåses upp,</p><p>dvs. rekryteras, direkt efter sugning.</p> / <p>INTRODUCTION</p><p>One of the most common routines in mechanically ventilated patients is endotracheal suction,</p><p>(ETS). To avoid desaturation connected to this routine, it is common to increase oxygen</p><p>concentration for a few minutes. High fractions of oxygen can be damaging, and it causes</p><p>athelectasis which impairs gas exchange in the lung. A physiological respond due to the</p><p>athelectasis is redirecting the bloodstream from poorly ventilated lungparts which leads to an</p><p>increased pulmonary pressure. The aim of this study was to investigate if preoxygenation and</p><p>lung recruitment with different oxygen concentrations influences hemodynamics, lung mechanics</p><p>and lung volume.</p><p>METHOD</p><p>In six anaesthetised pigs with assisted mechanical ventilation preoxygenation was given with</p><p>100 % or 60 % O2 for 5 minutes and followed by suction in the endotracheal tube. Thereafter, in</p><p>3 out of 4 protocols a deep sigh was delivered with 21 %, 60 % or 100 % O2 at a pressure 15</p><p>cmH2O above plateau pressure. Hemodynamics and lung mechanics were measured. For control</p><p>in the studie no lungrecruitment was performed in one of the protocols.</p><p>RESULTS</p><p>Mean pulmonary pressure was induced in the protocol where there was no regain of lung volume</p><p>after suction, 29±3 mmHg compared to bas line value of 22±2 mmHg (p<0.05). There was a clear</p><p>difference in lung compliance, whether the lung volume was recruited, 22±1 (100 % O2), 21±3</p><p>(21% O2), 21±3 (60 % O2) or not recruited, (13±1 mL cmH2O) after suction (p<0.001). The same</p><p>were seen for changes in VT (p<0.001) and EELV (p<0.05).</p><p>CONCLUSION</p><p>The oxygen concentration when performing endotracheal suctioning is in this experimental</p><p>model of no influence regarding hemodynamics, lung mechanics- or lung volumes, provided</p><p>recruitment of the lung is done directly after suctioning.</p>

<p>The aims of the study were:</p><p>To assess the risk for adverse obstetrical outcome in women where the EDD had been postponed more than 14 days with ultrasound.</p><p>To evaluate the mortality and morbidity of conservatively managed post-term pregnancies (gestation 294 days and beyond).</p><p>To assess the sensitivity for detecting fetal congenital anomalies with routine mid second trimester ultrasound performed in a routine clinical setting.</p><p>To estimate the random or biologic uncertainty of gestational age based on LMP and on routine ultrasound.</p><p>To compare the performance of the new Norwegian reference values for BPD measurement with the old reference values.</p> / Paper IV is reprinted with kind permission of Elsevier, sciencedirect.com

<p>Background: Despite a plethora of research, there are serious limitations in our knowledge of outcome in eating disorders. Almost all studies have been compromised by the problem of treatment dropout or non-participation in follow-ups. There exists a lack of consensus in definitions of outcome and choice of outcome measures, and there is a dearth of studies focusing on how patients subjectively perceive recovery. The overall aim of this thesis was to address problems in measuring outcome after treatment for eating disorders, with an emphasis on methodological issues. Specific areas of investigation included non-participation in long-term follow-ups, the role of self-image in treatment dropout, outcome among patients who drop out, patients’ subjective perspectives of recovery, and the impact of different methods of measuring outcome.</p><p>Method: Four quantitative studies (I, II, III and V) were conducted within the framework of a large Swedish multi-centre study of eating disorders, which adopted a prospective, longitudinal and naturalistic design. Study IV was a qualitative investigation encompassing interviews with former ex-patients who were considered recovered.</p><p>Results: Study I suggested that the reasons for non-participation in research were mainly patient related (69%). Those declining further participation in follow-ups were reported significantly lower levels of obsession-compulsion and anxiety, while those not traceable reported significantly higher levels of hostility at admission. Study II suggested that patients who dropped out from treatment initially presented with less negative self-image and fewer psychological problems compared to those who remained in treatment. Low levels of self-blame discriminated dropouts from completers and remainers, and significantly predicted treatment dropout. Study III found no significant differences between dropouts and completers at follow-up, with the exception that dropouts were more dissatisfied with treatment. However, patterns of treatment response revealed that those who completed treatment made significantly greater changes in terms of reduced eating disorder symptoms, fewer psychological problems and a more positive self-image compared to dropouts. Study IV found that patients who had recovered from an eating disorder tended to describe other dimensions of outcome than those usually reported in follow-ups. Patients tended to view recovery in terms of being able to relate in a relaxed and accepting manner to food, their bodies, themselves as individuals, and their social environment. Some perceived recovery in terms of coping better with emotions, while others experienced themselves as healthier than people generally regarding food and weight. Study V applied some of the most frequently used outcome measures for eating disorders and found marked variations in the number of patients who could be considered in remission. Overall remission rates varied from 24.3% to 77.8%, depending on the outcome measure used.</p><p>Discussion: The results suggest that non-participation and dropout are not unitary phenomena. There is also a need for greater consensus on how eating disorder outcome should be measured. This is necessary in order to make comparisons between different outcome studies meaningful, and to elucidate the overall picture of eating disorders outcome.</p> / issn 1652-4063

<p>Work and health are strongly connected because people spend the most part of their adult life in a workplace. The work environment influences the fellow co-workers experience of health and learning in different ways. Accordingly the organizations influence has by doing so, created a great significance to fellow co-workers experiences. Organizational changes often create turbulence within an organization and are often experienced negatively by the fellow-co-workers even if it will give positive effects later. The aim of this study was to illuminate nurses- and assistant nurses experiences of health and learning related to organizational changes. The method was qualitative and the collection of data was done through twelve semi structural interviews with staff nurses and assistant nurses in a hospital. The result showed several factors in the workplace that effect the experience of health and learning, for example stress, social support, hierarchy, reflection and ways of working. The conclusion showed that there's both obstacles and possibilities for an individual to appropriate a change. Foremost it's about different personalities that have either harder or easier to appropriate and to accept changes. That’s why it's important that the organization is aware of the fellow co-workers different prerequisites for learning so that the changes will succeed and bring forward the positive effect the new organization hopes to achieve. To pursue organizational changes with this understanding in mind bring positive effects on fellow co-workers health. In relation to a health promotion perspective it's important that the organization promotes a salutogenic way of thinking, where there is an emphasis upon a holistic approach so that the fellow co-workers will be able to achieve health and well being. </p>

<p>Ett av Sveriges största folkhälsoproblem just nu är den dramatiskt ökande sjukfrånvaron</p><p>på våra arbetsplatser, vilket drabbar både individer och samhället i stort. Det är därför viktigt att skapa hälsofrämjande arbetsplatser. Studiens syfte var att undersöka vilka faktorer personalen på en kommunal förvaltning anser kan bidra till att deras arbetsplatser blir mer hälsofrämjande. Vidare syftade studien till att undersöka personalens syn på hur förändring och lärande kan ske på deras förvaltning för att skapa hälsofrämjande arbetsplatser. Datainsamlingen har skett genom fyra fokusgruppsintervjuer med anställda inom en kommunal förvaltning. Resultatet visade att ledningen ansågs ha en viktig roll i det hälsofrämjande förändringsarbetet. Flertalet upplevde att de ville bli hörda och sedda av ledningen och ha inflytande i beslut särskilt angående frågor om arbetsmiljön, trivseln och hälsovården inom förvaltningen. Det kom även fram att kommunikationen behöver förbättras både mellan medarbetarna själva och mellan ledningen och medarbetarna. Slutsatserna var att för att skapa en hälsofrämjande arbetsplats krävs en helhetssatsning där det finns en öppen dialog mellan personal och ledning. Ledningen måste tillåta att personalen är delaktiga och har inflytande i arbetet angående bland annat arbetsmiljö, trivsel, arbetsuppgifter och även personalen måste ta sitt ansvar för att arbetsplatsen ska bli hälsofrämjande.</p><p>One of the biggest health problems in Sweden at this point is the dramatic increase of employees’ sick leave, which has an effect on both individuals and society as a whole. That is why it is important to create workplaces that promote the employees’ health. The aim of this study was to examine what factors the employees at a local government administration believe could contribute to making their workplaces healthier. The aim was also to examine the employees’ view on how change and learning at their administration could take place in order to promote health at their workplaces. The data was collected through four focus-group interviews with employees at a local government administration. The result showed that the management was considered to play an important role in health promotion at the workplace. The majority of the respondents also felt that they wanted to be seen and heard by the management. Important was also the ability to influence decision making, particularly regarding the work environment and climate, and health services. It was also made clear that the communication among co-workers, as well as, between the management and the co-workers needed to be improved. The conclusions were that in order to promote health in a workplace a holistic approach is necessary. An important factor is also to maintain an open dialog between the management and the co-workers. The management has to allow the employees to take an active part in decision making so that they can have an influence on, among other things, the work environment and climate, as well as on their everyday tasks. The employees must also take responsibility for the health promotion at their workplace.</p>