Cirka 3 % av kvinnor som fött barn uppfyller DSM-5 diagnostiska kriterier för PTSD, och minst en tredjedel uppger att de upplevt förlossningen som traumatisk. Prolonged exposure (PE) är en evidensbaserad traumafokuserad kognitiv beteendeterapi och en effektiv behandling för att reducera PTSD-symptom över en varierad traumatiserad population. Terapeutperspektivet gällande behandling av patienter med förlossningstrauma (PTSD-FC) är sällsynt i forskningen. Övergripande syfte var att belysa KBT-terapeuters perspektiv av att arbeta med behandlingsmetoden PE vid PTSD-FC med frågeställningar som; Vad kan vara utmärkande med att behandla patienter med PTSD-FC? Vilka kliniska erfarenheter har terapeuterna av att tillämpa PE-manualen med aktuell patientgrupp? Studien har en kvalitativ ansats. Semistrukturerade intervjuer har genomförts med åtta terapeuter. Bearbetning av data utgick från reflexiv tematisk analys. I resultatet genererades tre teman med subteman utifrån terapeuternas erfarenheter. ”Ett förlossningstrauma har vissa utmärkande drag”, ”Betydelsen av traumat”  samt ”PE-manualens möjligheter”. Terapeuterna ansåg att PE är en flexibel, hjälpsam och effektiv traumabehandling som fungerar väl med patientgruppen. Patienterna var vanligtvis motiverade och fullföljer terapin i hög grad. Tillgången till adekvat vård var god inom terapeuternas egna verksamheter medan en problematisk bild kom fram avseende andra vårdgivare. Utmaningar och möjligheter diskuteras angående det terapeutiska arbetet med patientgruppen. Kliniska implikationer som tas upp är till exempel behovet av ökade terapeutiska resurser inom kvinnosjukvården för adekvat bedömning och behandling vid PTSD-FC, där fördelen är samverkan mellan olika professioner. / Approximately 3% of women who have given birth, meet the DSM-5 diagnostic criteria for PTSD, and at least a third say they experienced childbirth as traumatic. Prolonged exposure (PE) is an evidence-based trauma-focused cognitive behavioral therapy and an effective treatment for reducing PTSD symptoms across a diverse traumatized population. The therapists’ perspective regarding the treatment of patients’ with postpartum trauma (PTSD-FC) is rare in research. The overall aim was to highlight CBT therapists' perspectives of working with the treatment method PE at PTSD-FC with questions such as; What may be distinctive about treating patients’ with PTSD-FC? What clinical experience do therapists’ have of applying the PE manual with the current patient group? The study has a qualitative approach. Semi-structured interviews have been conducted with eight therapists’. Processing of the data was based on reflexive thematic analysis. In the results, based on the therapists' experiences, three themes with subthemes were generated. “A postpartum trauma has some distinguishing features”, “The meaning of the trauma” and “The possibilities of the PE manual”. The therapists’ considered PE to be a flexible, helpful, and effective trauma treatment that works well with the patient group. The patients’ were usually motivated and completed the therapy to a high degree. Access to adequate care was good within the therapists' own settings, while a problematic picture emerged regarding other caregivers. Challenges and opportunities are discussed regarding the therapeutic work with the patient group. Clinical implications addressed are for example the need for increased therapeutic resources in women's healthcare for adequate assessment and treatment for PTSD-FC, where the advantage is collaboration between different professions. / <p>Linköpings universitet | Institutionen för beteendevetenskap och lärande Psykoterapeutexamensuppsats/magisteruppsats/uppsats på avancerad nivå, 15 hp | Psykoterapeutprogrammet (KBT) Höstterminen 2022 </p>

The present study compared lateralization of cortical activation patterns in the prefrontal cortex (PFC) of adults who stutter (AWS) and typical speakers (TS) as measured with functional near infrared spectroscopy (fNIRS) in habitual and fluency-enhanced speaking conditions. Participants were AWS (n = 11) and gender- and age-matched TS (n = 11) who completed speaking tasks in three condition blocks: (1) habitual speech using no speaking strategy (2) prolonged speech after receiving short-term training in fluency-shaping strategy-use (3) syllable-timed speech after being trained to speak in rhythm with a metronome at 92 beats per minute. The three primary dependent variables were mean change in HbO (oxygenation) relative to resting baseline in the right and left PFC hemispheres and a Laterality Index (L-R)/(L+R) calculated from these values. Two primary hypotheses were tested: (1) AWS will present with greater right-hemisphere PFC oxygenation relative to TS in a habitual or everyday speaking task (2) AWS will present with reduced right-hemisphere PFC activation (leftward shift in laterality more similar to TS) during fluency-enhanced speech strategy tasks relative to a habitual speech task. Real-time stuttered speech measures using fNIRS indicated greater effortfulness of speech production in AWS when speaking fluently and disfluently as measured by greater bilateral change in PFC HbO relative to TS. AWS laterality did not differ from TS during everyday conversation and did not significantly change when using fluency-enhancing strategies, which was counter to the hypotheses. The TS group presented with significantly greater leftward PFC HbO in the metronome condition compared to AWS. Prolonged speech and metronome-timed speech seem to be associated with different activation patterns in the PFC for AWS and for TS. Results suggest an alternative explanation for compensatory activation in AWS during speech production, such that AWS present with greater overall activation in both PFC hemispheres relative to TS which results in greater right-sided laterality than TS. Future long-term studies on adults receiving prolonged speech treatment and examination of similar measures in young children who stutter may reveal more about the compensatory versus causal nature of stuttering.

Foram produzidos comprimidos de liberação prolongada de teofilina baseados em matrizes hidrofílicas de misturas de hidroxipropilmetilcelulose e etilcelulose e polietilenoglicol. O planejamento estatístico de mistura Design Expert® foi empregado na seleção da composição do sistema de controle da liberação e, numa segunda fase, para otimização das formulações de comprimidos. Foram produzidas 26 formulações por compressão direta e as características físico-químicas dos comprimidos como peso médio, friabilidade, dureza e teor de fármaco foram determinadas. A porcentagem de teofilina liberada foi avaliada conforme o método da Farmacopéia Americana 30 ed. (2007), para cápsulas de liberação prolongada (Teste 10 - pá), por um período de 8 horas. Conforme as farmacopéicas os comprimidos produzidos apresentaram características físico-químicas de acordo com as especificações, com exceção das formulações 2 e 3, para o teste de friabilidade, cujos valores foram superiores. Entretanto, quanto ao ensaio de dissolução, a formulação 13, constituída por 30% de etilcelulose, atendeu aos valores preconizados para liberação prolongada de teofilina. As respostas obtidas dos experimentos foram introduzidas no programa Design Expert® que gerou superfícies de respostas nas quais foi possível avaliar a influência da composição nos parâmetros friabilidade e porcentagem de teofilina liberada na dissolução. Dessa forma, foi possível obter 3 formulações com etilcelulose (13,50% a 15,90%), metilcelulose tipo E4MCR (6,90% a 8,10%) e metilcelulose tipo K4MPRCR (0,30% a 0,60%), com as características desejadas empregando o planejamento estatístico de mistura, com o número mínimo de experimentos sem a necessidade de estudar todas as possíveis combinações experimentais, abreviando o trabalho com ganho de tempo. Os resultados encontrados para friabilidade e dissolução nas formulações otimizadas foram próximos dos previstos pela análise de regressão e dentro dos valores especificados na Farmacopéia Americana 30 ed. 2007. / Controlled release dosage forms of theophylline were prepared with hidrophyllic matrix using polymers as hydroxy-methyl-cellulose, hydroxy-ethyl-cellulose and polyethylenglycol. The program Design Expert® was used to select polymers composition and at the second moment, to optimized tablets formulations. It was obtained 26 formulations by direct compression that physical-chemical characteristics of tablets as weight deviation, friability, hardness and drug dosage were performed. Dissolution rate of these tablets were controlled by United States Pharmacopeia 30 ed. Test for theophylline extended-release capsules (test 10 - paddle) corresponding to 8 hours of experiment. The evaluation indicates that tablets produced were in accordance with Brazilian Pharmacopoeia 4 ed., and United States Pharmacopoeia 30 ed., except for formulations 2 and 3 that the values for friability were low. And about dissolution rate of these tablets only formulation 13 applied to preconized value for dissolution method for theophylline extendedrelease capsules. Design Expert® was fed with the results obtained from experiments that showed surface result after that it were possible to analyze the influence of the composition of components on the friability and dissolution rate of theophylline parameters. Considering the specifications, 3 formulations were obtained and were analyzed. The results obtained were close to results predicted for regression analysis and in accordance with Brazilian Pharmacopoeia 4 ed., and United States Pharmacopoeia 30 ed. The proposed experimental Design Expert® program strategy should allow a rapid evaluation and identification of the parameters important in determining the drug release rate from matrix tablets, providing a powerful support for their rational selection during preformulation studies and thus shortening the time necessary for the development of effective dosage forms with the desired drug release behavior.

Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística. / This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.

Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística. / This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.

Recent research has proposed a new stage in human development, termed emerging adulthood by Jeffrey Arnett, which is characterized by a prolonged journey to adult roles and responsibilities. This thesis explores the experience of Chinese emerging adults, university students aged 20-25 years using Erikson’s and Levinson’s developmental theories as a theoretical framework. These authors proposed that three major developmental tasks are necessary for the transition to adulthood: separating from family of origin, forming an adult identity and finding the place for the self in the larger society. Qualitative interviews were conducted virtually with 12 Chinese university students to understand their perceptions and lived experience. Qualitative thematic analysis was used to analyze the interview transcripts. The results suggest Chinese emerging adults (a) have a low level of separation from parents; (b) have not formed a clear sense of identity and have not achieved a self-definition in adulthood; and (c) have not made initial commitments to love and work. It is speculated that the Chinese sociocultural context may further postpone its young adults’ independence and autonomy, and this prolonged transition to adulthood is both positive and problematic to Chinese young adults. This study lends support to Arnett’s emerging adulthood theory through its exploration of emerging adulthood in China, where, to date, little research has been done on this subject. It provides rich descriptions of the experience of Chinese emerging adults’ lives and enhances understandings of the role of culture in influencing the emerging adulthood period.

Recent research has proposed a new stage in human development, termed emerging adulthood by Jeffrey Arnett, which is characterized by a prolonged journey to adult roles and responsibilities. This thesis explores the experience of Chinese emerging adults, university students aged 20-25 years using Erikson’s and Levinson’s developmental theories as a theoretical framework. These authors proposed that three major developmental tasks are necessary for the transition to adulthood: separating from family of origin, forming an adult identity and finding the place for the self in the larger society. Qualitative interviews were conducted virtually with 12 Chinese university students to understand their perceptions and lived experience. Qualitative thematic analysis was used to analyze the interview transcripts. The results suggest Chinese emerging adults (a) have a low level of separation from parents; (b) have not formed a clear sense of identity and have not achieved a self-definition in adulthood; and (c) have not made initial commitments to love and work. It is speculated that the Chinese sociocultural context may further postpone its young adults’ independence and autonomy, and this prolonged transition to adulthood is both positive and problematic to Chinese young adults. This study lends support to Arnett’s emerging adulthood theory through its exploration of emerging adulthood in China, where, to date, little research has been done on this subject. It provides rich descriptions of the experience of Chinese emerging adults’ lives and enhances understandings of the role of culture in influencing the emerging adulthood period.

Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated

With increased military personal protection equipment, body armor, comes the addition of carried load. Such person protection in recent history has been instrumental in combating the imminent threats (e.g., improvised explosive devices) of hostile environments, preventing otherwise lethal injuries. However, body armor has been suggested to degrade warfighters’ performance and compound the risk of musculoskeletal injuries. Both performance and risk of injury are intensely related to joint biomechanics. Therefore the objective of this project was set to determine the immediate and prolonged effects of wearing body armor on biomechanics of the lower back and knee. A randomized cross-over study design, wherein 12 sex-balanced, physically fit, young participants completed a series of tests before and after 45 min of treadmill walking with and without body armor. Tests included two simple tests (i.e., toe-touch and two-legged squat), two military inspired tests (i.e., box drop and prone to standing) and four knee torque tests (i.e., maximum isometric contraction of knee flexors and extensors, and concentric and eccentric isokinetic contraction of knee flexors and extensors. During these tests, kinematic, kinetic and torque measurements were used to investigate the immediate and prolonged effects of exposure to body armor on several measures of knee and lower back mechanics related to performance and risk of injuries. For the simple tests, the immediate effects of body armor were an increase of > 40 ms (p ≤ 0.02) in flexion duration of the dominant joint and an ~1 s (p ≤ 0.02) increase in overall test duration as well as an ~18% (p = 0.03) increase in the lumbopelvic rhythm ratio near mid-range trunk flexion. For the military inspired tests, the immediate effects of body armor were an increase of ≥ 0.02 s (p ≤ 0.001) in temporal test durations and an increase of ~158 N (p = 0.01) box drop peak ground reaction force. Finally during the dynamometer testing, the BA condition was found to cause a greater reduction, ~10 N•m, in the maximum isometric strength of knee flexors (p = 0.04) and an increase (p ≤ 0.03) of strength ratios compared to the no armor condition.

Recent research has proposed a new stage in human development, termed emerging adulthood by Jeffrey Arnett, which is characterized by a prolonged journey to adult roles and responsibilities. This thesis explores the experience of Chinese emerging adults, university students aged 20-25 years using Erikson’s and Levinson’s developmental theories as a theoretical framework. These authors proposed that three major developmental tasks are necessary for the transition to adulthood: separating from family of origin, forming an adult identity and finding the place for the self in the larger society. Qualitative interviews were conducted virtually with 12 Chinese university students to understand their perceptions and lived experience. Qualitative thematic analysis was used to analyze the interview transcripts. The results suggest Chinese emerging adults (a) have a low level of separation from parents; (b) have not formed a clear sense of identity and have not achieved a self-definition in adulthood; and (c) have not made initial commitments to love and work. It is speculated that the Chinese sociocultural context may further postpone its young adults’ independence and autonomy, and this prolonged transition to adulthood is both positive and problematic to Chinese young adults. This study lends support to Arnett’s emerging adulthood theory through its exploration of emerging adulthood in China, where, to date, little research has been done on this subject. It provides rich descriptions of the experience of Chinese emerging adults’ lives and enhances understandings of the role of culture in influencing the emerging adulthood period.