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  • 1.
    Abbasi, Seyed
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Determinants of social inequalities in cardiovascular disease among Iranian patients2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and objectives: Cardiovascular disease (CVD) is the single largest cause of mortality in the world. Similar to other health issues, CVD is generally affected either by individual risk factors, which may influence the risk for developing an illness or its complications, or by social indicators (social determinants of health). There is evidence from developed countries which shows that the so-called "upstream factors"—including social determinants such as political, social, spiritual, cultural, and economic factors—may affect the prevalence and incidence of CVD. Scarce evidence from studies in low- and middle-income countries also suggests that social factors may affect the distribution of CVD across population groups. However, there is a dearth of such data in Iran, where only a few small-sizedstudies have focused on the social determinants of health. Therefore, the present thesis sought to fill this gap by assessing the effects of socioeconomic status (SES) on the distribution of CVD and the relevant inequalities within the Iranian context.

    Methods: This thesis is based on four studies, which used data from the Tehran Heart Center’s Databases. In Study I, a total of 44,820 patients who underwent coronary angiography at Tehran Heart Center between 2005 and 2010 were recruited. Then, their pre- and post-procedural data—including demographics, CVD risk factors, symptoms, and laboratory tests—were compared between men and women. In Study II, 6,246 patients with acutecoronary syndrome who were hospitalized between March 2004 and August 2011 were included and, based on their education and their employment status, were divided into high- and low-SES groups. Thereafter, the effect of SES on the in-hospital death of the patients was evaluated. In Study III, 20,165 patients with documented coronary artery disease who underwent coronary angiography at Tehran Heart Center were enrolled and CVD risk factors and severity (measured by the Gensini score) were assessed among the six major Iranian ethnic groups. In Study IV, 9,088 patients with acute coronary syndrome who were hospitalized at Tehran Heart Center between May 2007and June 2014 were recruited and the association between in-hospital death due to acute coronary syndrome and place of residence (rural/urban) was assessed using logistic regression adjusted for potential confounders.

    Results: In this thesis, the data analyses were based on the hypothesis that there is a potential association between the different socioeconomic indicators and the selected cardiovascular outcomes. In Study I, among the recruited participant, 25,363 men and 11,995 women had coronary artery disease and the women not only were significantly older, less educated, and more overweight but also had higher blood levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar than the men. Moreover, hypertension and diabetes mellitus showed the strongest association in the women with coronary artery disease (OR=3.45, 95% CI: 3.28to 3.61 and OR=2.37, 95% CI: 2.26 to 2.48, respectively). In addition, the frequency of post-procedural recommendations for non-invasive procedures was higher in the women than in the men (20.1% vs 18.6%; P<0.001). In StudyII, of the 6,246 recruited patients with acute coronary syndrome, 3,290individuals were considered low-SES and 2,956 high-SES individuals. In-hospital death occurred in 79 (1.26%) patients: 1.9% in the low-SES and 0.6% in the high-SES groups. After adjustment for the possible cofounders, our multivariate analysis demonstrated a significant effect of the patients’ SES on their in-hospital death and a lower in-hospital mortality rate was shown in the high-SES patients (OR=0.30, 95% CI: 0.09 to 0.98; P=0.046). In Study III, the Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest frequency of having at least four simultaneous risk factors. Additionally, the mean Gensini score was lowest in the Lurs (67.5±52.8) and highest among the Gilaks (77.1±55.9). The multivariable regression analysis indicated that the Gilaks showed the worst CVD severity (β: 0.056, 95% CI: 0.009 to 0.102; P=0.018), followed by the Turks (β: 0.032, 95% CI: 0.005 to 0.059; P=0.020), and the lowest CVD severity, was detected in the Lurs (β: -0.087, 95% CI: -0.146 to -0.027;P=0.004). Study IV showed that while smoking (P=0.002), positive family history of coronary artery disease (P=0.003), higher body mass index (P=0.013),and hyperlipidemia (P=0.026) were more prevalent in the urban patients, the rural patients showed lower educational levels (P<0.001) and higher frequency of unemployment (P=0.009). Meanwhile, in-hospital death occurred in 135 (1.5%) patients: 125 (1.5%) urban and 10 (1.2%) rural. To adjust the effects of the possible confounders, we utilized the Firth regression model, which showed no significant difference regarding in-hospital death betweenthe rural and urban patients (OR=1.57, 95% CI: 0.376 to 7.450; P=0.585).

    Conclusions: The aim of this thesis was to investigate the effects of social determinants (particularly SES) on CVD and its modifiable risk factors among Iranian patients. Results showed that medical treatment for CVD was more recommended (by treating physicians) to the women than the men, and the low-SES patients with acute coronary syndrome were more likely to die in the hospital than their high-SES counterparts. In addition, the thesis found heterogeneity in the distribution of the traditional risk factors for CVD as well as CVD severity in the major Iranian ethnic groups. Further, there were no differences concerning the in-hospital death rates due to acute coronary syndrome between the urban and rural patients after adjustment for the potential confounders.

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  • 2.
    Abbasi, Seyed H
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, Arash
    Teheran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Högskolan i Gävle.
    Ethnic differences in the risk factors and severity of coronary artery disease: a patient-based study in Iran2018In: Journal of Racial and Ethnic Health Disparities, ISSN 2197-3792, Vol. 5, no 3, p. 623-631Article in journal (Refereed)
    Abstract [en]

    Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

    Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

    Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

    Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

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  • 3.
    Abbasi, Seyed
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ponce De Leon, Antonio
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Kassaian, Seyed Ebrahim
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Karimi, Abbasali
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, Arash
    Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Socioeconomic status and in hospital mortality of acute corony syndrome: Can education and occupation serves as preventive measures?2015In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 6, article id Art. no. 6:36Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.

    Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.

    Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).

    Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

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  • 4.
    Abbasi, Seyed
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Jalali, A
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mortality by acute Coronary syndrome in Iran: Does place of residence matter?In: Article in journal (Refereed)
  • 5.
    Abrahamsson, Erik
    et al.
    Lund University, Sweden.
    Schagatay, Erika
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A living based on breath-hold diving in the Bajau Laut2014In: Human Evolution, ISSN 0393-9375, Vol. 29, no 1-3, p. 171-183Article in journal (Refereed)
    Abstract [en]

    Sea nomads or 'sea people,' namely the 'Bajau Laut' in the Philippines, Malaysia and Indonesia are skilled divers, and many Bajau Laut make a living from freediving. Men do most of the spearfishing, but women also dive, predominantly for gathering sea food. They start to dive at an early age and spend most days of their lives on and in the sea. Our objective was to study their diving and way of life, to reveal if modern humans have the physiological potential for making a living from breath-hold diving for fishing and gathering. Bajau Laut were visited for a total of nine months, during three periods from 2010-2013, in a combined physiological and social-Anthropological study. The diving physiology studies focused on a total of 10 male divers, whose working day diving while spearfishing was logged with time-depth loggers. One group of 5 divers were engaged in shallow (5-7 m) spearfishing with an underwater working time of 60%, when diving for 2-9 h. The other group of 5 divers went to a mean depth of 10 m and had an underwater working time of 50%, when diving for 3-9 h per day. During that time, between one and eight kilograms of coral fish, blow fish, moray eels and octopuses were caught, per diver. Seafood collected by the women included clams, crustaceans, sea weed and sea cucumbers. Life among the Bajau Laut was much like it was 25 years ago, although in some areas the fish stock is diminishing, making it necessary for the Bajau Laut to spend more time in the water to obtain the same quantity of fish. It was concluded that modern humans do possess the physiological qualities necessary for making a living from hunting-gathering via breath-hold diving.

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  • 6.
    Adykhamova, Mihraj
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sjuksköterskors upplevelse av den psykosociala arbetsmiljön på psykiatrisk vårdavdelningar2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 7.
    Afvander, Anna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Myrén, Linda
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Användbarhet och begränsning med motiverande samtal i samband med rehablitering till arbete.: En kvalitativ intervjustudie med specialister från Arbetsförmedlingen.2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 8.
    Agnerling, Emma
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kombinationen av bikarbonat- och koffeinsupplementering förbättrar löpprestation i ett Beep-test2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 9.
    Ahlström, Pauline
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Wie, Lina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Att återgå till arbete efter stressrelaterad ohälsa: -En intervjustudie om betydelsen av psykosociala faktorer2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 10.
    Ahmed, Leila
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hälsofrämjande ledarskap ur anställdas perspektiv: - En kvalitativ intervjustudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 11.
    Ahmed Shire, F Sagal
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Healthcare professional´s experience of promoting maternal mental health: a qualitative study in Saudi Arabia.2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 12.
    Ainegren, Mats
    et al.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Technology and Management, Mechanical Engineering and Mathematics.
    Carlsson, Peter
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Technology and Management, Mechanical Engineering and Mathematics.
    Laaksonen, Marko S.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Tinnsten, Mats
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Technology and Management, Mechanical Engineering and Mathematics.
    The influence of grip on oxygen consumption and leg forces when using classical style roller skis2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 2, p. 301-310Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the influence of classical style roller skis' grip (static friction coefficients, μ S) on cross-country skiers' oxygen consumption and leg forces during treadmill roller skiing, when using the diagonal stride and kick double poling techniques. The study used ratcheted wheel roller skis from the open market and a uniquely designed roller ski with an adjustable camber and grip function. The results showed significantly (P≤0.05) higher oxygen consumption (∼14%), heart rate (∼7%), and lower propulsive forces from the legs during submaximal exercise and a shorter time to exhaustion (∼30%) in incremental maximal tests when using roller skis with a μ S similar to on-snow skiing, while there was no difference between tests when using different pairs of roller skis with a similar, higher μ S. Thus, we concluded that oxygen consumption (skiing economy), propulsive leg forces, and performance time are highly changed for the worse when using roller skis with a lower μ S, such as for on-snow skiing with grip-waxed cross-country skis, in comparison to ratcheted wheel roller skis with several times higher μ S.

  • 13.
    Alricsson, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Physical Activity Why and How?2013In: Journal of Biosafety & Health Education, ISSN 2332-0893, Vol. 1, p. e111-Article in journal (Refereed)
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  • 14.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Linnaeus University, Kalmar.
    Björklund, Glenn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Cronholm, Martin
    Scandinavian College of Naprapathic Manual Medicine, Stockholm.
    Olsson, Oscar
    Scandinavian College of Naprapathic Manual Medicine, Stockholm.
    Viklund, Peter
    Scandinavian College of Naprapathic Manual Medicine, Stockholm.
    Svantesson, Ulla
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Göteborgs Universitetet.
    Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers2016In: Journal of Exercise Rehabilitation, ISSN 2288-176X, Vol. 12, no 1, p. 21-28, article id PMC4771149Article in journal (Refereed)
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  • 15.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Linnaeus University.
    Björklund, Glenn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Swedish Sports Confederat.
    Ekström, A.
    Linnaeus University.
    Ostenberg, A. Hafsteinsson
    Linnaeus University.
    Introducing Tabata intervals and stability exercises in school children by a school-based study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Issue suppl_1, p. 417-417Article in journal (Refereed)
  • 16.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kahlin, Yvonne
    Karolinska institutet.
    Physical activity and Health in Adolescents2016In: Sedentary Lifestyle: Predictive Factors, Health Risks and Physiological Implications / [ed] Ahmad Alkhatib, New York: Nova Science Publishers, Inc., 2016, p. 115-130Chapter in book (Refereed)
  • 17.
    Amréus, Carina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Omorganisation och Hälsa: Hur påverkas anställdas hälsa av upprepad omorganisation/omstrukturering?2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
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  • 18.
    Andersson, Emilia
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    När ett barn får cancer: Ur föräldrarnas perspektiv2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion:

    Att få ett besked om att sitt barn har drabbats av cancer är ett förödande besked för hela familjen. Därför behöver sjukvården se till hela familjens behov och ge dem stöd och hjälp för att kunna hantera situationen. Syfte: Syftet med litteraturstudien var att beskriva föräldrarnas upplevelse och reaktion när deras barn får en cancerdiagnos samt vilka strategier de använder sig av för att hantera det. Metod: I denna litteraturstudie ingår 14 stycken artiklar varav 12 stycken är kvalitativa och 2 stycken är kvantitativa som granskades och sammanställdes. Resultat: Föräldrarna reagerade på diagnosen med stor sorg, rädsla och ångest. De beskrev en stor känslomässig stress och förnekelse. Stöd var viktigt för föräldrarna och det kunde vara från familj, vänner, sjukvårdspersonal och föräldrar som är i samma situation. Föräldrarna beskrev också olika strategier som de använde sig av för att hantera situationen, det kunde vara allt från att hålla en positiv attityd till att ta en mycket aktiv roll i barnets vård och tillstånd. Diskussion: Den rädsla, oro och sorg som uppstår hos föräldrarna ger upphov till lidande för dem. Detta lidande är ingenting som kan elimineras utan är något som sjukvården bör försöka lindra och hjälpa föräldrarna igenom. Genom att finnas till hands och tillgodose deras behov på bästa sätt så kan sjukvården underlätta för föräldrarna i en svår situation. Slutsats: Med denna litteraturöversikt kan sjukvården lättare sätta sig in i föräldrarnas tankar och känslor utifrån deras perspektiv när deras barn drabbas utav cancer. Därför kan sjukvården möta föräldrarnas behov och därmed lättare hjälpa dem hantera situationen.

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    När ett barn får cancer - ur föräldarnas perspektiv
  • 19.
    Andersson, Erik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    PHYSIOLOGICAL AND BIOMECHANICAL FACTORS DETERMINING CROSS-COUNTRY SKIING PERFORMANCE2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Cross-country (c.c.) skiing is a complex sport discipline from both physiological and biomechanical perspectives, with varying course topographies that require different proportions of the involved sub-techniques to be utilised. A relatively new event in c.c. skiing is the sprint race, involving four separate heats, each lasting 2-4 min, with diverse demands from distance races associated with longer durations. Therefore, the overall aim of the current thesis has been to examine the biomechanical and physiological factors associated with sprint c.c. skiing performance through novel measurements conducted both in the field (Studies I-III) and the laboratory (Studies IV and V).

    In Study I sprint skiing velocities and sub-techniques were analysed with a differential global navigation satellite system in combination with video recording. In Studies II and III the effects of an increasing velocity (moderate, high and maximal) on the biomechanics of uphill classical skiing with the diagonal stride (DS) (Study II) and herringbone (HB) (Study III) sub-techniques were examined.

    In Study I the skiers completed the 1,425 m (2 x 712 m) sprint time trial (STT) in 207 s, at an average velocity of 24.8 km/h, with multiple technique transitions (range: 21-34) between skiing techniques (i.e., the different gears [G2-7]). A pacing strategy involving a fast start followed by a gradual slowing down (i.e., positive pacing) was employed as indicated by the 2.9% faster first than second lap. The slower second lap was primarily related to a slower (12.9%) uphill velocity with a shift from G3 towards a greater use of G2. The maximal oxygen uptake ( O2max) was related to the ability to maintain uphill skiing velocity and the fastest skiers used G3 to a greater extent than G2. In addition, maximal speed over short distances (50 and 20 m) with the G3 and double poling (DP) sub-techniques exerted an important impact on STT performance.

    Study II demonstrated that during uphill skiing (7.5°) with DS, skiers increased cycle rate and cycle length from moderate to high velocity, while cycle rate increased and cycle length decreased at maximal velocity. Absolute poling, gliding and kick times became gradually shorter with an elevated velocity. The rate of pole and leg force development increased with elevated velocity and the development of leg force in the normal direction was substantially faster during skiing on snow than previous findings for roller skiing, although the peak force was similar in both cases. The fastest skiers applied greater peak leg forces over shorter durations.

    Study III revealed that when employing the HB technique on a steep uphill slope (15°), the skiers positioned their skis laterally (“V” between 25 to 30°) and planted their poles at a slight lateral angle (8 to 12°), with most of the propulsive force being exerted on the inside forefoot. Of the total propulsive force, 77% was generated by the legs. The cycle rate increased across all three velocities (from 1.20 to 1.60 Hz), while cycle length only increased from moderate to high velocity (from 2.0 to 2.3 m). Finally, the magnitude and rate of leg force generation are important determinants of both DS and HB skiing performance, although the rate is more important in connection with DS, since this sub-technique involves gliding.

    In Studies IV and V skiers performed pre-tests for determination of gross efficiency (GE), O2max, and Vmax on a treadmill. The main performance test involved four self-paced STTs on a treadmill over a 1,300-m simulated course including three flat (1°) DP sections interspersed with two uphill (7°) DS sections.

    The modified GE method for estimating anaerobic energy production during skiing on varying terrain employed in Study IV revealed that the relative aerobic and anaerobic energy contributions were 82% and 18%, respectively, during the 232 s of skiing, with an accumulated oxygen (O2) deficit of 45 mL/kg. The STT performance time was largely explained by the GE (53%), followed by O2 (30%) and O2 deficit (15%). Therefore, training strategies designed to reduce energetic cost and improve GE should be examined in greater detail.

    In Study V metabolic responses and pacing strategies during the four successive STTs were investigated. The first and the last trials were the fastest (both 228 s) and were associated with both a substantially larger and a more rapid anaerobic energy supply, while the average O2 during all four STTs was similar. The individual variation in STT performance was explained primarily (69%) by the variation in O2 deficit. Furthermore, positive pacing was employed throughout all the STTs, but the pacing strategy became more even after the first trial. In addition, considerably higher (~ 30%) metabolic rates were generated on the uphill than on the flat sections of the course, reflecting an irregular production of anaerobic energy. Altogether, a fast start appears important for STT performance and high work rates during uphill skiing may exert a more pronounced impact on skiing performance outdoors, due to the reduction in velocity fluctuations and thereby overall air-drag.

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  • 20.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Björklund, Glenn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Swedish Olympic Committee, Stockholm, Sweden.
    Ørtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster, University of Southern Denmark, Odense, Denmark.
    Energy system contributions and determinants of performance in sprint cross-country skiing2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 4, p. 385-398Article in journal (Refereed)
    Abstract [en]

    To improve current understanding of energy contributions and determinants of sprint-skiing performance, 11 well-trained male cross-country skiers were tested in the laboratory for VO2max , submaximal gross efficiency (GE), maximal roller skiing velocity, and sprint time-trial (STT) performance. The STT was repeated four times on a 1300-m simulated sprint course including three flat (1°) double poling (DP) sections interspersed with two uphill (7°) diagonal stride (DS) sections. Treadmill velocity and VO2 were monitored continuously during the four STTs and data were averaged. Supramaximal GE during the STT was predicted from the submaximal relationships for GE against velocity and incline, allowing computation of metabolic rate and O2 deficit. The skiers completed the STT in 232 ± 10 s (distributed as 55 ± 3% DP and 45 ± 3% DS) with a mean power output of 324 ± 26 W. The anaerobic energy contribution was 18 ± 5%, with an accumulated O2 deficit of 45 ± 13 mL/kg. Block-wise multiple regression revealed that VO2 , O2 deficit, and GE explained 30%, 15%, and 53% of the variance in STT time, respectively (all P < 0.05). This novel GE-based method of estimating the O2 deficit in simulated sprint-skiing has demonstrated an anaerobic energy contribution of 18%, with GE being the strongest predictor of performance.

  • 21.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ørtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Björklund, Glenn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Energy contributions and pacing strategies of elite XC skiers during sprint skiing2016Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: At present, knowledge regarding energy contributions and pacing strategies during successive sprint time-trials (STTs) in cross-country (XC) skiing is limited and, therefore, the current study was designed to examine these parameters. The results shown have recently been published elsewhere (Andersson et al., 2016).METHODS: Ten well-trained male XC skiers performed four self-paced 1300-m STTs on a treadmill, separated by 45 min of recovery. The simulated STT course was divided into three flat (1°) sections (S1, S3 and S5) involving the double poling (DP) sub-technique interspersed with two uphill (7°) sections (S2 and S4) involving the diagonal stride (DS) sub-technique. Treadmill velocity and VO2 were monitored continuously and technique-specific gross efficiency (based on submaximal pre-tests) was used to estimate anaerobic energy production.RESULTS & DISCUSSION: The average STT performance time was 229 ± 9 s and the aerobic energy contribution was 82 ± 5%. A positive pacing strategy was used during all STTs, with 3-9% more time spent on the second half of the course (P < 0.05). In addition, the pacing strategy was regulated to the terrain, with substantially higher (~30%) metabolic rates, due to primarily higher anaerobic energy production, for uphill compared with flat skiing (P < 0.05). The individually fastest STT was more aggressively paced compared to the slowest STT (P < 0.05), which resulted in a higher O2 deficit rate (13 ± 4 versus 11 ± 4 mL/kg/min, P < 0.05), while the VO2 was similar (both 52 ± 3 mL/kg/min). These findings emphasise the importance of a fast start. The within-athlete coefficient of variation (CV) in performance time, VO2 and O2 deficit were 1.3 ± 0.4%, 1.4 ± 0.9% and 11.2 ± 4.9%, respectively, with the CV in O2 deficit explaining 69% of the CV in performance. The pacing strategies were highly consistent, with an average CV in speed of 3.4%.CONCLUSION: The fastest STT was characterized by more aggressive pacing and a greater anaerobic energy production. Although the individual performance time during the four STTs was highly consistent, the small within-athlete variability in performance was related to variations in anaerobic energy production.

  • 22.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ørtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Björklund, Glenn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Metabolic responses and pacing strategies during successive sprint skiing time trials2016In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 48, no 12, p. 2544-2554Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine the metabolic responses and pacing strategies during the performance of successive sprint time trials (STTs) in cross-country skiing. METHODS: Ten well-trained male cross-country skiers performed four self-paced 1300-m STTs on a treadmill, each separated by 45 min of recovery. The simulated STT course was divided into three flat (1°) sections (S1, S3 and S5) involving the double poling sub-technique interspersed with two uphill (7°) sections (S2 and S4) involving the diagonal stride sub-technique. Treadmill velocity and V˙O2 were monitored continuously and gross efficiency was used to estimate the anaerobic energy supply. RESULTS: The individual trial-to-trial variability in STT performance time was 1.3%, where variations in O2 deficit and V˙O2 explained 69% (P < 0.05) and 11% (P > 0.05) of the variation in performance. The first and last STTs were equally fast (228 ± 10 s), and ~ 1.3% faster than the second and the third STTs (P < 0.05). These two fastest STTs were associated with a 14% greater O2 deficit (P < 0.05), while the average V˙O2 was similar during all four STTs (86 ± 3% of V˙O2max). Positive pacing was used throughout all STTs, with significantly less time spent on the first than second course half. In addition, metabolic rates were substantially higher (~_30%) for uphill than for flat skiing, indicating that pacing was regulated to the terrain. CONCLUSIONS: The fastest STTs were characterized primarily by a greater anaerobic energy production, which also explained 69% of the individual variation in performance. Moreover, the skiers employed positive pacing and a variable exercise intensity according to the course profile, yielding an irregular distribution of anaerobic energy production.

  • 23.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    McGawley, Kerry
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A Comparison between Different Methods of Estimating Anaerobic Energy Production2018In: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 9, no FEB, article id 82Article in journal (Refereed)
    Abstract [en]

    Purpose: The present study aimed to compare four methods of estimating anaerobic energy production during supramaximal exercise.

    Methods: Twenty-one junior cross-country skiers competing at a national and/or international level were tested on a treadmill during uphill (7°) diagonal-stride (DS) roller-skiing. After a 4-minute warm-up, a 4 × 4-min continuous submaximal protocol was performed followed by a 600-m time trial (TT). For the maximal accumulated O2 deficit (MAOD) method the V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2-speed regression relationship was used to estimate the V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2 demand during the TT, either including (4+Y, method 1) or excluding (4-Y, method 2) a fixed Y-intercept for baseline V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2. The gross efficiency (GE) method (method 3) involved calculating metabolic rate during the TT by dividing power output by submaximal GE, which was then converted to a V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2 demand. An alternative method based on submaximal energy cost (EC, method 4) was also used to estimate V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2 demand during the TT.

    Results: The GE/EC remained constant across the submaximal stages and the supramaximal TT was performed in 185 ± 24 s. The GE and EC methods produced identical V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2 demands and O2 deficits. The V." role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V.V.O2 demand was ~3% lower for the 4+Y method compared with the 4-Y and GE/EC methods, with corresponding O2 deficits of 56 ± 10, 62 ± 10, and 63 ± 10 mL·kg−1, respectively (P < 0.05 for 4+Y vs. 4-Y and GE/EC). The mean differences between the estimated O2 deficits were −6 ± 5 mL·kg−1 (4+Y vs. 4-Y, P < 0.05), −7 ± 1 mL·kg−1 (4+Y vs. GE/EC, P < 0.05) and −1 ± 5 mL·kg−1 (4-Y vs. GE/EC), with respective typical errors of 5.3, 1.9, and 6.0%. The mean difference between the O2 deficit estimated with GE/EC based on the average of four submaximal stages compared with the last stage was 1 ± 2 mL·kg−1, with a typical error of 3.2%.

    Conclusions: These findings demonstrate a disagreement in the O2 deficits estimated using current methods. In addition, the findings suggest that a valid estimate of the O2 deficit may be possible using data from only one submaximal stage in combination with the GE/EC method.

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    Andersson and McGawley 2018
  • 24.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    McGawley, Kerry
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A Comparison Between Different Methods Of Estimating Anaerobic Energy Production During Cross-Country Roller-Skiing2016Conference paper (Refereed)
    Abstract [en]

    Introduction

    Two frequently used approaches for estimating anaerobic energy production during supramaximal exercise are the maximal accumulated oxygen (O2) deficit (MAOD) method and the gross efficiency (GE) method (Noordhof et al., 2011). Despite clear computational differences between the two methods, only one direct comparison has been performed (Noordhof et al., 2011). In cross-country roller-skiing, both the MAOD and the GE methods have been employed (Andersson et al., 2016). Therefore, this study aimed to compare the O2 deficits attained with these methods.

    Methods

    Eleven male and ten female cross-country skiers were tested on a treadmill employing uphill (7°) diagonal-stride roller-skiing. After collecting a 1-min baseline VO2, participants performed a 4 × 4-min continuous submaximal protocol (~ 60-90% of VO2max) followed by, a self-paced 600-m time-trial (TT). Speed and VO2 were measured continuously during the TT. For the MAOD method, the linear relationship between treadmill velocity and VO2 during the final 30 seconds of each 4 × 4-min submaximal stage was derived with the baseline VO2 as a Y-intercept included (4+Y) in or excluded (4-Y) from the model. The two regression equations were then used to estimate the VO2 demand during the TT. For the GE method, the metabolic rate during the TT was calculated by taking the average power output divided by the GE (an average of the four submaximal stages) and converted to a VO2 demand. 

    Results

    The VO2 demand was significantly higher for the GE (68.9 ± 8.5 mL/kg/min) and 4-Y (68.4 ± 8.7 mL/kg/min) procedures compared with the 4+Y (64.3 ± 7.6 mL/kg/min) procedure (P < 0.05). The corresponding O2 deficits for the GE, 4-Y and, 4+Y procedures were 63.7 ± 9.7, 62.3 ± 10.4 and, 50.2 ± 9.6 mL/kg, respectively (P < 0.05 for GE and 4-Y vs. 4+Y). The mean difference between the O2 deficits estimated from the 4-Y and GE procedure -1.4 ± 3.9 mL/kg, and between the 4+Y and GE procedures was -13.5 ± 2.5 mL/kg.  Corresponding typical errors for the two comparisons were 2.74% and 1.74% while the intra-class correlation coefficients together with linear equations were r = 0.93 (0.99x – 0.8) for [4-Y vs. GE] and r = 0.97 (0.95x - 10.5) for [4+Y vs. GE].

    Discussion

    The main finding of the current study was the high agreement between the 4-Y and GE procedures which is in contrast to previous findings of Noordhof et al. (2011). Moreover, the inclusion of a Y-intercept for baseline VO2 resulted in a 20% lower O2 deficit compared to the 4-Y and GE procedures.  

    References

    Andersson E, Björklund G, Holmberg HC, Ørtenblad N. (2016). Scand J Med Sci Sports. Noordhof DA, Vink AM, de Koning JJ. Foster C. (2011). Int J Sports Med, 32, 422-8

  • 25.
    Andersson, Erik P.
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Govus, Andrew
    Department of Rehabilitation, Nutrition and Sport, La Trobe University, Australia.
    Shannon, Oliver M.
    Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, United Kingdom.
    McGawley, Kerry
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sex differences in performance and pacing strategies during a sprint time-trial in cross-country skiing2018Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to compare the pacing strategies, choice of sub-technique (i.e., gear) and overall performance between elite male and female cross-country (XC) skiers during a ski-skating sprint time-trial (TT) on snow.

    METHODS: Thirty-four elite XC skiers (20 males and 14 females: age, 23 ± 4 and 21 ± 3 yr; body mass, 76 ± 8 and 64 ± 5 kg; height, 183 ± 7 and 171 ± 5 cm; sprint FIS points, 86 ± 42 and 90 ± 54) performed a 1.6 km TT, which was 56% flat (or undulating), 21% uphill and 22% downhill. The sprint course was measured with a differential global navigation satellite system and divided into four flat, three uphill and two downhill sections. Race time was measured with the EMIT timing system (Emit AS, Oslo, Norway) and one 25-m uphill (4°) section was filmed continuously with a fixed camcorder (50 Hz). All skiers used a similar stone-grind and all skis were glide-waxed similarly. The air temperature was +1°C (fresh snow at ±0°C), relative humidity was 90% and the friction coefficient between ski and snow was estimated to 0.045 (i.e., very slow).

    RESULTS: Average speed during the TT was 25 ± 1 and 22 ± 1 km/h (TT time: 227 ± 11 and 254 ± 10 s) for males and females, respectively (P < 0.001, Cohen’s d effect size [ES] = 2.6). Average relative power output (PO) was estimated to 3.9 ± 0.3 and 3.3 ± 0.2 W/kg for males and females, respectively (P < 0.001, ES = 2.5). Average heart rate was 95 ± 2% and 96 ± 1% of maximum for males and females (P = 0.51), with a 2-min post-race blood lactate concentration of 10 ± 2 mmol/L for both sexes (P = 0.64). Within-athlete coefficient of variation in speed between sections was 20 ± 2% for males and 24 ± 1% for females (P < 0.001, ES = 2.6). Speeds on the flat, uphill and downhill sections were 26 ± 1, 19 ± 1 and 32 ± 1 km/h for males and 23 ± 1, 16 ± 1 and 30 ± 1 km/h for females (main effects for terrain, sex and interaction, all P < 0.01) corresponding to 9%, 16% and 8% slower speeds on flat, uphill and downhill terrain for females. Speeds relative to the average TT speed were 103 ± 1%, 77 ± 2% and 129 ± 4% for males and 105 ± 1%, 72 ± 2% and 133 ± 2% for females (main effects for terrain, sex and interaction, all P < 0.001). Relative PO on the flat, uphill and downhill sections were estimated to 4.0 ± 0.3, 4.9 ± 0.4 and 1.9 ± 0.2 W/kg for males and 3.5 ± 0.2, 4.0 ± 0.3 and 1.5 ± 0.2 W/kg for females (main effects for terrain, sex and interaction, all P < 0.001). The males were 20% faster than the females on the uphill video section (16 ± 1 versus 13 ± 1 km/h, P < 0.001, ES = 2.6), with 95% of the male skiers and 21% of the female skiers using gear 3 exclusively, and the remaining skiers using gear 2 exclusively or a combination of gears 2 and 3.

    CONCLUSION: The present results indicate an overall sex difference in sprint skiing performance of ~12% and reveal differences in terrain-specific pacing as well as gear choice between sexes with females showing a higher overall variation in speed and considerably slower uphill skiing.

  • 26.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Pellegrini, Barbara
    CeRiSM, Research Center for Sport, Mountain and Health, Rovereto, Italy.
    Sandbakk, Öyvind
    Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway .
    Stöggl, Thomas
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria .
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Swedish Olympic Committee, Stockholm, Sweden.
    The effects of skiing velocity on mechanical aspects of diagonal cross-country skiing2014In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116, Vol. 13, no 3, p. 267-284Article in journal (Refereed)
    Abstract [en]

    Cycle and force characteristics were examined in 11 elite male cross-country skiers using the diagonal stride technique while skiing uphill (7.5 degrees) on snow at moderate (3.5 +/- 0.3m/s), high (4.5 +/- 0.4m/s), and maximal (5.6 +/- 0.6m/s) velocities. Video analysis (50Hz) was combined with plantar (leg) force (100Hz), pole force (1,500Hz), and photocell measurements. Both cycle rate and cycle length increased from moderate to high velocity, while cycle rate increased and cycle length decreased at maximal compared to high velocity. The kick time decreased 26% from moderate to maximal velocity, reaching 0.14s at maximal. The relative kick and gliding times were only altered at maximal velocity, where these were longer and shorter, respectively. The rate of force development increased with higher velocity. At maximal velocity, sprint-specialists were 14% faster than distance-specialists due to greater cycle rate, peak leg force, and rate of leg force development. In conclusion, large peak leg forces were applied rapidly across all velocities and the shorter relative gliding and longer relative kick phases at maximal velocity allow maintenance of kick duration for force generation. These results emphasise the importance of rapid leg force generation in diagonal skiing.

  • 27.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stöggl, Thomas
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Pellegrini, Barbara
    CeRiSM Research Center for Sport, Mountain and Health University of Verona Rovereto Italy.
    Sandbakk, Øyvind
    Department of Human Movement Science Norwegian University of Science and Technology Trondheim Norway.
    Ettema, Gertjan
    Department of Human Movement Science Norwegian University of Science and Technology Trondheim Norway.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Biomechanical analysis of the herringbone technique as employed by elite cross-country skiers2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 3, p. 542-552Article in journal (Refereed)
    Abstract [en]

    This investigation was designed to analyse the kinematics and kinetics of cross-country skiing at different velocities with the herringbone technique on a steep incline. Eleven elite male cross-country skiers performed this technique at maximal, high, and moderate velocities on a snow-covered 15° incline. They positioned their skis laterally (25 to 30°) with a slight inside tilt and planted their poles laterally (8 to 12°) with most leg thrust force exerted on the inside forefoot. Although 77% of the total propulsive force was generated by the legs, the ratio between propulsive and total force was approximately fourfold higher for the poles. The cycle rate increased with velocity (1.20 to 1.60 Hz), whereas the cycle length increased from moderate up to high velocity, but then remained the same at maximal velocity (2.0 to 2.3 m). In conclusion, with the herringbone technique, the skis were angled laterally without gliding, with the forces distributed mainly on the inside forefoot to enable grip for propulsion. The skiers utilized high cycle rates with major propulsion by the legs, highlighting the importance of high peak and rapid generation of leg forces.

  • 28.
    Andersson, Erik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Willis, Sarah J.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ørtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Energy System Contributions And Determinants Of Performance In Classical Sprint Cross-Country Skiing2014In: Proceedings for the 19th ECCS in Amsterdam, The Netherlands, 2014Conference paper (Refereed)
  • 29.
    Andersson Nyberg, Robin
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Prestationsjämförelse mellan positionerna back och anfallare på daminnebandyspelare2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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    fulltext
  • 30.
    Andersson, Therese
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Attitudes, Knowledge and Practices Regarding Malaria Prevention and Treatment among Pregnant Women in Ahanta District, Ghana2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 31.
    Andersson, Therese
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gravida kvinnor och malaria - Kvalitativ intervjustudie om sjukvårdspersonals upplevelser av gravida kvinnors attityd och kunskap kring malaria.2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 32.
    Andersson, Tobias
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Linjechefens samarbete med Human Resource, företagshälsovården och Försäkringskassan i rehabiliteringsarbetet: - En kvalitativ intervjustudie2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 33.
    Appelqvist, Emma
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Fysiska aktivitetens påverkan på hälsorelaterad livskvalitet hos äldre2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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    fulltext
  • 34.
    Apro, William
    et al.
    Swedish School of Sport & Health Sciences, Stockholm, Sweden.
    Moberg, Marcus
    Swedish School of Sport & Health Sciences, Stockholm, Sweden.
    Hamilton, D. Lee
    University of Stirling, Scotland.
    Ekblom, Bjorn
    Swedish School of Sport & Health Sciences, Stockholm, Sweden.
    Rooyackers, Olav
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden .
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Blomstrand, Eva
    Swedish Sch Sport & Hlth Sci, Astrand Lab, SE-11486 Stockholm, Sweden ; Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Leucine does not affect mechanistic target of rapamycin complex 1 assembly but is required for maximal ribosomal protein s6 kinase 1 activity in human skeletal muscle following resistance exercise2015In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 29, no 10, p. 4358-4373Article in journal (Refereed)
    Abstract [en]

    We examined how the stimulatory effect of leucine on the mechanistic target of rapamycin complex 1 (mTORC1) pathway is affected by the presence of the remaining essential amino acids (EAAs). Nine male subjects performed resistance exercise on 4 occasions and were randomly supplied EAAs with leucine, EAAs without leucine (EAA-Leu), leucine alone, or flavored water (placebo; control). Muscle biopsies were taken from the vastus lateralis before and 60 and 90 min after exercise. Biopsies were analyzed for protein phosphorylation, kinase activity, protein-protein interactions, amino acid concentrations, and tracer incorporation. Leucine alone stimulated ribosomal protein s6 kinase 1 (S6K1) phosphorylation similar to 280% more than placebo and EAA-Leu after exercise. Moreover, this response was enhanced by 60-75% after intake of EAAs compared with that of leucine alone (P < 0.05). Kinase activity of S6K1 reflected that of S6K1 phosphorylation; 60 min after exercise, the activity was elevated 3.3- and 4.2-fold with intake of leucine alone and with EAAs, respectively (P < 0.05). The interaction between mammalian target of rapamycin and regulatory-associated protein of mammalian target of rapamycin was unaltered in response to both resistance exercise and amino acid provision. Leucine alone stimulates mTORC1 signaling, although this response is enhanced by other EAAs and does not appear to be caused by alterations inmTORC1 assembly.

  • 35.
    Apro, William
    et al.
    Swedish Sch Sport & Hlth Sci, Astrand Lab, SE-11486 Stockholm, Sweden.
    Moberg, Marcus
    Swedish Sch Sport & Hlth Sci, Astrand Lab, SE-11486 Stockholm, Sweden.
    Hamilton, D. Lee
    Univ Stirling, Hlth & Exercise Sci Res Grp, Stirling FK9 4LA, Scotland.
    Ekblom, Björn
    Swedish Sch Sport & Hlth Sci, Astrand Lab, SE-11486 Stockholm, Sweden.
    van Hall, Gerrit
    Univ Copenhagen, Rigshosp, Dept Biomed Sci, DK-1168 Copenhagen, Denmark.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Blomstrand, Eva
    Swedish Sch Sport & Hlth Sci, Astrand Lab, SE-11486 Stockholm, Sweden.
    Resistance exercise-induced S6K1 kinase activity is not inhibited in human skeletal muscle despite prior activation of AMPK by high-intensity interval cycling2015In: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 308, no 6, p. E470-E481Article in journal (Refereed)
    Abstract [en]

    Combining endurance and strength training in the same session has been reported to reduce the anabolic response to the latter form of exercise. The underlying mechanism, based primarily on results from rodent muscle, is proposed to involve AMPK-dependent inhibition of mTORC1 signaling. This hypothesis was tested in eight trained male subjects who in randomized order performed either resistance exercise only (R) or interval cycling followed by resistance exercise (ER). Biopsies taken from the vastus lateralis before and after endurance exercise and repeatedly after resistance exercise were assessed for glycogen content, kinase activity, protein phosphorylation, and gene expression. Mixed muscle fractional synthetic rate was measured at rest and during 3 h of recovery using the stable isotope technique. In ER, AMPK activity was elevated immediately after both endurance and resistance exercise (similar to 90%, P < 0.05) but was unchanged in R. Thr(389) phosphorylation of S6K1 was increased severalfold immediately after exercise (P < 0.05) in both trials and increased further throughout recovery. After 90 and 180 min recovery, S6K1 activity was elevated (similar to 55 and similar to 110%, respectively, P < 0.05) and eukaryotic elongation factor 2 phosphorylation was reduced (similar to 55%, P < 0.05) with no difference between trials. In contrast, markers for protein catabolism were differently influenced by the two modes of exercise; ER induced a significant increase in gene and protein expression of MuRF1 (P < 0.05), which was not observed following R exercise only. In conclusion, cycling-induced elevation in AMPK activity does not inhibit mTOR complex 1 signaling after subsequent resistance exercise but may instead interfere with the hypertrophic response by influencing key components in protein breakdown.

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  • 36.
    Apró, William
    et al.
    Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Moberg, Marcus
    Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Blomstrand, Eva
    Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Amino Acid-induced S6K1 Activity in Human Skeletal Muscle is Mediated By Increased mTor/Rheb Interaction: 128 June 1, 11: 15 AM - 11: 30 AM2016In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 48, no 5 Suppl 1, p. 17-Article in journal (Refereed)
    Abstract [en]

    Cell culture studies have shown that amino acids activate mTORC1 signaling by increasing the interaction between mTOR and its essential activator Rheb. However, the existence of this mechanism in human skeletal muscle remains to be determined.

    PURPOSE: To determine if increased mTORC1 signaling in response to amino acids in human skeletal muscle is due to an increased interaction between mTOR and Rheb.

    METHODS: Eight well trained men performed resistance exercise on two separate occasions. In connection with the exercise, subjects were supplemented with flavored water (Pla) and essential amino acids (EAA) in a double-blind, randomized cross-over design. Muscle biopsies were taken in the vastus lateralis muscle before, immediately after and 90 and 180 min post exercise. Activity of the mTORC1 pathway was assessed by a radiolabeled in-vitro kinase assay for its immediate downstream target S6K1. Protein-protein interactions were determined by western blot following co-immunoprecipitation of mTOR with Rheb. Co-immunoprecipitation was performed on pooled muscle samples from three of the eight subjects.

    RESULTS: Activity of S6K1 remained unchanged immediately after exercise in both trials. However, at 90 min post exercise, S6K1 activity increased by approximately 2- and 8-fold (p<0.05) from baseline the Pla and EAA trials, respectively. At the 180 min time point, S6K1 activity remained elevated in both trials being approx. 3-fold higher in the Pla trial and 5-fold higher (p<0.05) in the EAA trial. The fold-change in mTOR and Rheb interaction largely resembled the activity pattern of S6K1 in both trials; in the Pla trial the fold-change was 0.9, 1.3 and 1.4 while in the EAA trial the fold-change was 1.6, 2.9 and 1.9 immediately after, 90 min after and 180 min after exercise, respectively.

    CONCLUSIONS: The large increase in S6K1 activity following EAA intake appears to be mediated by an increased interaction between mTOR and its proximal activator Rheb. This is the first time this mechanism has been demonstrated in human skeletal muscle.

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  • 37.
    Arab-Zozani, Morteza
    et al.
    Tabriz University of Medical Sciences, Tabriz, Iran.
    Mostafazadehb, Noosheen
    Tabriz University of Medical Sciences, Tabriz, Iran.
    Arab-Zozani, Zeinab
    Mashhad University of Medical Sciences, Mashhad, Iran.
    Ghoddoosi-Nejadd, Djavad
    Birjand University of Medical Sciences, Birjand, Iran.
    Hassanipour Azgomie, Soheil
    Guilan University of Medical Sciences, Rasht, Iran.
    Soares, Joaquim J.F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Porto, Porto, Portugal.
    The prevalence of elder abuse and neglect in Iran: A systematic review and meta-analysis2018In: Journal of Elder Abuse & Neglect, ISSN 0894-6566, E-ISSN 1540-4129, Vol. 30, no 5, p. 408-423Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

    Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I2 statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

    Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

    Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.

  • 38.
    Araghi, Marzieh
    et al.
    Karolinska Inst, Stockholm.
    Galanti, Maria Rosaria
    Karolinska Inst, Stockholm; Stockholm City Council.
    Lundberg, Michael
    Karolinska Inst, Stockholm.
    Lager, Anton
    Karolinska Inst, Stockholm; Stockholm City Council.
    Engstrom, Gunnar
    Lund Univ, Lund.
    Alfredsson, Lars
    Karolinska Inst, Stockholm.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Norberg, Margareta
    Umeå Univ, Umeå.
    Sund, Malin
    Umeå Univ, Umeå.
    Wennberg, Patrik
    Umeå Univ, Umeå.
    Lagerros, Ylva Trolle
    Karolinska Inst, Stockholm; Karolinska Univ Hosp Huddinge, Stockholm.
    Bellocco, Rino
    Univ Milano Bicocca, Milan, Italy; Karolinska Inst, Stockholm.
    Pedersen, Nancy L.
    Karolinska Inst, Stockholm.
    Ostergren, Per-Olof
    Lund Univ, Lund.
    Magnusson, Cecilia
    Karolinska Inst, Stockholm; Stockholm City Council.
    Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies2017In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 141, no 4, p. 687-693Article in journal (Refereed)
    Abstract [en]

    While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer. What's new? While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. Smokeless tobacco like snus yields lower exposure to tobacco carcinogens compared with smoking, because it does not undergo combustion, but delivers an equivalent dose of nicotine. Using pooled individual data from the Swedish Collaboration on Health Effects of Snus Use, here the authors show that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.

  • 39.
    Araghi, Marzieh
    et al.
    Karolinska Institutet, Stockholm.
    Galanti, Maria Rosaria
    Karolinska Institutet, Stockholm; Stockholm Health Care District, Stockholm County Council.
    Lundberg, Michael
    Karolinska Institutet, Stockholm.
    Liu, Zhiwei
    Karolinska Institutet, Stockholm.
    Ye, Weimin
    Karolinska Institutet, Stockholm.
    Lager, Anton
    Karolinska Institutet, Stockholm; Stockholm Health Care District, Stockholm County Council.
    Engström, Gunnar
    Lund University.
    Manjer, Jonas
    Skåne University Hospital Malmö.
    Alfredsson, Lars
    Karolinska Institutet, Stockholm.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Norberg, Margareta
    Umeå University.
    Palmqvist, Richard
    Umeå University.
    Gylling, Björn
    Umeå University.
    Wennberg, Patrik
    Umeå University.
    Lagerros, Ylva Trolle
    Karolinska Institutet, Stockholm; Karolinska University Hospital Huddinge.
    Bellocco, Rino
    Karolinska Institutet, Stockholm; University of Milano-Bicocca, Italy.
    Pedersen, Nancy L.
    Karolinska Institutet, Stockholm.
    Östergren, Per-Olof
    Lund University.
    Magnusson, Cecilia
    Karolinska Institutet, Stockholm; Stockholm Health Care District, Stockholm County Council.
    Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 741-748Article in journal (Refereed)
    Abstract [en]

    Aims: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association. Methods: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis. Conclusions: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention. 

  • 40.
    Arvidsson, Charlotta
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hälsorelaterad livskvalitet hos nyanlända från Syrien.En enätstudie med EQ-5D-5L som mått på hälsorelaterad livskvalitet.2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
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  • 41.
    Ask, Sara
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Risk factors for HIV among prostituerad men in Chaing Mai, Thailand2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
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  • 42.
    Aspelin, Johanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Olofsson, Niclas
    FoU Västernorrland.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ahmadi, Nader
    Univerfsity of Gävle.
    Walander, Anders
    Karolinska Institutet.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gender differences in self-reported health during times of economic crises: Does employment status matter?.2015In: International Journal of Health Sciences & Research, ISSN 2249-9571, Vol. 5, no 2, p. 246-257Article in journal (Refereed)
    Abstract [en]

    Background: Employment status has an impact on health and is a source of health inequalities. But little is known about its impact on the health of people residing in the County of Västernorrland, Sweden. The recent economic recession affected this region in a way which worsened the already existing unemployment rate.Objective of the study: This study aimed to examine the relationship between employment status, gender and self-reported health in the County of Västernorrland, Sweden in the year 2010.Setting and Design: The study used data from a cross-sectional "Health on Equal Terms" survey, carried in the County of Västernorrland in 2010. A total of 6,050 women and men aged 16-65 years were included in the analysis. Descriptive statistics and logistic regression analyses were performed, and results were expressed as odds ratio with 95% confidence intervals.Results: Women and men who were out of work had odds of poor self-reported health of 2.31 (CI 1.94-2.94) and 2.39 (CI 1.96-2.58), respectively. Controlling for other variables reduced the odds of poor health, but the relationship continued to be statistically significant.Conclusion: Results of this study found that at the pick of the most recent economic crises there were equal odds of poor self-reported health among women and men residing in Gävleborg County. The observed association was to some extent explained by demographic, socioeconomic and health-related variables. Policymakers need to pay attention to the health status of those out of work, particularly during times of economic recession and hardship.

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  • 43.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The over time development of chronic illness self-management patterns: a longitudinal qualitative study2013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, p. Art. no. 452-Article in journal (Refereed)
    Abstract [en]

    Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.

    Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.

    Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.

    Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

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  • 44.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kneck, Åsa
    Ersta Sköndal Högskola.
    How to analyze time and change in qualitative longitudinal materials?: Insights from a literature review of longitudinal qualitative studies in nursing.2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, p. 10-10Article in journal (Refereed)
    Abstract [en]

    Background Longitudinal qualitative research can give new insights in social processes and experiences over time. In recent years, there has been a growing interest in conducting longitudinal qualitative research within nursing. However, the definition of what constitutes longitudinal qualitative research is unclear, the methodological literature scarce, and the variation of procedures great. This review of longitudinal qualitative articles within the nursing field aims to identify and describe various types of qualitative longitudinal approaches. Materials and Method Searches in pubmed identified over a hundred qualitative nursing articles with data collection over time. These articles were analyzed regarding 1) described analysis procedure, 2) how the results related to aspects of time and change, and 3) if results were person oriented vs category oriented. Results Five different types of longitudinal qualitative approaches were identified. In total, a large part of the papers described as having a longitudinal design performed a data collection over time, but did not integrate ideas of time or change in their analysis or results. Four fruitful approaches to analyzing longitudinal qualitative data were identified; time-line, pool, phase and pattern-oriented approaches. Articles classified as using any of these approaches have a clear perspective of time or change in the results. However, depending on type of approach different aspects of time, change, and process are in focus. Further, using different approaches yielded different kinds of results. Conclusion All approaches have pros and cons and researchers need to make informed decisions when choosing which approach they will take when analyzing qualitative longitudinal material.

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  • 45.
    Augustsson, Gunnar
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Education.
    Ekelund-Book, Teresia
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstad, Bodil
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Utilization of Consultant Doctors’ Competence and Impact on Perceived Psychosocial Work Environment: A Pilot Study2017In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 9, p. 189-207Article in journal (Refereed)
    Abstract [en]

    Background: Work agencies that assign temporary jobs to doctors and nurses are becoming an increasing phenomenon. Aim: The purpose of this pilot study was to explore how consultant doctors (CDs) experience their competence as utilized in practice and what impact this has on their perceived psychosocial work environment. Methods: The findings are based on 11 interviews with CDs working on consultancy assignments in Norway. The CDs were all specialists in fields such as general practice, psychiatry, anesthesia, gynecology, orthopedics, and otolaryngology. Results: The competence that the CDs contributed to their hosting work organization was interpreted differently based on whether the consultant played an active role in the psychosocial work environment and also depended on the doctor’s specialty. Not being integrated into the hosting work organization enhanced the feeling of exclusion and the idea that little or no room was available to contribute one’s competence. Most of the CDs experienced their competence as being utilized to a certain extent, which strengthened their work satisfaction and feeling of playing an active role in the psychosocial work environment.

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  • 46.
    Axner, Markus
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Repeated-sprint performance in junior ice-hockey players following a 3-week "train low" nutritional intervention2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 47.
    Azzinnari, M
    et al.
    University of Las Palmas, Spain.
    Martin-Rincon, M
    University of Las Palmas, Spain.
    Juan-Habib, J
    University of Las Palmas, Spain.
    Gelabert-Rebato, M
    University of Las Palmas, Spain.
    Calbet, JAL
    University of Las Palmas, Spain.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Morales –Alamo, D
    University of Las Palmas, Spain.
    Efectos del ejercicio en la señalización de NF-kB durante la restricción calórica severa2017Conference paper (Refereed)
    Abstract [es]

    El sobrepeso y la obesidad, en crecimiento en todo el mundo, se asocian con una alta tasa de mortalidad e morbilidad[1,2]. La causa principal que conduce a éstas condiciones patológicas es un balance energético positivo sostenido a largo plazo, debido a la inactividad física y la ingesta calórica excesiva[3]. Por lo tanto, ejercicio físico y restricción calórica podrían ser dos estratégias eficaces para prevenir y contrastar el excesivo acumulo de grasa corporal que caracteriza estas patologías. Sin embargo, durante dietas muy bajas en calorías (<800 Kcal/día) se pierde no solo masa grasa sino también masa muscular, reportando efectos negativos para la salud[4]. En dichas condiciones,  el ejercicio físico permite preservar masa muscular de manera local y dosis-dependiente, mientras la ingestión de proteínas no ejerce particulares efectos protectivos sobre el tejido contráctil[5]. Los mecanismos moleculares implicados en la preservación de la masa muscular inducida por el ejercicio durante este tipo de dietas no han sido definidos claramente. NF-kB es un factor de transcripción cuya activación provoca atrofia muscular, y su bloqueo puede parcialmente limitar este fenomeno[6]. NF-kB se ha mostrado activado de manera aguda por el ejercicio y la restricción calorica, sin embargo no ha sido definida su respuesta a la restricción calórica en conjunción con el ejercicio prolongado de baja intensidad. Además, cuando los niveles basales de NF-kB son altos, el ejercicio no parece aumentar ulteriormente su señalización[7]. Por las razones presentadas, NF-kB podría desempeñar un rol en la preservación de masa magra inducida por el ejercicio durante  la restricción calórica.

    El objetivo del estudio es establecer la respuesta de NF-kB a la restricción calórica severa en conjunción con el ejercicio prolongado de baja intensidad. Las hipótesis fueron las siguientes: 1) la restricción calórica severa activaría la via de NF-kB y 2) dicha activación será atenuada por el ejercicio de manera local y dosis-dependiente.

    15 sujetos con sobrepeso y obesidad fueron sometidos a tres fases experimentales: fase 1, en la que la dieta y el nivel de actividad física de los participantes fue monitorizado durante una semana (PRE); fase 2, caracterizada por cuatro días de ejercicio prolongado y de restricción calórica severa (RCE); fase 3, caracterizada por tres días de ejercicio reducido y una dieta isoenergética (DC). Durante la fase 2, los sujetos ingeriron hidratos de carbono o proteínas (0.8 g/kg peso corporal/día; 320 kcal/día) y hicieron 45 minutos de pedaleo con un solo miembro superior (15% Ppeak) seguidos de 8 horas de caminata (4.5 km/h; 35 km/día). Las biopsias musculares fueron recogidas de ambos los deltoides y del vasto lateral en la fase 1 y después de la fase 2 y 3. Mediante Western blot, se determinó la expresión de NF-κB p105, NF-κB p50, la fosforilación de la Serina 32/36 de IκBα e IκBα total. La composición corporal se midió mediante DXA. Estadística: ANOVA para medidas repetidas.

    Durante los 4 días de restricción calórica severa el deficit energético fue de 5500 Kcal. Después de la fase 2 los sujetos perdieron menos masa magra en los miembros inferiores y en el brazo ejercitado respecto al brazo de control: 57% (P<0.05) y 29% (P=0.05), respectivamente. Tras la fase 2 y 3, el contenido de p105 y de p50 fue menor en los miembros inferiores respecto a los superiores: efecto extremidad P=0.003 y P=0.024 para p105 y p50, respectivamente. Tras la fase 3, la fosforilación de la Serina 32/36 de IkBα aumentó únicamente en las piernas, mientras la expresión total IkBα fue mayor solo en los miembros ejercitados (P<0.05).

    El ejercicio físico atenuó la activación de la señalización de NF-kB durante 4 días de restricción calórica severa, limitando el incremento de la expresión de p50 y p105, que resultó más baja después de la fase 2 y la fase 3 en los miembros inferiores respecto a los miembros superiores, posiblemente debido a la mayor cantidad de ejercicio a la que fueron sometidos. Además, la expresión total de IkBα fue más alta tras la fase 3 solo en los miembros ejercitados, indicando una posible inhibición de la vía de   NF-kB inducida por el ejercicio. Por lo tanto, dado la menor activación de la señalización de NF-kB en los miembros que perdieron menor masa muscular, los resultados sugieren que los efectos protectores del ejercicio físico sobre el tejido contráctil podrían ser mediados a una menor activación de la señalización de NF-kB.

    El ejercicio físico desempeña una función preservadora sobre la masa muscular durante la restricción calórica severa. La preservación de masa muscular es dosis-dependiente (a mayor volumen, mayor preservación) y está mediada, al menos parcialmente, por una menor activación de la señalización por NF-kB.

    1.Hill, J. O., H. R. Wyatt, et al. (2012). Circulation 126(1): 126-132.2.Di Angelantonio, E., N. Bhupathiraju Sh, et al. (2016). Lancet 388(10046): 776-786. 3.Chaston, T. B., J. B. Dixon, et al. (2007). Int J Obes (Lond) 31(5): 743-750. 4.Calbet, J. A., J. G. Ponce-Gonzalez, et al. (2017). Front Physiol (Accepted, In press).5.Cai, D., J. D. Frantz, et al. (2004). Cell 119(2): 285-298.6.Tantiwong, P., K. Shanmugasundaram, et al. (2010). Am J Physiol Endocrinol Metab 299(5): E794-801.7.NCD-RisC (2016). Lancet 387(10026): 1377-1396.

  • 48.
    Back, Madeleine
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Endometriosis – still a modern version of hysteria: A qualitative interview study2021Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To explore women’s experiences from awaiting endometriosis diagnose and treatment, its consequences and how the procedure can be improved.

    Subject and methods: A qualitative study based on semi-structured interviews, consisting total eight women with a diagnosis of endometriosis and women with symptoms of endometriosis, were conducted. The material analyzed using a qualitative content analysis according to Graneheim and Lundman (2004).

    Results: The overarching theme A neglected and invisible woman disease poured out from four categories; discriminative treatment, unnecessary suffering, social and physical constrains and raise awareness and adequate measures. There was a clear pattern that women with endometriosis do not receive the care and treatment they should. The consequences limit their lives that affect relationships, not least intimate relations, and well-being.

    Conclusion: This study shows that it sometimes takes decades to get a diagnose and that women are dismissedas having mere menstrual pain or worse - a modern version of hysteria. The findings support such stigma myths as it shows that the women felt they were neglected, and they suffered in silence. It was also evident that increased awareness and adequate measures are needed to improve a holistic approach in the society, and among health care providers that can prevent unnecessary suffering and minimize negative daily life consequences, in women suffering from endometriosis. 

  • 49.
    Backlund, Carola Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sociala företag- en väg mot förändrad social delaktighet på arbetsmarknaden?: En kvalitativ studie om upplevelser av möjlighet till delaktighet i arbetet på ett socialt företag2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 50.
    Backlund, Claudia
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Akut smärta - Patienters uppfattningar av deras omhändertagande och smärtlindring under en vårdvistelse från akutmottagningen till internmedicin.2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
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