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S Ekblad

Publications and source records attributed to S Ekblad.

At least 19 recordsLinked to original sources
PubMed2001

Self-reported life event patterns and their relation to health among recently resettled Iraqi and Kurdish refugees in Sweden.

This paper presents the findings of a longitudinal study of life events in refugees belonging to different language groups from Iraq. Eighty-six individuals were included in the study. Data regarding life events and self-reported health measurements were collected after baseline assessment with 3-monthly intervals on three occasions. Posttraumatic stress disorder was diagnosed by means of a structured interview at baseline. The results indicate that the subjects were influenced to a great extent by political events and the situation of significant others in the home country. Further, the number of negative life events in the host country showed a significant association with self-rated deteriorated health. In subjects with posttraumatic stress disorder, the effects of certain life events were more pronounced.

Adolescent↗
PubMed2000

Effects of estrogen therapy on well-being in postmenopausal women without vasomotor complaints.

OBJECTIVE: To establish whether estrogen treatment affects well-being in postmenopausal women without current or previous vasomotor symptoms. DESIGN: Forty postmenopausal women, aged 45-59 years, without current or previous vasomotor complaints, were included. They were randomized to masked treatment with either transdermal 17beta-estradiol 50 microg/24 h or to placebo. At baseline and after 12 and 14 weeks of treatment, the women completed a questionnaire which reflects well-being, the Psychological General Well-Being (PGWB) Index. RESULTS: The women scored high on the PGWB Index, both at baseline and after 12 and 14 weeks of treatment. There was no significant difference in well-being according to PGWB Index between the groups treated with estrogen and placebo, neither at baseline, nor after therapy. Furthermore, there was no difference in change during therapy between the treatment groups. CONCLUSION: There is a gradual decline in estrogen during the climacteric, and it is controversial to which extent this affects women's mental health. The PGWB scores in this study were high before therapy, reflecting that these women without previous or current vasomotor complaints represented a selected sample. Neither short-term estrogen treatment over 12 weeks nor addition with medroxyprogesterone acetate during 2 weeks improved well-being in postmenopausal women without vasomotor symptoms who had high well-being at baseline.

Administration, Cutaneous↗
PubMed2000

Estrogen effects on postural balance in postmenopausal women without vasomotor symptoms: a randomized masked trial.

OBJECTIVE: To assess whether estrogen treatment given to postmenopausal women without vasomotor symptoms improves balance more than placebo. METHODS: Forty healthy postmenopausal women without vasomotor symptoms were randomized to transdermal 17beta-estradiol (E2) 50 microg/day for 14 weeks or identical transdermal placebo patches. Postural balance was measured with dynamic posturography before and after 4, 12, and 14 weeks of therapy. In this test, the visual, vestibular, and somatosensory systems were provoked with increasing difficulty and body sway was measured with a dual forceplate. A low score showed large sway and a score of 100 showed no sway at all. RESULTS: Thirty-eight women completed the study. Both groups had normal balance for their ages and near maximum scores in the three easier balance tests at baseline. In the most difficult test, both groups improved their postural balance significantly (from 13 to 32 and from 22 to 39, respectively) after 4 weeks. Thereafter, no change was seen. One problem was low statistical power, but the relative change in balance did not differ between groups. The comparison did not show even a minute advantage of E2 over placebo, so a study with higher power would probably not have shown a more pronounced effect of estrogen than placebo. The change over time did not differ between groups, which indicates a significant learning effect. CONCLUSION: In women without vasomotor symptoms, estrogen therapy did not seem to increase postural balance significantly more than placebo. However, we could not rule out that estrogens affect postural balance in women with vasomotor symptoms.

Administration, Cutaneous↗
PubMed2000

Turkish migrant women encountering health care in Stockholm: a qualitative study of somatization and illness meaning.

This paper presents the results from a qualitative study conducted with the aim of exploring structures of illness meaning among somatizing Turkish-born migrant women (age 31-48) living in a poor and low status suburb of Stockholm in contact with local health care services. Two to three interviews regarding experiences and understanding of illness were conducted as well as one year, validating follow-up interviews. Interviews were analysed with a grounded theory approach. Results are presented as the participants' agenda of understanding. Distress was communicated by concrete expressions about the body, emotions, social and life situation. Pain was prominent and often lateralised to one side of the body. The use of traditional expressions of distress ranged from open use to avoidance. Attribution was characterised by verbalising links of coherence between health and aspects of life. Psychiatric attribution was rarely accepted or valued as a tool for recovery, or as helpful in linking bodily symptoms to emotional distress. Three main sources for healing were used: medical care in Sweden and in Turkey and traditional treatment. Own capacity to influence recovery was mostly regarded as low. Relations to family and the clinician were regarded as important to recovery. The encounter with local health care had brought the participants in contact with a psychological agenda of understanding their illness and new ways of dealing with illness and healing. Some expressed a feeling of being misunderstood whereas some related positive experiences of re-evaluation. They were all actively trying, but experiencing varying degrees of difficulty, to grasp the meaning of the caregiver. The results of the study point to the mutual need of exploring meaning in the clinical encounter to help patients make sense out of different perspectives of illness and healing. The need for enhanced knowledge about this process in a migration context will be discussed.

Adult↗
PubMed2000

Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm.

Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end-of-life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden. The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3-day seminar in multicultural end-of-life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post-training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end-of-life care; 3) post-training reflections about one's own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end-of-life care. One of the study's main findings was that to better understand other cultures it is important to raise awareness about the staff's own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.

Adult↗
PubMed2000

Disturbances in postural balance are common in postmenopausal women with vasomotor symptoms.

OBJECTIVES: To establish the prevalence of unsteadiness and rotatory vertigo in peri- and postmenopausal women, and whether balance disturbances are more common in women with vasomotor symptoms and without hormone replacement therapy (HRT). METHOD: A validated questionnaire was sent to all 1523 women aged 54 or 55 years in Linköping, Sweden. RESULTS: Daily or weekly unsteadiness was reported by 5%, and daily or weekly rotatory vertigo by 4% of all women. The frequency of vasomotor symptoms correlated with reported unsteadiness (rs = 0.23, p < 0.001). Fourteen per cent of women with daily vasomotor symptoms reported weekly or daily unsteadiness, compared with 3% of those without vasomotor symptoms (odds ratio (OR) 7.58, 95% confidence interval (CI) 3.72-15.45). The frequency of vasomotor symptoms correlated with rotatory vertigo (rs = 0.19, p < 0.001). Ten per cent of women with daily vasomotor symptoms reported weekly or daily rotatory vertigo, compared with 2% of women without vasomotor symptoms (OR 5.21, 95% CI 1.07-25.52). No correlation was seen between vasomotor symptoms and falls. Users of HRT had the same prevalence of balance disturbances as non-users. CONCLUSIONS: Women with frequent vasomotor symptoms seem to run a greater risk of unsteadiness and rotatory vertigo than do women without symptoms. This association may not be explained by means of a cross-sectional study, but there might exist a causal connection between vasomotor symptoms and balance disturbances.

Dizziness↗
PubMed2000

Adrenocorticotropin and corticotropin-releasing hormone tests in preterm infants.

The short ACTH test is used in evaluating the hypothalamo-pituitary-adrenal axis (HPA-axis) in preterm neonates after dexamethasone treatment. This test mainly examines primary adrenal suppression but is also used as a method to test secondary adrenal insufficiency because long-term deprivation of ACTH causes atrophy of the adrenal cortex. The CRH test, on the other hand, directly examines the function of the pituitary. We tested 18 infants in the neonatal intensive care unit with both the ACTH test and the CRH test to determine which of these two tests more reliably demonstrates HPA-axis suppression. One patient had normal responses both in the ACTH test and in the CRH test when the limit of 360 nmol/L was used as a sign of proper cortisol secretion. In four cases the patients' cortisol secretion would have been regarded as normal by the low-dose ACTH test, whereas the CRH test did not show an adequate cortisol response. In conclusion, the ACTH test did not reliably indicate HPA-axis suppression after a short (<2 weeks) course of dexamethasone therapy in this study. Therefore, whether the infant is or will be under acute stress after short glucocorticoid treatment, ensuring adequate cortisol secretion with the CRH test should be considered.

Adrenal Gland Diseases↗
PubMed1999

Postmenopausal women without previous or current vasomotor symptoms do not flush after abruptly abandoning estrogen replacement therapy.

BACKGROUND: Most but not all women suffer from vasomotor symptoms around menopause. The exact mechanisms behind these symptoms are unknown, but the rate of decline in estrogen concentrations has been suggested to affect the risk of hot flushes. OBJECTIVE: The objective was to assess whether vasomotor symptoms were induced in women without previous such symptoms, when the women were given combined estradiol and progestagen therapy for 3 months, whereafter therapy was abruptly withdrawn. MATERIALS AND METHOD: After randomization, 40 postmenopausal women without previous or current vasomotor symptoms were treated transdermally with either 50 micrograms/day 17 beta-estradiol or placebo during 14 weeks. During the 13th and 14th weeks, treatment was combined with oral medroxyprogesterone acetate 10 mg/day. Serum estradiol and follicle-stimulating hormone (FSH) concentrations were analysed before and after 12 weeks of therapy. Climacteric symptoms were assessed at the same intervals as well as 8 weeks after the end of therapy. RESULTS: All women had low pretreatment levels of estradiol and high FSH concentrations. During estradiol therapy estradiol levels increased significantly, whereas FSH only decreased slightly. No woman developed vasomotor symptoms after withdrawal of therapy. CONCLUSION: Postmenopausal women without previous or current vasomotor symptoms did not develop such symptoms when estrogen replacement therapy was first instituted and then abruptly stopped. Probably other factors than the rate with which estrogen concentrations decrease determine whether or not a woman will develop vasomotor symptoms. Evidently, estrogens can be prescribed to a woman who has no vasomotor symptoms, without much risk of inducing such symptoms if she decides to abandon therapy, even after 3 months of treatment.

Administration, Cutaneous↗
PubMed1998

[Traumatic stress in adult refugees: when ill-health is silent or speaks broken Swedish].

It is well established that a significant proportion of refugees in Sweden have had traumatic experiences prior to immigration, causing mental and psychosomatic disorders. The actual frequency is difficult to assess because of methodological problems. Of refugees resettled in Stockholm county in 1996, 13 per cent were immediately referred to specialised trauma centres, thus comprising half of all referrals. Moreover, it has to be borne in mind that underdiagnosis is common in clinical practice. In the article, the relevance of accessible data, the clinical picture and epidemiological issues are discussed with regard to the refugee population.

Adult↗
PubMed1997

Diagnosing posttraumatic stress disorder in multicultural patients in a Stockholm psychiatric clinic.

Our objective was to test the assessment of posttraumatic stress disorder (PTSD) and associated symptoms in a multicultural immigrant/refugee population at a psychiatric out-patient clinic. The pilot study included volunteer patients who were randomly assigned to an intervention group (N = 33), who received SCID diagnosis and a battery of life event questionnaires, and a referent group (N = 30), who received the standard diagnostic program. All were followed-up for 1 year. Forty percent of the intervention group, but none in the referent group, were judged to have PTSD. In the intervention group, positive significant correlations were found between HTQ and HSCL-25 and SCID, Axis I PTSD. Experience of trauma influenced the ill-health in the psychometric indices, and the psychometric indices correlated negatively with present and optimal functioning. A targeted trauma approach toward multicultural psychiatric patients using a multidisciplinary team and validated psychometric tools provided sensitive and accurate diagnostic information for this group.

Adult↗
PubMed1997

Help for refugees.

The reception and treatment of refugees traumatized by war and violence are discussed with particular reference to the author's experience of such work in a suburb of Stockholm.

Adaptation, Psychological↗
PubMed1995

Oral contraceptives and low back pain. Attitudes among physicians, midwives and physiotherapists.

BACKGROUND: Only few indications have appeared in the literature concerning a possible relationship between the use of oral contraceptives and low back pain. In our daily work we often meet women who have been recommended to abandon their use of oral contraceptives depending on coexisting low back pain. In order to assess the opinions of a possible relationship between oral contraceptives and low back pain this study was undertaken. METHODS: A validated questionnaire was sent out to physicians, physiotherapists and midwives dealing with either contraceptive counselling or low back pain. A modified questionnaire was sent to medical- and physiotherapist students to assess whether the opinions were a result of the education or the working experience. RESULTS: A total of 225 questionnaires were sent out and 206 (91%) were returned. Sixteen percent thought there was a relationship between the use of oral contraceptives and risk of low back pain. Thirty percent had seen patients with low back pain that was interpreted as being affected by use of oral contraceptives. Twenty-five percent recommended at least some patients with low back pain to change their contraceptive method. Among the students there was a difference in opinion between the first and the last year students indicating that their opinions had been influenced by their education. CONCLUSIONS: Evidently many professionals dealing with oral contraceptives and low back pain believe that there is a relationship between oral contraceptives and low back pain, despite the lack of scientific evidence. These recommendations might influence the contraceptive safety for the individual woman and the possible relationship between use of oral contraceptives and low back pain should therefore be more thoroughly investigated before general recommendations are given.

Adolescent↗