Saliva cortisol in girls with functional abdominal pain disorders: A randomized controlled dance and yoga intervention

Introduction: Functional abdominal pain disorders (FAPDs) are common among girls and has been associated with stress. Cortisol is one of the major stress hormones. Dance and yoga have been shown to reduce abdominal pain among girls with FAPDs. Aim: To investigate the effect of an 8-month intervention with dance and yoga on cortisol levels in saliva among girls with FAPDs. Methods: A total of 121 girls aged 9–13 years with irritable bowel syndrome (IBS) or functional abdominal pain were included in the study. Participants were randomized into an intervention group and a control group. The intervention group attended a combined dance and yoga session twice a week for 8 months. Saliva samples were collected during 1 day, in the morning and evening, at baseline, and at 4 and 8 months. Subjective pain and stress were assessed as well. Results: No significant effects on saliva cortisol levels between groups were observed after completion of the intervention at 8 months. However, evening cortisol and evening/morning quotient were significantly reduced at 4 months in the intervention group compared to the control group (p = 0.01, p = 0.004). There was no association between cortisol quota and pain or stress. Conclusion: Improvements in cortisol levels were seen in the intervention group at 4 months but did not persist until the end of the study. This indicates that dance and yoga could have a stress-reducing effect during the ongoing intervention

An intervention with dance and yoga for girls with functional abdominal pain disorders (Just in TIME): Protocol for a randomized controlled trial

©Anna Philipson, Stefan Särnblad, Lars Ekstav, Mats Eriksson, Ulrika L Fagerberg, Margareta Möller, Evalotte Mörelius, Anna Duberg. Background: Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus. Objective: This study aims to evaluate the effects of a dance and yoga intervention among girls aged 9 to 13 years with FAPDs. Methods: The study is a prospective randomized controlled trial among girls aged 9 to 13 years with functional abdominal pain, irritable bowel syndrome, or both. The target sample size was 150 girls randomized into 2 arms: an intervention arm that receives dance and yoga sessions twice weekly for 8 months and a control arm that receives standard care. Outcomes will be measured at baseline and after 4, 8, 12, and 24 months, and long-term follow-up will be conducted 5 years from baseline. Questionnaires, interviews, and biomarker measures, such as cortisol in saliva and fecal microbiota, will be used. The primary outcome is the proportion of girls in each group with reduced pain, as measured by the faces pain scale-revised in a pain diary, immediately after the intervention. Secondary outcomes are gastrointestinal symptoms, general health, mental health, stress, and physical activity. The study also includes qualitative evaluations and health economic analyses. This study was approved by the Regional Ethical Review Board in Uppsala (No. 2016/082 1-2). Results: Data collection began in October 2016. The intervention has been performed in 3 periods from 2016 through 2019. The final 5-year follow-up is anticipated to be completed by fall 2023. Conclusions: Cost-effective and easily accessible interventions are warranted to reduce the negative consequences arising from FAPDs in young girls. Physical activity is an effective strategy, but intervention studies are needed to better understand what types of activities facilitate regular participation in this target group. The Just in TIME (Try, Identify, Move, and Enjoy) study will provide insights regarding the effectiveness of dance and yoga and is anticipated to contribute to the challenging work of reducing the burden of FAPDs for young girls

The development of a conceptual test facility : A case study

Background There exist an external demand forcing the manufacturing industry to increase their sustainable practice. For manufacturing companies to stay competitive it is necessary for them to transform their organization and operation to be more sustainably responsive. To meet the external demand for sustainable practice in the manufacturing industry, companies need to find new innovative solutions for their production processes.  Implementing new process innovations in production processes can be an uncertain task for companies to manage. To reduce the uncertainty, it is important to experiment with different solutions before implementation. To conduct experiments in an efficient and safe way, companies can use the tool simulation to validate process innovations before implementation.  There exist different simulation methods a company can use. Physical simulations are used when a company have production processes that cannot be simulated through a computer. Physical simulations are conducted in test facilities where companies can analyze material behavior in a laboratory scale production process.  Research questions RQ1: What need exists for test facilities in manufacturing companies?  RQ2: What benefits can be obtained using test facilities?  Aim A1: Identify stakeholder needs and based on these needs develop a conceptual test facility adapted to the case company.  Method To answer the research questions and fulfill the aim of the study, a literature review and a case study was conducted. The literature review explored the need and benefits of conducting physical simulations in test facilities when implementing new innovations in production processes to meet the demand for sustainability.  The case study was conducted at Volvo Construction Equipment in Hallsberg where the need to implement a test facility for their chemical production process was explored together with the benefits such a facility might contribute with. The case study also entailed information with stakeholder’s need for the development of a conceptual test facility to fulfill to the aim of the thesis.  Findings The findings suggest that there exists a need for implementing test facilities in manufacturing companies with chemical production processes. To transform production processes to meet external demands, companies must experiment with new innovations before implementation. A test facility could increase the efficiency when transforming and improving chemical production processes as well as strengthen the knowledge within the company for organizational development.  Furthermore, findings contributed with the development of a conceptual test facility adapted to the case company’s chemical production process. This facility was constructed increase the company’s ability for conducting quality and development test of their current state production process. Bakgrund Det existerar ett yttre krav som tvingar tillverkningsindustrin att öka sin hållbarhet. För att tillverkande företag ska förbli konkurrenskraftiga är det nödvändigt att omvandla sin organisation och verksamhet för att bli mer hållbart lyhörd. För dem att bemöta de yttre kraven på hållbart utövande inom tillverkningsindustrin behöver företag hitta nya innovativa lösningar för sina produktionsprocesser.  Att implementera nya processinnovationer i produktionsprocesser kan vara en osäker uppgift för företag att hantera. För att minska osäkerheten är det viktigt att experimentera med olika lösningar innan implementering. För att genomföra experiment på ett effektivt och säkert sätt kan företag använda simulering för att validera processinnovationer innan implementering.  Det finns olika simuleringsmetoder som ett företag kan använda. Fysiska simuleringar används när ett företag har produktionsprocesser som inte kan simuleras via en dator. Fysiska simulering genomförs i testanläggningar där företag kan analysera materialbeteende i produktionsprocess i laboratorieskala.  Forskningsfrågor F1: Vilket behov för testanläggningar existerar i tillverkningsföretag?  F1: Vilka fördelar kan erhållas genom att använda testanläggningar?  Mål M1: Identifiera intressentbehoven och utifrån dessa behov utveckla en konceptuell testanläggning anpassad till företaget.  Metod För att svara på forskningsfrågorna och uppfylla målet med studien genomfördes en litteraturstudie och en fallstudie. Litteraturstudien undersökte behovet och fördelarna med att utföra fysiska simuleringar i testanläggningar när nya innovation i produktionsprocesser ska implementeras för att möta hållbarhetskraven.  Fallstudien genomfördes på Volvo Construction Equipment i Hallsberg där behovet av att implementera en testanläggning för deras kemiska produktionsprocess undersöktes tillsammans med vilka fördelar en sådan anläggning kan bidra med. Fallstudien medförde också information med intressenters behov vid utvecklingen av en konceptuell testanläggning för att uppfylla avhandlingens mål.  Resultat Resultaten tyder på att det finns ett behov av att implementera testanläggningar i tillverkande företag med kemiska produktionsprocesser. För att omvandla produktionsprocesser för att bemöta de yttre kraven måste företag experimentera med nya innovationer innan de implementeras. En testanläggning skulle kunna öka effektiviteten vid omvandling och förbättring av kemiska produktionsprocesser samt stärka kunskapen inom företaget för utveckling av organisationen.  Dessutom bidrog resultaten till utvecklingen av en konceptuell testanläggning anpassat till det studerade företagets kemiska produktionsprocess. Denna anläggning konstruerades för att öka företagets förmåga att genomföra kvalitets- och utvecklingstest av deras nuvarande produktionsprocess.

”Om jag kan få barn att förstå det magiska med boken… då kommer jag göra en jättestor skillnad.” : En studie om hur förskollärare resonerar om sitt arbete med utformningen av en stimulerande läsmiljö.

Syftet med den här studien är att belysa hur förskollärare resonerar om och arbetar med utformningen av den stimulerade läsmiljön i förskoleverksamheten. Undersökningen riktar sig mot förskollärare som är verksamma i förskolan och arbetar med barn mellan ett och fem år. Utifrån syftet har tre frågeställningar formulerats. Frågorna berör inredning och utformning av rummet, samarbetet med hem och bibliotek samt på vilket sätt boken används i verksamheten. I studien har en kvalitativ metod använts och empirin har samlats in med semistrukturerade intervjuer. Studien tar sin utgångspunkt i en sociokulturell teori där relevanta begrepp för studien lyfts fram. Intervjumaterialet har transkriberats och har därefter ordnats tematiskt i fyra olika kategorier. Vårt resultat tyder på att förskolors samarbete med bibliotek är en central del i skapandet för stimulerande läsmiljöer. Biblioteket är dock inget som förskolorna kontinuerligt besöker med barngruppen. Resultatet visar att tillgänglighet av böcker i läsmiljön är viktig för barnen och att förskollärare strävar efter att visa ett intresse och engagemang för böcker. Boken används på olika sätt och i olika sammanhang i verksamheten som bland annat i temaarbeten, i relationsskapande och för att främja barnens språkutveckling. Resultatet synliggör att det blir tydligt att böcker som visar sin framsida och är lättillgängliga fångar barnens intresse, vilket bidrar till ett mer aktivt användande av boken. Det blir även enklare för förskollärarna att se vilka böcker som används mest av barnen. The purpose of this study is to analyze how preschool teachers resonate and work with the design of a stimulated reading environment in preschools activities. The survey aims for preschool teachers who work in preschools with children in the ages 1-5. Three questions have been formulated based on the purpose. The questions concern the interior and design of a room, the cooperation with the home and library and the way the book is used in the activities. The study is carried out by a qualitative method and the empirical has been collected with semi-structured interviews. The study is based on a sociocultural theory where relevant concepts for the study is highlighted. The interview material has been transcribed and has been arranged in four different categories. Our result indicates that preschools’ collaboration with libraries is a central part of the creation of stimulating reading environments. However, the library is not something that preschools continuously visit with the children's group. The results show that accessibility of books in the reading environment is important for children and that preschool teachers strive to show an interest and commitment to books. The book is used in different ways and in different contexts in the activities, including in thematic work, as a relationship creation and to promote children's language development. The result also makes it clear that books that show their front page and are easily accessible, capture children's interest and contribute to a more active use of the book. It also makes it easier for preschool teachers to see which types of books children used the most. 

The development of a conceptual test facility : A case study

Background There exist an external demand forcing the manufacturing industry to increase their sustainable practice. For manufacturing companies to stay competitive it is necessary for them to transform their organization and operation to be more sustainably responsive. To meet the external demand for sustainable practice in the manufacturing industry, companies need to find new innovative solutions for their production processes.  Implementing new process innovations in production processes can be an uncertain task for companies to manage. To reduce the uncertainty, it is important to experiment with different solutions before implementation. To conduct experiments in an efficient and safe way, companies can use the tool simulation to validate process innovations before implementation.  There exist different simulation methods a company can use. Physical simulations are used when a company have production processes that cannot be simulated through a computer. Physical simulations are conducted in test facilities where companies can analyze material behavior in a laboratory scale production process.  Research questions RQ1: What need exists for test facilities in manufacturing companies?  RQ2: What benefits can be obtained using test facilities?  Aim A1: Identify stakeholder needs and based on these needs develop a conceptual test facility adapted to the case company.  Method To answer the research questions and fulfill the aim of the study, a literature review and a case study was conducted. The literature review explored the need and benefits of conducting physical simulations in test facilities when implementing new innovations in production processes to meet the demand for sustainability.  The case study was conducted at Volvo Construction Equipment in Hallsberg where the need to implement a test facility for their chemical production process was explored together with the benefits such a facility might contribute with. The case study also entailed information with stakeholder’s need for the development of a conceptual test facility to fulfill to the aim of the thesis.  Findings The findings suggest that there exists a need for implementing test facilities in manufacturing companies with chemical production processes. To transform production processes to meet external demands, companies must experiment with new innovations before implementation. A test facility could increase the efficiency when transforming and improving chemical production processes as well as strengthen the knowledge within the company for organizational development.  Furthermore, findings contributed with the development of a conceptual test facility adapted to the case company’s chemical production process. This facility was constructed increase the company’s ability for conducting quality and development test of their current state production process. Bakgrund Det existerar ett yttre krav som tvingar tillverkningsindustrin att öka sin hållbarhet. För att tillverkande företag ska förbli konkurrenskraftiga är det nödvändigt att omvandla sin organisation och verksamhet för att bli mer hållbart lyhörd. För dem att bemöta de yttre kraven på hållbart utövande inom tillverkningsindustrin behöver företag hitta nya innovativa lösningar för sina produktionsprocesser.  Att implementera nya processinnovationer i produktionsprocesser kan vara en osäker uppgift för företag att hantera. För att minska osäkerheten är det viktigt att experimentera med olika lösningar innan implementering. För att genomföra experiment på ett effektivt och säkert sätt kan företag använda simulering för att validera processinnovationer innan implementering.  Det finns olika simuleringsmetoder som ett företag kan använda. Fysiska simuleringar används när ett företag har produktionsprocesser som inte kan simuleras via en dator. Fysiska simulering genomförs i testanläggningar där företag kan analysera materialbeteende i produktionsprocess i laboratorieskala.  Forskningsfrågor F1: Vilket behov för testanläggningar existerar i tillverkningsföretag?  F1: Vilka fördelar kan erhållas genom att använda testanläggningar?  Mål M1: Identifiera intressentbehoven och utifrån dessa behov utveckla en konceptuell testanläggning anpassad till företaget.  Metod För att svara på forskningsfrågorna och uppfylla målet med studien genomfördes en litteraturstudie och en fallstudie. Litteraturstudien undersökte behovet och fördelarna med att utföra fysiska simuleringar i testanläggningar när nya innovation i produktionsprocesser ska implementeras för att möta hållbarhetskraven.  Fallstudien genomfördes på Volvo Construction Equipment i Hallsberg där behovet av att implementera en testanläggning för deras kemiska produktionsprocess undersöktes tillsammans med vilka fördelar en sådan anläggning kan bidra med. Fallstudien medförde också information med intressenters behov vid utvecklingen av en konceptuell testanläggning för att uppfylla avhandlingens mål.  Resultat Resultaten tyder på att det finns ett behov av att implementera testanläggningar i tillverkande företag med kemiska produktionsprocesser. För att omvandla produktionsprocesser för att bemöta de yttre kraven måste företag experimentera med nya innovationer innan de implementeras. En testanläggning skulle kunna öka effektiviteten vid omvandling och förbättring av kemiska produktionsprocesser samt stärka kunskapen inom företaget för utveckling av organisationen.  Dessutom bidrog resultaten till utvecklingen av en konceptuell testanläggning anpassat till det studerade företagets kemiska produktionsprocess. Denna anläggning konstruerades för att öka företagets förmåga att genomföra kvalitets- och utvecklingstest av deras nuvarande produktionsprocess.

Saliva Cortisol in Girls With Functional Abdominal Pain Disorders : A Randomized Controlled Dance and Yoga Intervention.

INTRODUCTION: Functional abdominal pain disorders (FAPDs) are common among girls and has been associated with stress. Cortisol is one of the major stress hormones. Dance and yoga have been shown to reduce abdominal pain among girls with FAPDs. AIM: To investigate the effect of an 8-month intervention with dance and yoga on cortisol levels in saliva among girls with FAPDs. METHODS: A total of 121 girls aged 9-13 years with irritable bowel syndrome (IBS) or functional abdominal pain were included in the study. Participants were randomized into an intervention group and a control group. The intervention group attended a combined dance and yoga session twice a week for 8 months. Saliva samples were collected during 1 day, in the morning and evening, at baseline, and at 4 and 8 months. Subjective pain and stress were assessed as well. RESULTS: No significant effects on saliva cortisol levels between groups were observed after completion of the intervention at 8 months. However, evening cortisol and evening/morning quotient were significantly reduced at 4 months in the intervention group compared to the control group (p = 0.01, p = 0.004). There was no association between cortisol quota and pain or stress. CONCLUSION: Improvements in cortisol levels were seen in the intervention group at 4 months but did not persist until the end of the study. This indicates that dance and yoga could have a stress-reducing effect during the ongoing intervention

Tio »väsentliga aktiviteter« framtagna för läkarprogrammen

De 10 EPA som presenteras här (Fakta 1) har tagits fram av läkare och studenter som representerar läkarutbildningarna vid samtliga lärosäten. Utvecklingsarbetet baserades på internationell litteratur och förslagen har genomgått valideringsprocesser [2]. Samtliga avser aktiviteter som ingår i en läkares dagliga arbete och som läkaren ska klara självständigt (i förhållande till handledare) första dagen som legitimerad läkare. Det är samtidigt viktigt att poängtera att de bara täcker in en del av examensmålen för läkare

Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with Type 1 diabetes in Sweden from 2011 to 2016 : A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS)

Objective: This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as body mass index standard deviation scores (BMI-SDS) in a nationwide sample of children and adolescents with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively. Research Design and Methods: Longitudinal data from 2011 to 2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia. Results: Data were available from 35,624 patient-years (54% boys). In general, HbA1c decreased approximately 0.5% (2–5 mmol/mol) from 2011 to 2016 (ptrend < 0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7–1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011–2016. Conclusions: There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control

An Intervention With Dance and Yoga for Girls With Functional Abdominal Pain Disorders (Just in TIME) : Protocol for a Randomized Controlled Trial

Background: Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus. Objective: This study aims to evaluate the effects of a dance and yoga intervention among girls aged 9 to 13 years with FAPDs. Methods: The study is a prospective randomized controlled trial among girls aged 9 to 13 years with functional abdominal pain, irritable bowel syndrome, or both. The target sample size was 150 girls randomized into 2 arms: an intervention arm that receives dance and yoga sessions twice weekly for 8 months and a control arm that receives standard care. Outcomes will be measured at baseline and after 4, 8, 12, and 24 months, and long-term follow-up will be conducted 5 years from baseline. Questionnaires, interviews, and biomarker measures, such as cortisol in saliva and fecal microbiota, will be used. The primary outcome is the proportion of girls in each group with reduced pain, as measured by the faces pain scale-revised in a pain diary, immediately after the intervention. Secondary outcomes are gastrointestinal symptoms, general health, mental health, stress, and physical activity. The study also includes qualitative evaluations and health economic analyses. This study was approved by the Regional Ethical Review Board in Uppsala (No. 2016/082 1-2). Results: Data collection began in October 2016. The intervention has been performed in 3 periods from 2016 through 2019. The final 5-year follow-up is anticipated to be completed by fall 2023. Conclusions: Cost-effective and easily accessible interventions are warranted to reduce the negative consequences arising from FAPDs in young girls. Physical activity is an effective strategy, but intervention studies are needed to better understand what types of activities facilitate regular participation in this target group. The Just in TIME (Try, Identify, Move, and Enjoy) study will provide insights regarding the effectiveness of dance and yoga and is anticipated to contribute to the challenging work of reducing the burden of FAPDs for young girls

Dance and yoga reduced functional abdominal pain in young girls : A randomized controlled trial

Background Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio-respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain. Objectives The aim of this study was to evaluate the effect of a dance and yoga intervention on maximum abdominal pain in 9- to 13-year- old girls with FAPDs. Methods This study was a prospective randomized controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale–Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes. Results Dance and yoga were superior to standard health care alone, with a medium to high between-group effect size and significantly greater pain reduction (b = −1.29, p = 0.002) at the end of the intervention. Conclusions An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9- to 13-year-old girls with FAPDs. Significance FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group