Ability in everyday activities and morale among older women with chronic musculoskeletal pain living alone : a behavioural medicine approach in physiotherapy

The overall purpose of this thesis was to utilise a behavioural medicine approach in physiotherapy to study how older women with chronic musculoskeletal pain, who live alone and are dependent on formal care, perceive their everyday lives and to explore how their ability to perform everyday activities and morale could be promoted. Method: This thesis used a descriptive, correlative design (Study I), a randomised two-group design (Study III) and a qualitative inductive explorative design (Study II and IV). Participants in Studies I-III: Older women (≥65 years) with chronic musculoskeletal pain, who live alone, are able to walk with or without walking aids indoors and are dependent on formal care to manage their everyday lives. Study IV: Home help service staff who were involved in study III. Results: The results showed that many different factors appeared to have impact on the women’s health, everyday activities and morale. The target group of older women seemed to report the same pain-related problems, the same degree of pain-related disability and the same beliefs as those found in previous research on older individuals with chronic pain conditions. Despite their chronic musculoskeletal pain and other health complaints as well as their dependencies on others to manage their everyday lives, the results show how important it was for the women to live at home for as long as possible. A key factor in promoting the ability to perform everyday activities among the women was having a daily rhythm in a supportive environment. Another key factor in this context was the home help service staff, who had a strong will and desire to promote their care recipients’ independence and quality of life. Nonetheless, the resource that the staff represent could most likely be utilised in a better way. The behavioural medicine in physiotherapy intervention showed that more support from physiotherapists and home help services staff is needed to enhance the effect of this type of intervention among the target group. Nevertheless, the results imply that this type of intervention may improve levels of physical activity, self- efficacy in relation to exercise and management of everyday life, but further research is needed in larger samples. Conclusions: This thesis demonstrates that there are many different factors that seem to affect the women’s health, ability in everyday activities and morale. The women describe how their ability in everyday activities can be promoted by performing their everyday activities in a daily rhythm, and home help service staff are a key resource in this context. Moreover, physical activity, self-efficacy in relation to exercise and management of everyday life can be improved by a behavioural medicine-based physiotherapy intervention in the target group. To promote the women’s abilities in everyday activities, to improve their morale and, in the end, to enable the target group of women to be “ageing in place” in the best possible way, society and health care professionals may have to pay them special attention

Married Women in Legal Practice : Agency and Norms in the Swedish Realm 1350-1450

This book describes the ways in which married women appeared in legal practice in the medieval Swedish realm 1350-1450, through both the agency of women, and through the norms that surrounded their actions. Since there were no court protocols kept, legal practice must be studied through other sources. For this book, more than 6,000 original charters have been researched, and a database of all the charters pertaining to women created. This enables new findings from an area that has previously not been studied on a larger scale, and reveals trends and tendencies regarding aspects considered central to married women’s agency, such as networks, criminal liability, and procedural capacity.Peer reviewe

The Legal Guardian and Married Women : Norms and Practice in the Swedish Realm 1350-1450

The purpose of this dissertation is to research the guardian (Sw. malsman) and the guardianship in the Swedish realm 1350-1450, with focus on how this affected married women’s legal capacity. The purpose is reached by comparing written law with practice. The medieval Swedish word malsman is usually translated into legal guardian, which is also the modern meaning of the word. In Magnus Eriksson’s Law of the Realm from 1350 – the first law to apply to the whole realm – it was stated that a husband should be the malsman of his wife once they were married. The malsman and guardianship are therefore frequently used in research on medieval and early modern women as an explanatory model for the gender related hierarchies within marriage. According to this, the husband, as malsman, was his wife’s legal representative, and supposed to represent her in all legal matters. By studying the history of the malsman, in the laws preceding the Law of the Realm, I provide evidence of that the malsman system was introduced into the realm wide legislation through the regional law of Östergötland, in southern Sweden. I further show that the only regional laws in which a malsman, and a gendered legal guardianship over women, even existed were the laws of the Göta regions in the south. In the laws of the Svea regions, in the north, neither the word malsman nor the function of the husband as guardian can be found. Since the Law of the Realm came to be derived from both the regional law of Östergötland and that of the northern region Uppland – of which only the former recognized the malsman system – the new law became an equivocal compromise regarding the legal capacity of women. According to the law, married women were legally able and had procedural capacity, but the husband was still malsman. In order to compare the law with practice, I have read more than 6000 original charters. Based on these, I have created a database containing all the charters in any way concerning women from 1350-1450. The database contains closer to 3700 charters, and enables statistical calculations of women’s de facto actions in a multitude of legal matters. Through these statistics, it becomes obvious that married women could represent themselves at the assembly (Sw. ting), and participate in legal rituals, and that they hence were legally able and had the procedural capacity described in the law also in practice. My dissertation also shows that married women had control over their own landed property, that they were especially active in donations, and that women by no means were passive transmitters of land between men as has been argued by previous research. Women could, and did benefit from what they owned. My dissertation further shows that women, regardless of marital status, participated in legal matters to a far lesser extent than what men did. Even if women had legal capacity, law and legal matters were still a heavily male dominated area. This can, however, not be tied to the malsman system even by the middle of the 15th century. The system incorporated into the Law of the Realm, from the Göta regions, had not spread to the rest of the realm in practice even a hundred years after the creation of the law. The hierarchies within marriage had significant regional differences during the whole period studied here, and a uniform malsman system did not exist.Syftet med den här avhandlingen är att undersöka målsmannen och målsmanskapet i Sverige 1350–1450, med särskilt fokus på hur målsmanskapet påverkade gifta kvinnors rättsliga kapacitet. Syftet uppnås genom att jämföra lag och praxis. I Magnus Erikssons Landslag från 1350 – den första rikstäckande lagen – stod det att en man skulle vara sin hustrus målsman när de hade gift sig. Målsmannen och målsmanskapet figurerar därför flitigt i studier av medeltida och tidigmoderna kvinnor som förklaringsmodell till de genusrelaterade hierarkierna inom äktenskapet. Enligt detta skulle maken, i egenskap av målsman, vara sin hustrus lagliga ombud och representera henne i rättsliga angelägenheter, samt vara den som disponerade hennes egna och hela hushållets gemensamma jordegendomar. Genom att undersöka målsmannens historia i de lagar som föregick rikslagen, landskapslagarna, kan jag emellertid påvisa att målsmanssystemet infördes i landslagen via Östergötlands landskapslag. De enda landskapslagarna som överhuvudtaget kände till målsmanskapet och ett manligt förmyndarskap över kvinnor hörde till Götaregionen, och i Svearegionens landskapslagar fanns varken ordet ”målsman” eller själva systemet med manliga förmyndare (legal guardians) för kvinnor. Eftersom landslagen kom att baseras primärt på Östgötalagen och Upplandslagen – av vilka den senare inte kände till målsmanskapet – blev den nya lagen en tvetydig kompromiss beträffande kvinnors rättsliga kapacitet. Enligt lagen var gifta kvinnor myndiga och hade processbehörighet, men maken var likväl målsman. För att kunna jämföra lagen med praxis har jag läst över 6 000 urkunder i original, och utgående ifrån dessa skapat en databas innehållande alla urkunder som på något vis rör kvinnor från 1350–1450. Databasen, som kom att innehålla närmare 3 700 urkunder, möjliggör statistiska beräkningar av kvinnors faktiska deltagande i en lång rad rättsliga ärenden. På så vis blir det uppenbart att gifta kvinnor kunde representera sig själva på tinget och delta i juridiska ritualer, och att de därmed var myndiga och hade processbehörig så som lagen föreskrev även i praxis. Min avhandling visar också hur gifta kvinnor disponerade sin egen jord, att de var särskilt aktiva när det gällde donationer samt att kvinnor ingalunda var passiva överförare av jordegendomar mellan män utan att de hade rättslig kapacitet att själva dra nytta av vad de ägde. Avhandlingen visar dock också att kvinnor, oavsett civilstatus, deltog i rättsliga ärenden i betydligt mindre utsträckning än vad män gjorde. Även om kvinnor hade rättskapacitet var juridiska angelägenheter företrädesvis männens arena. Detta kan dock inte ännu vid 1450 knytas till målsmanskapet. Det system som kommit in i lagen från Götaregionen hade nämligen inte under de första hundra åren efter lagens tillblivande i praxis spridit sig över resten av riket. Hierarkierna inom äktenskapet hade stora regionala skillnader under hela undersökningsperioden och något enhetligt målsmanssystem står inte att finna

Rifting in heterogeneous lithosphere inferences from numerical modeling of the northern North Sea and the Oslo Graben.

Permian rifting and magmatism are widely documented across NW Europe. The different Permian basins often display contrasting structural styles and evolved in lithospheric domains with contrasting past evolution and contrasting thermotectonic ages. In particular, the Oslo Graben and the northern North Sea rift initiated in close areas of northern Europe. The Oslo Graben evolved in the cold and stable Precambrian lithosphere of Fennoscandia, whereas the northern North Sea rift took birth in freshly reworked Caledonian lithosphere. Huge volumes of magmatic rocks characterize the relatively narrow Oslo Graben. In contrast, little magmatism is documented for the wide northern North Sea rift. Differences in timing between both rifts are inferred but still debated. We present numerical thermomechanical models along a lithospheric E-W section that involves both the Oslo Graben and the northern North Sea area. Because the modeled section crosses the boundary between Caledonian and Proterozoic provinces, thermal and compositional heterogeneities are considered. As is suggested by various geophysical data sets, we also consider lithospheric thickness heterogeneities in the Precambrian lithosphere. Modeling results suggest that the northern North Sea was on top of "weak" lithosphere very sensitive to far-field stresses. Consequently, we suggest that rifting in the northern North Sea began as early as regional extension was effective (i.e., Late Carboniferous-Early Permian) and does not postdate the Oslo Graben as it is commonly assumed. Rifting in the "strong" Precambrian lithosphere is unexpected. Modeling results suggest that a pre-existing lithospheric thickness contrast within the Fennoscandian lithosphere favored rifting in the Oslo Graben

Linking the northern Alps with their foreland: The latest exhumation history resolved by low-temperature thermochronology

The evolution of the Central Alpine deformation front (Subalpine Molasse) and its undeformed foreland is recently debated because of their role for deciphering the late orogenic evolution of the Alps. Its latest exhumation history is poorly understood due to the lack of late Miocene to Pliocene sediments. We constrain the late Miocene to Pliocene history of this transitional zone with apatite fission track and (U-Th)/He data. We used laser ablation inductively coupled mass spectrometry for apatite fission track dating and compare this method with previously published and unpublished external detector method fission track data. Two investigated sections across tectonic slices show that the Subalpine Molasse was tectonically active after the onset of folding of the Jura Mountains. This is much younger than hitherto assumed. Thrusting occurred at 10, 8, 6–5 Ma and potentially thereafter. This is contemporaneous with reported exhumation of the External Crystalline Massifs in the central Alps. The Jura Mountains and the Subalpine Molasse used the same detachments as the External Crystalline Massifs and are therefore kinematically coupled. Estimates on the amount of shortening and thrust displacement corroborate this idea. We argue that the tectonic signal is related to active shortening during the late stage of orogenesis

Prevalence of Foxp3 Positive T Regulatory Cells is Increased during Progression of Cutaneous Squamous Tumors

cells (Tregs) have a functionally immunosuppressive property that prevents effector cells from acting against self in autoimmune diseases or a tumor. It is known that Tregs may be highly relevant in cancer progression. Dendritic cells (DCs) induce cutaneous immune response, however several studies have suggested that DCs are involved in immunosuppression. The aim of this study is to evaluate the prevalence of Tregs and DCs infiltration in cutaneous premalignant and malignant squamous lesions. Materials and Methods: We evaluated Tregs and DCs in skin tissue samples obtained from 83 patients with actinic keratosis, Bowen's disease or squamous cell carcinoma by immunohistochemistry. Results: The prevalence of Tregs and DCs was significantly higher in squamous cell carcinoma and Bowen's disease than in actinic keratosis. In addition, the number of DCs was closely correlated with the prevalence of Tregs, and DCs were also located in direct proximity to Tregs. Conclusion: Tregs is related to cutaneous squamous tumor progression. Key Words: Forkhead box p3, T regulatory cells, skin tumo

OX40 is required for regulatory T cell–mediated control of colitis

The immune response in the gastrointestinal tract is a tightly controlled balance between effector and regulatory cell responses. Here, we have investigated the role of OX40 in influencing the balance between conventional T cells and Foxp3+ regulatory T (T reg) cells. Under steady-state conditions, OX40 was required by T reg cells for their accumulation in the colon, but not peripheral lymphoid organs. Strikingly, under inflammatory conditions OX40 played an essential role in T reg cell–mediated suppression of colitis. OX40−/− T reg cells showed reduced accumulation in the colon and peripheral lymphoid organs, resulting in their inability to keep pace with the effector response. In the absence of OX40 signaling, T reg cells underwent enhanced activation-induced cell death, indicating that OX40 delivers an important survival signal to T reg cells after activation. As OX40 also promoted the colitogenic Th1 response, its expression on T reg cells may be required for effective competition with OX40-dependent effector responses

Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study

Purpose: Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program. Patients and Methods: A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤ 0.01 was considered as statistically significant. Results: The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p 0.10). Conclusion: These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program