Mats Sjöling

Effectiveness of motivational interviewing and physical activity on prescription on leisure exercise time in subjects suffering from mild to moderate hypertension

BackgroundPhysical inactivity is considered to be the strongest individual risk factor for poor health in Sweden. It has been shown that increased physical activity can reduce hypertension and the risk of developing cardiovascular diseases. The objective of the present pilot study was to investigate whether a combination of Motivational Interviewing (MI) and Physical Activity on Prescription (PAP) would increase leisure exercise time and subsequently improve health-related variables.MethodsThis pilot study was of a repeated measures design, with a 15 months intervention in 31 patients with mild to moderate hypertension. Primary outcome parameter was leisure exercise time and secondary outcome parameters were changes in blood pressure, Body Mass Index (BMI), waist circumference, lipid status, glycosylated haemoglobin (HbA1c) and maximal oxygen uptake (VO2 max). Assessments of the outcome parameters were made at baseline and after 3, 9 and 15 months.ResultsLeisure exercise time improved significantly from < 60 min/week at baseline to a mean activity level of 300 (± 165) minutes/week at 15 months follow up. Furthermore, statistically significant improvements (p < 0.05) were observed in systolic (-14,5 ± 8.3 mmHg) and diastolic blood pressure (-5,1 ± 5.8 mmHg), heart rate (-4.9 ± 8.7 beats/min, weight (-1.2 ± 3.4 kg) BMI -0.6 ± 1.2 kg/m2), waist circumference (-3.5 ± 4.1 cm) as well as in VO2 max (2.94 ± 3.8 ml/kg and 0.23, ± 0.34 lit/min) upon intervention as compared to baseline.ConclusionsA 15 month intervention period with MI, in combination with PAP, significantly increased leisure exercise time and improved health-related variables in hypertensive patients. This outcome warrants further research to investigate the efficacy of MI and PAP in the treatment of mild to moderate hypertension.

Decreased Risk for Violence in Patients Admitted to Forensic Care, Measured With the HCR-20

AIM The aim of this study was to explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the clinical (C) and risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data. METHODS The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment. RESULTS The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce. CONCLUSION The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patients risk for violence in order to work with the patients specific risk factors to reduce the risk.

The SKYNET data: Demography and injury reporting in Swedish skydiving

BACKGROUND The Swedish Parachute Association (SFF) national registry of skydiving injuries is one of the few trauma databases available for research on sport parachuting. The usefulness of this compulsory reporting system may benefit from a description of its base population and an evaluation of its sensitivity and specificity. METHODS Cross-sectional analysis based on data collected through a web-based questionnaire (SKYNET), from all persons renewing a Swedish skydiving license 2008 (n=1049). Sensitivity was measured as the proportion of injury events fulfilling the reporting criterion (injury event requiring care of a physician) that were actually reported, by comparing the injury events reported to the SFF during the skydiving seasons 2006 and 2007 with the injury events retrospectively reported to the web-based questionnaire for the same time period. Specificity was measured as the proportion of false positives in relation to the defined reporting criterion for the same time period. Self-stated bone fractures, shoulder dislocations and cruciate ligament injuries were labeled as non-minor injuries. Factors affecting the likelihood of reporting were evaluated using logistic regression. RESULTS The response rate was 100%. The overall sensitivity of the reporting system 2006/2007 was 0.37 (95% confidence interval (CI) 0.24-0.51). With self-stated non-minor injuries as the target for reporting, the sensitivity was 0.67 (95% CI 0.43-0.85). No significant effect on reporting was found for gender, age, license level, years in the sport, total number of jumps or club affiliation. The specificity was 0.91 (95% CI 0.83-0.95). Descriptive statistics of the Swedish skydiving population show several gender differences. CONCLUSIONS The low sensitivity will yield false low incidence calculations, but as there is no evidence for differential underreporting, risk comparisons related to the candidate predictor variables appear reasonably valid. The false positive reporting warrants assortment of incoming data and a clarification of the reporting criteria. Attitudes to reporting may be of value to study, to understand the drivers and constraints for achieving a more complete notification of skydiving injuries.

Women’s postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section

AIM The aim was to evaluate a new anaesthetic routine and to study the effect of spinal opioids for caesarean section on postoperative pain, expectations of pain, satisfaction with pain treatment, breastfeeding, infant care and length of hospital stay. BACKGROUND Inadequate postoperative pain relief is a problem among hospitalised patients. Women undergoing caesarean section have been shown to experience high levels of pain during the first days after operation. Women are expected to breastfeed and care for their newborn while recovering from major abdominal surgery and sufficient pain relief are of importance. DESIGN Comparative patient survey. METHODS Data were collected through a questionnaire distributed to two independent samples of women undergoing elective and emergency caesarean section before and after the introduction of an additive of opioids in obstetric spinal anaesthesia. Chi-square tests were performed, and risk ratios were used for bivariate analysis. Logistic regression modelling was used for multivariate analysis. RESULTS The group of women undergoing caesarean section with opioids added to the spinal anaesthesia reported significantly lower levels of experienced pain. High pain levels irrespective of mode of caesarean section affected breastfeeding and infant care. Length of hospital stay for caesarean women was shortened and the consumption of analgesics was reduced. CONCLUSIONS Women receiving an additive of opioids in spinal anaesthesia experienced lower levels of pain. Low pain levels facilitate breastfeeding and infant care and are of relevance for financial considerations. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate that spinal opioids for women undergoing caesarean section have a positive effect on the postoperative pain experience. Women undergoing caesarean section and have high pain levels are in special need of attention and care because of a higher risk of a decreased ability to breastfeed and to take care of their newborn.

P02.128. The effects of guided imagery on preoperative anxiety and pain management in patients undergoing Laparoscopic Cholecystectomy in a multi-centre RCT study

PurposeLaparoscopic Cholecystectomy (LC) is common practicein treatment of symptomatic gall stones. LC is often associatedwith preoperative anxiety and stress which maynegatively impact postoperative pain perception andrecovery from surgery. The aim of the present study wasto investigate whether a “non-pharmacological” interventionwith guided imagery can reduce preoperative anxiety,postoperative pain perception and medication comparedto standard care in patients undergoing LC.MethodsIn a pragmatic multi-centre randomized controlled study140 patients were randomized to a Guided Imagery (GI)group or control group. The GI group was provided witha CD to practice guided imagery once a day, 7 days priorto surgery. Patients in the control group received standardcare instructions only. Primary outcome measurement wasthe use of postoperative analgesics. Secondary outcomeparameters were preoperative anxiety levels using theAmsterdam Preoperative Anxiety and Information Scale(APAIS), postoperative pain perception (VAS-scale), generalpatient satisfaction (PSQ) and safety (adverse events)with treatment.Results95 out of 140 randomized patients completed the study,43 in the GI and 52 in the control group. The major reasonsfor dropping out were acute LCs or cancellation ofLC. Both groups were highly comparable with respect todemographic data. The majority was female (GI: 77%,Control: 75%). Postoperative morphine use was not significantlydifferent between the GI (15.8±18.5 mg) andcontrol group (12.5±13.6 mg, p=0.34). No significant differenceswere observed in anxiety and postoperative VASscores. Twenty-three percent of patients did exercises1-3 times, 65% 4-7 times and 12% >7 times. Within GIgroup analysis showed significantly less postoperativemorphine use upon better compliance to GI exercises(p=0.02).ConclusionIt is not as simple as replacing a pill with a CD. GuidedImagery seems to reduce postoperative pain medicationonce compliance to imagery exercises is achieved.

P02.185. The effects of tactile massage (TM) on blood pressure, heart rate and blood glucose in a sample of women suffering from primary insomnia.

The overall objective of this pilot study was to study the direct effects of tactile massage (TM) on blood pressure, heart rate and blood glucose in a sample of women suffering from primary insomni ...