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Xiu, L., Hagströmer, M., Bergqvist-Norén, L., Johansson, E., Ekbom, K., Svensson, V., . . . Ekstedt, M. (2019). Development of sleep patterns in children with obese and normal-weight parents. Journal of Paediatrics and Child Health, 55(7), 809-818
Open this publication in new window or tab >>Development of sleep patterns in children with obese and normal-weight parents
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2019 (English)In: Journal of Paediatrics and Child Health, ISSN 1034-4810, E-ISSN 1440-1754, Vol. 55, no 7, p. 809-818Article in journal (Refereed) Published
Abstract [en]

Aim

To study the sleep development and sleep characteristics in children at different obesity risks, based on parental weight, and also to explore their weekday–weekend sleep variations and associated family factors.

Methods

A total of 145 children participating in a longitudinal obesity prevention project were included, of which 37 had normal‐weight parents (low obesity risk), and 108 had overweight/obese parents (high obesity risk). Sleep diaries at ages 1 and 2 years were used to study sleep development in children at different obesity risks. Objectively assessed sleep using an accelerometer at 2 years of age was used to analyse weekday–weekend sleep variations.

Results

There was no difference in sleep development from age 1 to age 2 among children at different obesity risks, but more children in the high‐risk group had prolonged sleep onset latency and low sleep efficiency. At 2 years of age, children in the high‐risk group had more weekday–weekend variation in sleep offset (mean difference 18 min, 95% confidence interval (CI) 4–33 min), midpoint of sleep (mean difference 14 min, 95% CI 3–25 min) and nap onset (mean difference 42 min, 95% CI 10–74 min) than children in the low‐risk group, after adjusting for other family factors. However, no difference could be detected between groups in weekday–weekend variation in sleep duration.

Conclusions

Unfavourable sleep characteristics, as well as more variation in sleep schedules, have been observed in children at high obesity risk. While the differences were relatively small, they may reflect the unfavourable sleep hygiene in families at high obesity risk.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
child sleep, childhood obesity, sleep variation
National Category
Pediatrics
Research subject
Health and Caring Sciences, Nursing; Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-79268 (URN)10.1111/jpc.14294 (DOI)000473989600012 ()30414228 (PubMedID)2-s2.0-85056308655 (Scopus ID)
Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2019-08-29Bibliographically approved
Ekstedt, M., Schildmeijer, K., Wennerberg, C., Nilsson, L., Wannheden, C. & Hellström, A. (2019). Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer. JMIR Research Protocols, 8(3), 1-13, Article ID e11625.
Open this publication in new window or tab >>Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 3, p. 1-13, article id e11625Article in journal (Refereed) Published
Abstract [en]

Background: Prostate cancer has increased in incidence worldwide and is the leading cause of cancer death in 24 countries. The most common treatment is radical prostatectomy. However, surgery is associated with postoperative complications such as urinary incontinence and sexual dysfunction, causing decreased quality of life. If survivors are encouraged to be more active in self-care management, the symptom burden may decrease and quality of life may improve. An electronic health (eHealth) intervention based on motivational behavioral theory has been developed for this purpose.

Objective: This study aimed to compare the effectiveness of standard care in combination with a tailored eHealth and mobile health self-management support system, electronic Patient Activation in Treatment at Home (ePATH), with standard care of adverse effects of prostate cancer treatment (urinary incontinence and sexual functioning) in men undergoing radical prostatectomy. The secondary aim was to test the effect on patient activation, motivation, overall well-being, and health literacy over time in and between groups.

Methods: A pragmatic multicenter, block-randomized controlled trial with 2 study arms, standard care (control) and eHealth-assisted standard care (intervention), for patients undergoing radical prostatectomy. For 80% power, a sample of 242 men will need to be recruited.

Results: Recruitment started in January 2018 and is expected to be completed by August 2019. Data collection will be completed in August 2020. The first cross-sectional results from this trial are anticipated to be published in January 2020.

Conclusions: With the increasing number of prostate cancer survivors, attention should be paid to rehabilitation, psychosocial care, and support for endurance of self-care to reduce suffering from adverse treatment effects, poor quality of life, and depression because of postoperative complications. This project may increase knowledge of how patients can be supported to feel involved in their care and returning to as normal a life as possible. The anticipated effects of ePATH could improve health outcomes for individuals and facilitate follow-up for health care professionals.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
medical informatics, eHealth, mHealth, motivation, patient activation, prostate cancer, self-management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-81619 (URN)10.2196/11625 (DOI)000462890300001 ()30900999 (PubMedID)2-s2.0-85067901358 (Scopus ID)
Funder
The Kamprad Family Foundation, 2015-0067Swedish Cancer Society, CAN 2017/748Medical Research Council of Southeast Sweden (FORSS), FORSS-657211;FORSS-760131
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-08-29Bibliographically approved
Ekstedt, M. & Rustoen, T. (2019). Factors That Hinder and Facilitate Cancer Patients' Knowledge About Pain Management-A Qualitative Study. Journal of Pain and Symptom Management, 57(4), 753-760
Open this publication in new window or tab >>Factors That Hinder and Facilitate Cancer Patients' Knowledge About Pain Management-A Qualitative Study
2019 (English)In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 57, no 4, p. 753-760Article in journal (Refereed) Published
Abstract [en]

Context. Pain management education may improve pain control for some patients, whereas individual differences exist. Objectives. To evaluate possible critical components, facilitators, and hindrances for improved knowledge about pain management, in not hospitalized adult oncology patients with pain from bone metastasis participating in a pain management intervention. Methods. This substudy is a qualitative evaluation of the PRO-SELF Pain Control Program, tested in a randomized controlled trial. During six weeks, 87 participants in the intervention group received tailored coaching encounters by a trained oncology nurse. Three encounters for each patient were audio recorded. The encounter between patient's with the largest (n = 12) and lowest (n = 8) change in knowledge about pain management from before to after the intervention was transcribed verbatim and analyzed with qualitative content analysis. Results. The critical components of the intervention were repetition of information, struggling with resistance, use of peer experiences, and keeping track of variations. Facilitators of improvement were patients' trust and preparedness to try new procedures, the patient's self-awareness and body awareness, and taking active role in own care. Difficulties in processing complex information, culturally conditioned behaviors, fear, and lack of knowledge were the most important barriers to the success of the intervention. Conclusion. Education in pain management in cancer patients requires repeated information, allowing time for overcoming resistance related to dysfunctional beliefs and fear. To facilitate the patient's involvement in their pain management, tailored and person-centered education is needed. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Cancer pain, PRO-SELF Pain Control Program, interview, barriers, facilitators
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81843 (URN)10.1016/j.jpainsymman.2018.12.334 (DOI)000462027900008 ()30593908 (PubMedID)2-s2.0-85061056360 (Scopus ID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Wallerstedt, B. & Ekstedt, M. (2019). Healthcare professionals' perceptions of risk when care is given in patients' homes. Home Healthcare Now, 37(2), 97-105
Open this publication in new window or tab >>Healthcare professionals' perceptions of risk when care is given in patients' homes
2019 (English)In: Home Healthcare Now, ISSN 2374-4529, E-ISSN 2374-4537, Vol. 37, no 2, p. 97-105Article in journal (Refereed) Published
Abstract [en]

Perceptions of risks in decision making for home healthcare were examined. Twenty home healthcare professionals were interviewed. Content analysis yielded one theme (management of known and unpredictable risks) and four categories. Healthcare professionals had to handle both known and unpredictable risks in daily work in patients' homes concerning communication challenges, a fragmented organization at several levels, risky medication management, and balancing respect for patient autonomy and involvement in care against risk taking. Priority must be given to creating safer care in this setting.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81622 (URN)10.1097/NHH.0000000000000717 (DOI)30672823 (PubMedID)2-s2.0-85062417017 (Scopus ID)
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-08-29Bibliographically approved
Kyte, K., Ekstedt, M., Rustoen, T. & Oksholm, T. (2019). Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery.. Journal of Clinical Nursing, 28(9-10), 1546-1554
Open this publication in new window or tab >>Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery.
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 9-10, p. 1546-1554Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs.

BACKGROUND: Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital.

DESIGN: This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ).

METHODS: The information about 14 patients' experiences was collected from semi-structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis.

RESULTS: The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle.

CONCLUSIONS: The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning.

RELEVANCE TO CLINICAL PRACTICE: Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
discharge plan, lung cancer, non-small cell lung cancer, qualitative method, supportive care needs, surgery, symptom burden
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-82606 (URN)10.1111/jocn.14751 (DOI)000468589500016 ()30589147 (PubMedID)2-s2.0-85060046866 (Scopus ID)
Available from: 2019-05-19 Created: 2019-05-19 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Frykholm, O., Kneck, Å. & Ekstedt, M. (2019). Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system. Cancer Nursing, 42(1), E36-E43
Open this publication in new window or tab >>Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system
2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 42, no 1, p. E36-E43Article in journal (Refereed) Published
Abstract [en]

Background

Cancer and its treatment can severely impact quality of life, giving rise to complex needs with respect to follow-up care. To support patient needs and increase efficiency of care with limited resources, the Swedish government has launched national reforms to redesign cancer care pathways.

Objective

The aim of this study was to explore how prostate cancer patients experience their journey through the healthcare system when their care is provided according to the standardized care pathway, as described in healthcare policy documents.

Methods

A qualitative, descriptive approach with individual interviews was used. A template of a standardized prostate cancer pathway, created together with healthcare professionals, was used during interviews. Fourteen interviews were conducted with prostate cancer patients all operated on at a midsized hospital in southeast Sweden between October 2015 and April 2016. The interviews were analyzed with qualitative content analysis and illustrated in a patient journey map.

Results

We identified an overall theme, “walking a tightrope,” consisting of 4 categories: “waiting,” “becoming familiar with a troublesome body,” “adjusting to a different life,” and “information challenges.”

Conclusions

The clinical implementation of the standardized care pathway is described as a straight path through care, but patients described their experiences as walking a tightrope. Lack of information, especially about cancer treatment and its adverse effects, was the most common experience.

Implications for Practice

Our findings indicate areas where further healthcare tools could improve patient experiences of cancer treatment. This could include offering individualized information and tools to increase patient empowerment, as well as patient/caregiver collaboration (co-care).

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-70033 (URN)10.1097/NCC.0000000000000559 (DOI)000453788200010 ()29334523 (PubMedID)2-s2.0-85058698431 (Scopus ID)
Funder
The Kamprad Family Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2019-08-29Bibliographically approved
Göras, C., Olin, K., Unbeck, M., Pukk-Härenstam, K., Ehrenberg, A., Tessma, M. K., . . . Ekstedt, M. (2019). Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ Open, 9(5), 1-12, Article ID e026410.
Open this publication in new window or tab >>Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, p. 1-12, article id e026410Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

SETTING: An OR department at a county hospital in Sweden.

PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

TRIAL REGISTRATION NUMBER: 2016/264.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Complexity, Interruptions, Multitasking, Operating room, Patient safety
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82604 (URN)10.1136/bmjopen-2018-026410 (DOI)000471192800188 ()31097486 (PubMedID)2-s2.0-85065927356 (Scopus ID)
Available from: 2019-05-19 Created: 2019-05-19 Last updated: 2019-08-29Bibliographically approved
Flink, M., Brandberg, C. & Ekstedt, M. (2019). Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing?. Trials, 20, 1-7, Article ID 82.
Open this publication in new window or tab >>Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing?
2019 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, p. 1-7, article id 82Article in journal (Refereed) Published
Abstract [en]

BackgroundDespite worldwide interest in reducing re-hospitalization, there is limited knowledge regarding characteristics of patients who chose to decline participation in such efforts and why. The aim is to explore reasons to decline participation in an intervention using motivational interviewing to reduce re-hospitalization through patient activation for persons with chronic obstructive pulmonary disease or heart failure.MethodsThis study uses data from 385 patients who were asked about participating in a randomized controlled trial; of these, 232 declined participation. Data on age, gender, and diagnosis were collected for those who agreed to participate and those who declined. Reasons to decline participation were collected for those who were asked to participate but refused. The stated reasons to decline were analyzed using content analysis, and the categories identified were used for the statistical analysis.ResultsThe main reasons for declining participation were having sufficient support (17.5%), no need for support (16%), being too ill (14.6%), and lack of time for illness-related activities (14.2%). A statistically significant negative association between age and willingness to participate was found (odds ratio=-0.03, 95% confidence interval 0.95-0.99).ConclusionsThose who agreed to participate were younger than non-participants, and non-participants either lacked time for illness-related activities or did not have the energy needed to become involved in the intervention.Trial registrationClinicalTrials.gov, NCT02823795. Registered on 1 July 2016.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Self-care, Re-hospitalization, Randomized controlled trial, COPD, Heart failure, Patient activation intervention
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-80561 (URN)10.1186/s13063-019-3187-9 (DOI)000456783400004 ()30683140 (PubMedID)2-s2.0-85060533955 (Scopus ID)
Available from: 2019-02-19 Created: 2019-02-19 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Unbeck, M., Ekstedt, M., Lindblad, M. & Nilsson, L. (2018). Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology. BMJ Open, 8(1), Article ID e019267.
Open this publication in new window or tab >>Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019267Article in journal (Refereed) Published
Abstract [en]

Objective Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.

Design A study using retrospective record review and trigger tool methodology. setting and methods Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 prede ned triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed. Primary and secondary outcome measures The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.

results The patients were aged 20–79 years, 280 men and 320 women. The review teams identi ed 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.

conclusions AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Research subject
Health and Caring Sciences; Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-69507 (URN)10.1136/bmjopen-2017-019267 (DOI)000431743500241 ()2-s2.0-85040600022 (Scopus ID)
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2019-11-13Bibliographically approved
Schildmeijer, K., Wannheden, C., Nilsson, L., Frykholm, O., Hellström, A., Flink, M. & Ekstedt, M. (2018). Developing an eHealth Tool to Support Patient Empowerment at Home. In: Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen (Ed.), Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth. Paper presented at MIE2018, Gothenburg, Sweden, April 24-26, 2018 (pp. 925-929). IOS Press, 247
Open this publication in new window or tab >>Developing an eHealth Tool to Support Patient Empowerment at Home
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2018 (English)In: Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth / [ed] Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen, IOS Press, 2018, Vol. 247, p. 925-929Conference paper, Published paper (Refereed)
Abstract [en]

In previous research we have learned that patients with chronic or complex diseases often experience difficulties when transitioning from hospital care to self-care in their home. We address these difficulties by developing an eHealth tool for patients - ePATH (electronic Patient Activation in Treatment at Home) - intended to empower each patient to manage their individual situation. We have employed a user-centered design process involving both patients and healthcare personnel to specify the content and functionality of ePATH. The system is deployed as a web application with secure login for patients. In this article, we describe the main content and functionality of the system that makes it possible for a patient to manage symptoms development in relation to treatment progression Interactive functionality, e.g., reminders and social support, is included to make the ePATH a useful and informative bridge between patients, next-of-kin and different caregivers. One lesson learned is that it is necessary to incorporate motivational components in the development of an eHealth tool to successfully overcome the "intention-behavior" gap. The self-determination theory of motivation can be used to ensure that important aspects are not missed.

Place, publisher, year, edition, pages
IOS Press, 2018
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 247
Keywords
eHealth, patient participation, personalized care, transitions in care, user-centered design
National Category
Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-75584 (URN)10.3233/978-1-61499-852-5-925 (DOI)29678096 (PubMedID)2-s2.0-85046550034 (Scopus ID)9781614998518 (ISBN)9781614998525 (ISBN)
Conference
MIE2018, Gothenburg, Sweden, April 24-26, 2018
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4948
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2019-08-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4108-391x

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