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  • 1.
    Melin, Eva O.
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Gustavsson, Sven-Åke
    Region Kronoberg, Sweden.
    Winberg, Agneta
    Region Kronoberg, Sweden.
    Denward-Olah, Ewa
    Region Kronoberg, Sweden.
    Landin-Olsson, Mona
    Lund University, Sweden;Lund University Hospital, Sweden.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Affect school and script analysis versus basic body awareness therapy in the treatment of psychological symptoms in patients with diabetes and high HbA1c concentrations: two study protocols for two randomized controlled trials2016In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, article id 221Article in journal (Refereed)
    Abstract [en]

    Background: Depression is linked with alexithymia, anxiety, high HbA1c concentrations, disturbances of cortisol secretion, increased prevalence of diabetes complications and all-cause mortality. The psycho-educational method 'affect school with script analysis' and the mind-body therapy 'basic body awareness treatment' will be trialled in patients with diabetes, high HbA1c concentrations and psychological symptoms. The primary outcome measure is change in symptoms of depression. Secondary outcome measures are changes in HbA1c concentrations, midnight salivary cortisol concentration, symptoms of alexithymia, anxiety, self-image measures, use of antidepressants, incidence of diabetes complications and mortality. Methods: Two studies will be performed. Study I is an open-labeled parallel-group study with a two-arm randomized controlled trial design. Patients are randomized to either affect school with script analysis or to basic body awareness treatment. According to power calculations, 64 persons are required in each intervention arm at the last follow-up session. Patients with type 1 or type 2 diabetes were recruited from one hospital diabetes outpatient clinic in 2009. The trial will be completed in 2016. Study II is a multicentre open-labeled parallel-group three-arm randomized controlled trial. Patients will be randomized to affect school with script analysis, to basic body awareness treatment, or to treatment as usual. Power calculations show that 70 persons are required in each arm at the last follow-up session. Patients with type 2 diabetes will be recruited from primary care. This study will start in 2016 and finish in 2023. For both studies, the inclusion criteria are: HbA1c concentration >= 62.5 mmol/mol; depression, alexithymia, anxiety or a negative self-image; age 18-59 years; and diabetes duration >= 1 year. The exclusion criteria are pregnancy, severe comorbidities, cognitive deficiencies or inadequate Swedish. Depression, anxiety, alexithymia and self-image are assessed using self-report instruments. HbA1c concentration, midnight salivary cortisol concentration, blood pressure, serum lipid concentrations and anthropometrics are measured. Data are collected from computerized medical records and the Swedish national diabetes and causes of death registers. Discussion: Whether the "affect school with script analysis" will reduce psychological symptoms, increase emotional awareness and improve diabetes related factors will be tried, and compared to "basic body awareness treatment" and treatment as usual.

  • 2.
    Melin, Eva O.
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 123-133Article in journal (Refereed)
    Abstract [en]

    Objectives: Feasibility testing of a psychoeducational method - The Affect School and Script Analyses (ASSA) - in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS). Design: Pilot study. Setting: Three Swedish primary care centers serving 20,000 people. Intervention: 8 weekly 2-hour sessions with a 5-7 participant group led by two instructors - followed by 10 individual hour-long sessions. Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia. Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS. Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p < .05 after correction for multiple testing for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); 18 months post intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate). Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had >80% participation rates, and dear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.

  • 3.
    Melin, Eva O.
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Thunander, Maria
    Lund University, Sweden;Region Kronoberg, Sweden.
    Hillman, Magnus
    Lund University, Sweden.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Landin-Olsson, Mona
    Lund University, Sweden;Skåne University Hospital, Sweden.
    Gender, alexithymia and physical inactivity associated with abdominal obesity in type1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic2017In: BMC Obesity, E-ISSN 2052-9538, Vol. 4, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Obesity is linked to cardiovascular diseases and increasingly common in type 1 diabetes mellitus (T1DM) since the introduction of intensified insulin therapy. Our main aim was to explore associations between obesity and depression, anxiety, alexithymia and self-image measures and to control for lifestyle variables in a sample of persons with T1DM. Secondary aims were to explore associations between abdominal and general obesity and cardiovascular complications in T1DM.

    Methods: Cross sectional study of 284 persons with T1DM (age 18–59 years, men 56%), consecutively recruited from one secondary care hospital diabetes clinic in Sweden. Assessments were performed with self-report instruments (Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale-20 items and Structural Analysis of Social Behavior). Anthropometrics and blood samples were collected for this study and supplemented with data from the patients ’ medical records. Abdominal obesity was defined as waist circumference men/women (meters): ≥ 1.02/≥0.88, and general obesity as BMI ≥30 kg/m2 for both genders. Abdominal obesity was chosen in the analyses due to the high association with cardiovascular complications. Different explanatory logistic regression models were elaborated for the associations and calibrated and validated for goodness of fit with the data variables.

    Results: The prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Abdominal obesity was associated with women (AOR 4.9), physical inactivity (AOR 3.1), alexithymia (AOR 2.6) and age (per year) (AOR 1.04). One of the three alexithymia sub factors, “difficulty identifying feelings” (AOR 3.1), was associated with abdominal obesity. Gender analyses showed that abdominal obesity in men was associated with “difficulty identifying feelings ” (AOR 7.7), and in women with use of antidepressants (AOR 4.3) and physical inactivity (AOR 3.6). Cardiovascular complications were associated with abdominal obesity (AOR 5.2).

    Conclusions: Alexithymia, particularly the alexithymia subfactor “difficulty identifying feelings”, physical inactivity, and women, as well as cardiovascular complications were associated with abdominal obesity. As abdominal obesity is detrimental in diabetes due to its association with cardiovascular complications, our results suggest two risk factor treatment targets: increased emotional awareness and increased physical activity.

  • 4.
    Melin, Eva Olga
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Hillman, Magnus
    Lund University, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Landin-Olsson, Mona
    Lund University, Sweden.
    Thunander, Maria
    Lund University, Sweden;Region Kronoberg, Sweden.
    Lower HDL, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes2019In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 287, p. E228-E228Article in journal (Other academic)
  • 5.
    Melin, Eva Olga
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden;Lund University, Sweden.
    Hillman, Magnus
    Lund University, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Landin-Olsson, Mona
    Lund University, Sweden;Skåne University Hospital, Sweden.
    Thunander, Maria
    Lund University, Sweden;Region Kronoberg, Sweden;Central Hospital Växjö, Sweden.
    Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study2019In: Lipids in Health and Disease, ISSN 1476-511X, E-ISSN 1476-511X, Vol. 18, p. 1-10, article id 65Article in journal (Refereed)
    Abstract [en]

    Background: Depression, metabolic disturbances and inflammation have been linked to cardiovascular disease and mortality. Low levels of high-density lipoprotein cholesterol (HDL-cholesterol), a known marker of cardiovascular risk, have been observed in patients with major depression in psychiatric populations. Our main aim was to explore associations between depression, antidepressants, and metabolic and inflammatory variables in patients with type 1 diabetes (T1D). A secondary aim was to explore variables associated with HDL-cholesterol. Methods: Cross-sectional design. T1D patients (n = 292, men 55%, age 18-59 years, diabetes duration >= 1 year) were consecutively recruited from one specialist diabetes clinic. Depression was defined as 8 points for Hospital Anxiety and Depression Scale-Depression sub scale. Blood samples, anthropometrics, blood pressure, and data regarding medication and life style were collected from electronic health records. Non-parametric tests, multiple logistic and linear regression analyses were performed. Results: The depression prevalence was 10 and 8% used antidepressants. Median (q(1), q(3)) HDL-cholesterol (mmol/l) was for the depressed 1.3 (1.2, 1.5) and for the non-depressed 1.6 (1.3, 1.8), p = 0.001. HDL-cholesterol levels (per mmol/l) were negatively associated with depression (Adjusted odds ratio (AOR) 0.2, p = 0.007), and the use of antidepressants was positively associated with depression (AOR 8.1, p < 0.001). No other metabolic or inflammatory variables, or life style factors, were associated with depression when adjusted for antidepressants. Abdominal obesity was associated with antidepressants in women (AOR 4.6, p = 0.029). Decreasing HDL-cholesterol levels were associated with increasing triglyceride levels (p < 0.001), increasing high-sensitive C-reactive protein (hs-CRP) levels (p = 0.021), younger age (p < 0.001), male sex (p < 0.001), and depression (p = 0.045). Conclusions: Lower HDL-cholesterol levels, known predictors of cardiovascular disease, were associated with depression in patients with T1D. The use of antidepressants was associated with abdominal obesity in women. Depression, low-grade inflammation measured as hs-CRP, higher triglycerides, male sex, and lower age were independently associated with lower HDL-cholesterol levels.

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  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
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  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
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  • html
  • text
  • asciidoc
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