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By: Denise H. Rhoney, PharmD, FCCP, FCCM
- Ron and Nancy McFarlane Distinguished Professor and Chair, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
https://pharmacy.unc.edu/news/directory/drhoney/
Antigenic shift in influenza viruses gives rise to arteriosclerosis vs atherosclerosis buy cheap warfarin 5mg global planet has any protective immunity to heart attack 90 year old discount warfarin uk this virus arteria epigastrica superficialis discount warfarin 2 mg with mastercard. Antigen detection techniques are dependent on the within key epitopes of the viral nucleoprotein blood pressure drops after eating order warfarin discount. Which of the following statements regarding disease whether the cell/virus remains viable on its journey to associated with influenza virus infection is/are true Genome detection techniques are the most sensitive results in transformation of those cells. Which of the following drugs has proven efficacy viruses not fully neutralizable by pre-existing circulating against influenza A viruses The mode of action of amantadine involves blockage of to escape pre-existing immunity in a vaccinated host. Resistance to oseltamivir has not been described in risk groups constitute a majority of the population. Zanamavir should not be used in patients with a history in an immunocompromised host – although, of course, of egg allergy. Influenza vaccines contain antigens derived from neuraminidase inhibitor is a sensible alternative strategy. Which of the following statements regarding influenza provide protection against all three. Which of the following are true of the host response to incompletely treated infection. Transforming growth factor-b activates macrophages to increase leishmanicidal functions. Mucocutaneous disease can be diagnosed clinically in either a Th1 or Th2 response. Clinical features alone are sufficient to differentiate mucocutaneous leishmaniasis All cutaneous lesions need to be treated to prevent become painful when secondarily infected. Which of the following are true of the control and combination of bone marrow suppression and prevention of leishmaniasis The distribution of mosquito nets to control malaria has immediate reaction to treatment for visceral reduced the incidence of leishmaniasis. Jaundice and renal failure with conjunctival outer membrane in the periplasmic space. Which of the following are true for disease caused by can be detected by dark ground microscopy. Which of the following are true of the clinical food from raw food and correct cooking temperatures presentation of diseases caused by L. It binds to the target cells via genus-specific more pseudogenes and inactivated genes. Each infected person infects on average 20 other of lymphocytes in the cerebrospinal fluid compared with individuals. Which of the following are typical signs of pulmonary giant cells and the whole entity is surrounded by tuberculosis The colonies may take 2–4 weeks to become host cell response is also lymphocytes, similar to visible. Which of the following antibiotics are used to treat staining red and all else staining green. The process of phase and antigenic variation in dysuria (pain on urination) and cervical discharge. A 16-year-old female comes to the physician because of following culture media should be used for the follow an increased vaginal discharge. Examination reveals some erythema of be overgrown by the commensal microbiota in the the cervix but is otherwise unremarkable. A Gram stain of the discharge shows the presence of gram-negative diplococci and numerous neutrophils. All of the following are important in the isolation and the lab reports the isolation of nonhemolytic, gram laboratory diagnosis of Neisseria gonorrhoeae infections, negative, oxidase-positive diplococci that utilize glucose. Use of selective media to suppress the growth of other which one of the following would make the organism bacteria and fungi while allowing gonococci to grow. Neisseria gonorrhoeae is capable of all of the following, presents with fever and right knee swelling. Close contacts of the index case should receive membranes, principally the oropharynx. Frequent re-evaluation and, in patients with a poor be transmitted by receptive oral sex. Rapid latex agglutination can be used to detect capsular production of a purpuric rash. A characteristic appearance of the intestine on which genetic variation arises by point mutation and endoscopy. Persons with norovirus gastroenteritis may prepare food diagnosis of norovirus gastroenteritis However, this method is close an affected ward to new admissions and wait for very insensitive as there have to be at least a million the outbreak to burn out. The cellular receptor for binding is the blood group B periodicity to major epidemics of 4–5 years. A 25-year-old woman presents with a diffuse after infection, coincident with the generation of an IgG morbilliform rash and a small joint polyarthropathy. Symptoms are usually less severe than those caused by following results: parvovirus B3 infection. Options A, B, and C are well-recognized features erythema infectiosum, also known as 5th disease. The serological results indicate a maternal acute following results: parvovirus infection. The most likely outcome among those IgG anti-rubella positive, IgM anti-rubella positive listed is a normal healthy baby. There is also a much increased IgG anti-parvovirus positive, IgM anti-parvovirus risk of spontaneous miscarriage. The serological results indicate a maternal acute requires prior activation by viruses which can only be rubella infection. At this stage in pregnancy, such infection performed in cells infected with a virus that possesses a almost invariably results in multiple severe developmental thymidine kinase enzyme. A 25-year-old woman presents with a diffuse hemolytic anemia and a parvovirus-induced aplastic morbilliform rash and a small joint polyarthropathy. Which of the following are true of respiratory syncytial unclear whether children who get bronchiolitis have a virus Which of the following tests would be helpful for the pneumoviruses, a subfamily of paramyxoviruses. Which of the following are true of Rickettsia Enterobacteriaceae, not to be confused with Rickettsia typhi, rickettsii Which of the following are true of the clinical practices or a poor public health infrastructure. It is capable of killing schistosomula through IgE associated with each schistosome species: Biomphalaria, mediated mechanisms. Which of the following are true for tissue granulomas normally live in blood vessels around the intestine. Which of the following statements are true about pattern is observed, but in the case of schistosomiasis schistosome eggs However, for schistosomiasis this is too early and testing after about 12 weeks is more sensitive. It is being achieved in some countries by population worms living in blood vessels. This erythematous rash covering the whole body including was followed by the development of a sunburn-like rash the palms and the soles. A 1-year-old boy is brought to his pediatrician with a severely inflamed cut on his knee. He has had four ear infections in the past Refer to the case history below to answer questions 3–5 year, and several additional wound infections that generally respond to A man presents to the emergency room with high fever and malaise. Culture of the current wound reveals gram-positive He claims to have felt this way for about 3 days, worse every day.
Before agreeing to hypertension uncontrolled icd 9 generic warfarin 5 mg without prescription screening tests jnc 07 hypertension purchase 2 mg warfarin with visa, parents need to blood pressure on forearm buy cheap warfarin 2mg on-line be fully informed about the risks arteria retinae purchase warfarin in india, benets and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive. The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down’s syndrome will have. Objectives To estimate and compare the accuracy of rst and second trimester serum markers with and without rst trimester ultrasound markers for the detection of Down’s syndrome in the antenatal period, as combinations of markers. We also searched reference lists of retrieved articles First and second trimester serum tests with and without rst trimester ultrasound tests for Down’s syndrome screening (Review) 1 Copyright © 2017 the Cochrane Collaboration. Selection criteria Studiesevaluatingtestsof combiningrst and second trimester maternal serum markersinwomenup to 24 weeksof gestationfor Down’s syndrome, with or without rst trimester ultrasound markers, compared with a reference standard, either chromosomal verication or macroscopic postnatal inspection. Data collection and analysis Data were extracted as test positive/test negative results for Down’s and non-Down’s pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specicity). We investigated the impact of maternal age on test performance in subgroup analyses. Studies were generally high quality, although differential verication was common with invasive testing of only high risk pregnancies. We looked at tests combining rst and second trimester markers with or without ultrasound as complete tests, and we also examined stepwise and contingent strategies. However, the evidence was limited in terms of the number of studies evaluating this strategy, and we therefore cannot recommend one single screening strategy. Authors’ conclusions Testsinvolvingrsttrimesterultrasound withrstand second trimesterserummarkersincombinationwithmaternalage aresignicantly better thanthose without ultrasound, or those evaluating rst trimester ultrasound in combination with second trimester serum markers, without rst trimester serum markers. We cannot make recommendations about a specic strategy on the basis of the small number of studies available. P L A I N L A N G U A G E S U M M A R Y Screening tests for Down’s syndrome in the rst 24 weeks of pregnancy Background Down’s syndrome (also known as Down’s or Trisomy 21) is an incurable genetic disorder that causes signicant physical and mental health problems, and disabilities. Some individuals are severely affected whilst others have mild problems and are able to lead relatively normal lives. Expectant parents are given the choice to be tested for Down’s syndrome during pregnancy to assist them in making decisions. If a mother is carrying a baby with Down’s syndrome, then there is the decision about whether to terminate or continue with the pregnancy. The information offers parents the opportunity to plan for life with a child with Down’s syndrome. Both these tests involve inserting needles through the mother’s abdomen and are known to increase the risk of miscarriage. Rather, tests that measure markers in the mother’s blood, urine, or on ultrasound scans of the baby are used for screening. These screening tests are not perfect as they can miss cases of Down’s syndrome and also give high risk test results to a First and second trimester serum tests with and without rst trimester ultrasound tests for Down’s syndrome screening (Review) 2 Copyright © 2017 the Cochrane Collaboration. What we did We assessed combinations of rst trimester (up to 14 weeks’ gestation) and second trimester serum screening tests (up to 24 weeks’ gestation), with or without rst trimester ultrasound screening tests, Our aim was to identify the most accurate test(s) for predicting the risk of a pregnancy being affected by Down’s syndrome. We found 22 studies, involving 228,615 pregnancies (including 1067 fetuses affected by Down’s syndrome). Five per cent of pregnant women receiving a high risk test result based on this combination would not be affected by Down’s syndrome. There were relatively few studies assessing these tests and therefore we cannot make a strong recommendation about the best test. Other important information to consider the ultrasound tests themselves have no adverse effects for the woman, and blood tests can cause discomfort, bruising and, rarely, infection. B A C K G R O U N D is the commonest cause of mental disability, and is also associated with a number of congenital malformations, notably affecting the this is one of a series of reviews on antenatal screening for heart. There is also an increased risk of cancers such as leukaemia, Down’s syndrome following a generic protocol (Alldred 2010) and numerous metabolic problems including diabetes and thyroid see Published notes for more details. Some of these problems may be life-threatening, or lead to considerable ill health, while some individuals with Down’s syn drome have only mild problems and can lead a relatively normal Target condition being diagnosed life. There is no cure for Down’s syndrome, and antenatal diagnosis allows for preparation for the birth and subsequent care of a baby Down’s syndrome with Down’s syndrome, or for the offer of a termination of preg Down’s syndrome affects approximately one in 800 live born ba nancy. It results from a person having three, rather signicant impact on family and social life, relationships and par than two, copies of chromosome 21 or the specic area of chro ents’ work. Special provisions may need to be made for education mosome 21 implicated in causing Down’s syndrome as a result of and care of the child, as well as accommodating the possibility of trisomy (an additional copy of the whole chromosome) or translo periods of hospitalisation. It First and second trimester serum tests with and without rst trimester ultrasound tests for Down’s syndrome screening (Review) 3 Copyright © 2017 the Cochrane Collaboration. Such screening tests are used during the rst duced in the rst trimester of Down’s syndrome pregnancies, with and second trimester of pregnancy. Inhibin A is high in the second trimester in pregnancies af fected by Down’s syndrome (Cuckle 1995; Wallace 1995). There are some issues concerning the biological stability for example, Screening tests for Down’s syndrome delay in samples arriving in the laboratory and hence reliability of this marker, and the effect this will have on individual risk. There is controversy In 1987, in a small case-control study of women carrying fe about their value (Wald 2003a). They need to be informed of the risk of a fetal adrenals and the placenta, was also evaluated as a potential miscarriage due to invasive diagnostic testing, and the possibility screening marker. In another retrospective case-control study, uE3 that a miscarried fetus may be chromosomally normal. If, follow was shown to be lower in Down’s syndrome pregnancies compared ing invasive diagnostic testing, the fetus is shown to have Down’s with unaffected pregnancies. The deci First and second trimester serum tests with and without rst trimester ultrasound tests for Down’s syndrome screening (Review) 4 Copyright © 2017 the Cochrane Collaboration. It is usually performed between a high level of anxiety at all stages of the screening process, and the 10 and 13 weeks’ gestation. Both tests use ultrasound severity of problems a person with Down’s syndrome will have. These markers can sessed in the other Cochrane reviews include rst trimester serum be used individually, in combination with age, and can also be tests (Alldred 2015); urine tests (Alldred 2015a); second trimester used in combination with each other. The risks are calculated by serum markers (Alldred 2012); and rst trimester ultrasound tests comparing a woman’s test result for each marker with values for an alone, or in combination with rst trimester serum tests (in press). Where several markers are combined, risks are computed us vious systematic review (Smith-Bindman 2001). Stepwise testing allows for triage of women into risk categories this is one of a suite of Cochrane reviews, the aim of which is to at two stages. Women found to be very high risk at the end of identify all screening tests for Down’s syndrome used in clinical rst trimester screening are offered invasive testing, whereas those practice, or evaluated inthe research setting, inorder totry toiden women deemed to be lower risk are then screened again in the tify the most accurate test(s) available, and to provide clinicians, second trimester and a further overall risk is calculated once both policy makers and women with robust and balanced evidence on stages of the test are completed. The full set of reviews is described in the generic protocol high risk, medium risk and low risk. The review concluded that other second trimester ultra sound markers did not usefully distinguish between Down’s syn drome and pregnancieswithout Down’ssyndrome. Amniocentesis is an invasive procedure which in rst trimester serum tests alone, rst trimester ultrasound alone, volves taking a small sample of the amniotic uid (liquor) sur rsttrimesterserumandultrasound,secondtrimesterserumalone, rounding the baby, using a needle which goes through the abdom rst and second trimester serum, combinations of serum and ul inal wall into the uterus, and is usually performed after 15 weeks’ trasound markers and urine markers alone. This review is written with Participants the global perspective in mind, rather than to conform with any Pregnant women up to 24 weeks’ gestation conrmed by ultra specic local or national policy, as not all tests will be available in sound, who had not undergone previous testing for Down’s syn all areas where screening for Down’s syndrome is carried out. Studies were included if the pregnant womenwere unselected, or if they represented groups with increased risk of Down’s syndrome, or difculty with con ventional screening tests including maternal age greater than 35 O B J E C T I V E S years old, multiple pregnancy, diabetes mellitus and family history the aim of this review was to estimate and compare the accu of Down’s syndrome. Individual markers are described in the other reviews belonging to the following index tests were examined; nuchal translucency this suite. All strategies included rst and second trimester serum tests, and some included additional rst trimester ultra sound markers. The maximum number of markers in any one test Investigation of sources of heterogeneity was seven, in combination with maternal age. Wheretestswereusedincomparisonwelookedattheperformance We planned to investigate whether a uniform screening test is suit of test comparisons according to predicted probabilities computed able for all women, or whether different screening methods are using risk equations and dichotomised into high risk and low risk more applicable to different groups, dened by advanced mater (and medium risk, where applicable). We also considered whether there existed Target conditions evidence of overestimation of test accuracy in studies evaluating Down’s syndrome in the fetus due to trisomy, translocation or risk equations in the derivation sample rather than in a separate mosaicism.
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Poor sleep has been shown to blood pressure exercise warfarin 1mg otc significantly worsen the symptoms of many mental health issues blood pressure medication valturna purchase warfarin 5 mg. All of the scientific data shows the connection between medical and mental illnesses: good sleep is necessary for recovery—or prevention—in both types of conditions heart attack the alias radio remix best warfarin 5mg. Treatment the first-line treatment for insomnia is good sleeping habits and taking care of any underlying conditions that may be causing the problems with sleeping pomegranate juice blood pressure medication warfarin 1 mg with mastercard. Treatment options could include relaxation techniques, medication, exercise, light therapy or cognitive behavioral therapy. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the practitioner in light of all the circumstances presented. Thus, an approach that differs from the guidance in this document, standing alone, does not necessarily imply that the approach was below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in this document when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to the guidance in this document will not assure an accurate diagnosis or a successful outcome. The sole purpose of this document is to assist practitioners in achieving this objective. With both methods, image data are routinely acquired at suspended full inspiration with patients in the supine position. Additional options, useful in many cases, include obtaining inspiratory prone images to differentiate posterior lung disease from dependent atelectasis and end-expiratory images to evaluate for air trapping [20-23]. Quantification of the extent of diffuse lung disease for evaluating effectiveness of treatment 4. Guidance in selection of the most appropriate site for biopsy of diffuse lung disease B. The physician should be thoroughly acquainted with the many anatomic and physiologic manifestations of thoracic disease. The accompanying clinical information should be provided by a physician or other appropriately licensed health care provider familiar with the patient’s clinical problem or question and consistent with the state scope of practice requirements. Automatic exposure control (angular and longitudinal tube current modulation) and image quality reference parameter 11. Reconstruction techniques such as filtered back projection or iterative reconstruction 14. Technique should be selected that provide image quality consistent with the diagnostic needs of the examination at acceptably low radiation dose levels to the patient. Use of lower tube potentials (eg, 100 kVp) and tube-current settings is encouraged, especially for younger patients or those who may need serial imaging. Utilization of techniques available to minimize dose (eg, tube current modulation) is encouraged. Proper supine and/or prone patient positioning with optimal breathing instructions d. State of respiration (inspiration and/or expiration), with appropriate breathing instructions; Expiratory images are typically acquired at end-expiration. Acquiring exploratory and/or prone sequence images in a helical fashion is discouraged. For those sequences, axial acquisition with nonirradiated increments of 10–20 mm or more is preferable. Moderately high-spatial-frequency reconstruction algorithm, such as a bone algorithm for lung images j. Proper patient positioning (positioning the patient at isocenter to minimize radiation dose and optimize image quality) k. Superior and inferior extent of the region of interest to be imaged, typically from the lung apices to the costophrenic sulci. When possible, scan field of view should be selected appropriate to patient size at time of image. Reconstructed field of view limited to the lungs adjusted for small, medium, and large patients to optimize spatial resolution for each patient n. Techniques such as increasing pitch, lowering tube current or kV, and limiting the z-axis coverage to the region of clinical question. Producing motion-free images at the appropriate inspiratory and expiratory level 3. All personnel that work with ionizing radiation must understand the key principles of occupational and public radiation protection (justification, optimization of protection and application of dose limits) and the principles of proper management of radiation dose to patients (justification, optimization and the use of dose reference levels) pub. Automated dose reduction technologies available on imaging equipment should be used whenever appropriate. If such technology is not available, appropriate manual techniques should be used. Additional information regarding patient radiation safety in imaging is available at the Image Gently for children ( These advocacy and awareness campaigns provide free educational materials for all stakeholders involved in imaging (patients, technologists, referring providers, medical physicists, and radiologists). Collaborative Committee Members represent their societies in the initial and final revision of this practice parameter. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Monitoring of nonsteroidal immunosuppressive drugs in patients with lung disease and lung transplant recipients: American College of Chest Physicians evidence based clinical practice guidelines. A practical high-resolution computed tomography-based approach to diagnosis and management and a review of the literature. Usefulness of coronal reformations in the diagnostic evaluation of infiltrative lung disease. Multidetector spiral high-resolution computed tomography of the lungs: distribution of findings on coronal image reconstructions. Pulmonary emphysema: histopathologic correlation with minimum intensity projection imaging, high-resolution computed tomography, and pulmonary function test results. Additional computed tomography scans in the prone position to distinguish early interstitial lung disease from dependent density on helical computed tomography screening patient characteristics. Review article: current indications for high resolution computed tomography scanning of the lungs. Multidetector computed tomographic imaging in chronic obstructive pulmonary disease: emphysema and airways assessment. They arise when macrophages attempt to phagocytose asbestos fibers; the iron is presumably derived from phagocyte ferritin. We will see patients with asbestos lung problems still today Can sample these fibers and determine their source Takes more than a causal exposure to asbestos to cause significant harm Pleural Plaques Pleural plaques: a. Plaques appear on parietal pleura Damage of asbestos depends on the level of exposure. A higher exposure leads to pleural plaques asbestos pleural plaque; no physiological Location: consequence Plaques usually form on the anterior and posterolateral aspects of parietal pleura and over the domes of the diaphragm Pleural plaques are the most common manifestation of asbestos Lymphatics communicates with exposure and are well circumscribed parietal pleura to form pleural plaques of dense collagen that often plaques after exposure to contain calcium. Is benign without clinical significance airless lung Round Atelectasis could look like lung cancer but is asbestos this round atelectasis could be resected used to be a huge problem for individuals working in shipyards seeing less and less as we improve hygiene Asbestosis Associated with prolonged/heavy oocupational exposure to commercial forms Linear interstitial and bronchiolocentric fibrosis, lower lobes is where the asbestos seem to settle out most sever in lower lobes, periphery Histologic sine qua non is the asbestos body Asbestos fibers have been linked to Increased risk for lung cancer increased free radical production. The link between smoking and asbestos and lung Asbestosis: cancer could be related to the ability of the a. Increases risk of bronchogenic carcinoma in smokers body for a longer period of time; 35 fold increase for lung cancer when individuals is exposed to smoking and asbestos Have to see asbestos bodies to make a diagnosis of asbestosis, because can be confused for other diseases. No treatment for asbestosis this radiograph is backwards Lower lobe formation of asbestosis. Thickened septum and numerous asbestos bodies asbestosis Patients with asbestosis more likely to get lung cancer. Eggshell calicification in the hilar lymph nodes If the disease continues to progress, expansion and coalescence of lesions may produce progressive massive fibrosis.
This would change the focus of the assessment of work and leisure from an activity-type definition hypertension 20 year old male purchase warfarin 2mg on line, based on the activities a person engages in blood pressure chart to age cheap warfarin uk, to prehypertension definition safe 1 mg warfarin an assessment where the affective experiences are also included prehypertension thyroid generic warfarin 1 mg fast delivery. Further, this would reflect the meaning of activities and the ability for the person to accomplish goals in life (90). Further, Cynkin and Robinson (93) point out that only individuals themselves can determine whether the number and variety of activities are appropriate and balanced for that specific person. They also maintain that experiencing balance will lead to a feeling of comfort and satisfaction with the activities of everyday living. Aims the purpose of Study 1 was to describe the work situation of women with fibromyalgia. No systematic studies had been done at that time in Sweden, and few in other parts of the world. Factors previously known from literature research to cause disability such as pain interference, concomitant symptoms, and type of occupation need to be investigated. It was also important to capture the women’s own experiences and thoughts about which factors they felt had influenced their decisions to leave or remain in a work role. The purpose of Study 2 was to gain information from young, newly-diagnosed women with fibromyalgia about the difficulties and limitations these women encountered during their first year after diagnosis. This was done by using instruments and semi-structured interviews, with a special focus on employment and consequences for daily life. The aim of Study 3 was to describe how the time-use and activity patterns in working and non-working women could be visualised and compared. A time-geographic diary method was used to discover how the working women prioritise among their activities in order to fulfil a work role. Methods need to be developed to gather more information about activity patterns and their influence on health. The women participating were diagnosed with fibromyalgia, except for one who had myofascial pain. Background data on women with fibromyalgia participating in the different studies. The different occupational areas where the women currently work or have previously been employed are in Table 2. The 278 women have been divided into a working and a non-working group, in which previous occupation has been recorded. Working, Non-working, Classification of Occupations n= 133 n= 145 Management, leadership 8 2 Theoretical specialist competency. Inclusion criteria were: a fibromyalgia diagnosis with no other diseases, age 16-65 years, and female. The inclusion criteria excluded 70 persons, leaving the remaining 218 women in the study. Only the participant’s identification and diagnosis were drawn from the case notes. Figure 2 shows a flowchart illustrating the design and the women participating in Study 1. The purpose was to select 20 women who were still working outside their homes, and 20 who had left the labour market. The women were divided into working or non-working groups, and chosen from various ages, different types of occupations, and different numbers of working hours. Three declined to participate, and five of the 14 women in the working group had stopped working since the previous contact and thus did not fulfil the inclusion criteria. Thus, answers from the interviews included 39 women; 19 still in paid work and 20 who had left the labour market and were on sickness leave or had disability pension. The inclusion criteria were: meeting the diagnostic criteria for fibromyalgia, 39 years or younger, and diagnosed with fibromyalgia at the time of the first interview or within the previous six 15 months. In all, 49 women from Sweden participated 28 from the university pain clinic and 21 from the regional hospital clinic and 45 from the United States. Eight women who participated in Study 2 were informed and asked to participate in this study. Six were asked in connection with entering a rehabilitation programme for people with longstanding pain, and two were asked by a physician in the university referral clinic. All the women fulfilled the criteria for longstanding pain; 15 had fibromyalgia and one myofascial pain. Ethics the studies in this thesis have been approved by the Research Ethics Committee, Faculty of Health Sciences, Linkoping University. The women were informed about the content of the studies in an introductory letter and asked to participate. In Study 1 the women gave written consent to be contacted again, and in the other studies gave written consent to participate. Written information was presented to the participants to enable them to voluntarily decide whether or not to participate in the different research studies. Efforts were made to write the information in a language that could easily be understood by the participants. Physical examination by medical specialists was performed in order to confirm the diagnosis, and the women were informed that the pain might increase after the examination. In all informed consent documents the responsible research personnel were presented with names and telephone numbers, which gave the participants the opportunity to ask questions, before, during and after the project. It was emphasised that withdrawal at any time, or a refusal to participate in the study, would have no effect on ongoing or future treatment. The inductive approach was used when data needed to be analysed and understood from the women’s perspective in order to achieve new or deeper knowledge about a phenomenon. The interviews were analysed using a qualitative approach and a content analysis method. The deductive approach was used in questionnaires and instruments when the aim was to describe, analyse and predict certain phenomena in women with fibromyalgia. Study 1 In Paper I a descriptive, cross-sectional design was used, and a mail questionnaire (Appendix) was sent out. The questionnaire was designed to collect demographic data, data about the fibromyalgia condition, and data about the work situation. In addition, information on satisfaction with the global life situation, type of occupation, and present work tasks were gathered. In the questionnaire the women were asked whether they might be contacted again; 160 agreed. Finally, a pain mannequin was used to investigate the location of experienced pain “during the past week”. Individual interviews were performed with a focus on the factors the women themselves regarded as important for facilitating or hindering their retention of a work role. An interview guide was used to ensure that certain areas were discussed, such as: present or previous employment; adaptations in the workplace; additional responsibilities; the value attached to work; personal strengths and weaknesses as workers; and, finally, opinions about future work. Data were collected by interviews and self-administered questionnaires three times, six months apart. The scale ranges from 0-100, where a higher score indicates a better health status. Yelin Scale of Job Flexibility: this is a 5-item questionnaire asking the participant to assess work autonomy concerning adjustments of work hours and the possibility to take time off from work. The response alternatives given are that it can be “done independently”, “done by telling a supervisor”, “done by asking permission” or “cannot be done at all” (104). The open-ended questions in the three interviews were: 1) What, if any, physical difficulties or limitations do you have because of fibromyalgia At interview 2 and 3 the women were also asked: 6) Have you found any ways to prevent the difficulties or limitations that you have experienced related to your fibromyalgia Study 3 In Paper V, a longitudinal descriptive cohort design was used, with a time-geographic diary method. This is a qualitative method to study time use, and to describe activity patterns and the complexity of daily life (107). The time-geographic approach illustrates and observes, in a systematic way, how circumstances in time and space exert restrictions and put limits on the ways people live their lives.