GUPEA

Gothenburg University Publications Electronic Archive

GUPEA is a platform for e-publishing of theses, student essays and other research publications.

Recent Submissions

  • Acceptansbaserad kognitiv beteendeterapi via internet för frekvent migrän i primärvården:utveckling och utvärdering av en komplex intervention
    (2026-04-20) Persson, Marie
    Background: Migraine is an episodic neurological disorder affecting 14% of the population, which can develop into chronic migraine, leading to significant suffering and disability. Standard treatment in primary care is primarily pharmacological, while psychological interventions that can enhance patients' pain management and quality of life are relatively underdeveloped. Objective: The overall aim of this doctoral project was to develop and evaluate an acceptance-based cognitive-behavioral therapy (CBT) intervention delivered via internet, called I AM (Internet Approach to Migraine), for individuals with frequent migraine within primary care. The intervention was developed through successive phases following the Medical Research Council (MRC) framework. Results: During the development phase, two qualitative interview studies (Studies I and II) were conducted to deepen understanding of pain experiences and pain management in episodic and chronic migraine. Study I identified dilemmas related to when and how to relieve pain in chronic migraine. Study II highlighted the complexity of the pain experience, common reactions, and behaviors during a migraine attack. These findings, along with current research on pain treatment, risk factors and evidence-based methods in CBT, formed the basis for the development of I AM. In the feasibility phase, a randomized controlled pilot study (RCT) with a mixed-methods design (Study III) demonstrated good feasibility of I AM in primary care, with patients perceiving it as an important and meaningful complement to medical treatment. The effectiveness phase evaluated the clinical effects of I AM in a larger RCT involving 154 participants with episodic and chronic migraine from the Västra Götaland region in Sweden (Study IV). A subsequent follow up study of the RCT with a mixed-methods design examined the long-termeffects of I AM (Study V). At 12 months follow up the study showed significant between-group differences in pain intensity (0.7; p=0.043), disease burden (3.9; p=0.001), and mental health and well-being (5.1; p=0.023), favoring the I AM group over Treatment as usual (TAU). Conclusion: I AM, as a supplement to standard medical care, appears to promote long-term psychological and functional improvements in individuals with frequent or chronic migraine. These findings suggest that acceptance-based CBT has potential as part of stepped and integrated care models for migraine management in primary care.
  • Från provöversättning till publicering. Vägen från oVanliga till oVäsen
    (2025-01) Britt-Marie Ingdén-Ringselle; University of Gothenburg/HDK­-Valand - Academy of Art and Design; Göteborgs universitet/HDK-Valand - Högskolan för konst och design
    An essay about the process of translating the Ukrainian author Taras Prochasko's novel непрОсті (neprOsti), with the Swedish title unBeing, without any prior knowledge of the source material. Specifically, it's about trying to translate a book from a language you don't master well enough to handle on your own, and then embarking on a co-operative translation journey with a native speaker. About the exciting experience of how this process results in a steadily improving translation, from the first raw draft, to the final polished version, and then on to approval. And how, when both translators are sufficiently satisfied with their work, dare present it to their classmates and teacher, prompting further improvements during discussions thanks to everyone's excellent feedback and suggestions. About how after a fully discussed version of the translation has been finalized, the editing process with a publisher or magazine editor commences, ultimately producing a final, printed version.
  • Glycinergic compounds for modulating accumbal dopamine levels and alcohol intake
    (2026-04-20) Olsson, Yasmin
    Alcohol use disorder (AUD) is a brain disorder that substantially contributes to the global burden of disease. The positive reinforcing properties of alcohol involve phasic dopamine (DA) release in the nucleus accumbens (nAc), a key structure of the brain reward circuitry. In AUD, neuroadaptations within this circuitry compromise its function, yielding a hypothesized hypodopaminergic state that constitutes a neurobiological correlate of anhedonia and perpetuates the disorder through negative reinforcement. Inhibitory glycine receptors (GlyRs) in the nAc regulate both alcohol- induced and basal accumbal DA levels; glycine acts as an endogenous GlyR agonist, whereas alcohol functions as a positive allosteric modulator. While intra-accumbal glycine perfusion and systemic glycine transporter 1 (GlyT1) inhibition elevate basal DA levels and reduce alcohol intake in rats, improved strategies for glycinergic treatment remain to be explored. The aim of this thesis was to investigate different glycinergic treatment approaches in modulating accumbal DA levels and voluntary alcohol intake. To this end, behavioral paradigms modeling voluntary alcohol consumption was combined with in vivo microdialysis in freely moving Wistar rats. Systemic glycine increased extracellular glycine levels in the nAc and, in a subgroup of rats, elevated basal DA levels. In another group of rats, alcohol intake was reduced, thus presenting effects similar to those produced by glycine perfused into the nAc. Glycine- containing dipeptides, hypothesized to facilitate central glycine availability, produced modest DA elevations in a subpopulation of animals but did not consistently increase extracellular glycine levels. Combining an irreversible GlyT1-inhibitor with compounds manipulating mesolimbic DA output at threshold doses yielded additive effects on basal DA levels. While all active treatments abolished the alcohol deprivation effect (ADE), no further reductions in behavior reflecting impaired control of alcohol intake could be discerned with the doses used. Immunohistochemistry confirmed the presence of glycine transporter 2 (GlyT2)-expressing fibers in the nAc. Partial, but not full GlyT2 inhibition, modestly elevated accumbal DA levels and attenuated the ADE without detectable changes in extracellular glycine. Combined GlyT1 and GlyT2 inhibition did not produce additive neurochemical effects; however, a reversible GlyT1-inhibitor robustly elevated basal DA levels, indicating that extrasynaptic rather than synaptic GlyRs near GlyT2 regulate basal DA. Altogether, these findings support the notion that differential glycinergic treatment strategies can elevate basal accumbal DA levels and reduce alcohol intake in rats. Ultimately, this work may contribute to the development of novel pharmacological approaches aimed at counteracting compromised mesolimbic DA function and targeting negative reinforcement in AUD.
  • Imgaging myocardial stunning in ST-elevation myocardial infarction and Takotsubo syndrome
    (2026-04-20) Poller, Angela
    This thesis longitudinally investigates the mechanics of myocardial stunning that may occur in patients with Takotsubo syndrome (TS) or ST-elevation myocardial infarction (STEMI) with timely reperfusion, using repeated transthoracic echocardiographic (TTE) examinations. All articles in this thesis are based on the Stunning in Takotsubo syndrome and Acute Myocardial Infarction (STAMI) protocol. Using repeated TTE the studies evaluate left ventricular systolic and diastolic recovery over the acute and subacute phase of TS and STEMI. Paper I: The study examined the inter- and intra-observer variability of a novel TTE approach of evaluating wall motion regionality (PrA), and also compared it to the well-established TTE method of wall motion score index (WMSI). A low inter- and intra-observer variability was found in both PrA and WMSI, indicating that PrA is at least as reliable and reproducible as WMSI. Paper II: This study evaluates the reversibility of the left ventricular myocardial dysfunction in women with TS compared to women with STEMI using PrA. Both TS and STEMI women continued to improve left ventricular function beyond 7 days of follow-up, supporting the importance of serial examinations. Paper III: This study aimed to investigate whether differences in left ventricular global and segmental strain in TS and to STEMI could account for the more favorable hemodynamic profile observed in TS compared with STEMI. Furthermore, it sought to determine whether the more favorable clinical outcome observed in men compared with women with STEMI could be explained by faster recovery of global and segmental strain. At hospital admission, global strain was reduced in both TS and STEMI. However, longitudinal strain appeared to be more impaired in TS than in STEMI, particularly in segments from the akinetic regions. No correlation was observed between global longitudinal and radial strain in TS, suggesting that TS may affect different myocardial fiber layers, whereas STEMI appears to affect all myocardial layers. Paper IV: This study evaluated left ventricular diastolic function at admission, 24 hours and 30-days after admission in women with STEMI compared to TS. At admission and 24 hours after admission differences in left ventricular diastolic function parameters were found in some diastolic function indices. At admission, there was a difference in diastolic grade between STEMI versus TS, but 24 hours later and after 30 days there was no difference in diastolic grade between the groups. Patients improved in diastolic indices and grade over the follow-up period indicating that as systolic function improves, left ventricular diastolic function improves in both conditions. Conclusion: Our studies suggest that improvement in left ventricular function over the acute and subacute phase of ST-elevation myocardial infarction and Takotsubo syndrome follow similar trajectories. These results deepen our understand in myocardial stunning and may help inform patient management.