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  • 1851. Welch, Vivian
    et al.
    Howe, Tracey E.
    Marcus, Sue
    Mathew, Christine M.
    Sadana, Ritu
    Rogers, Morwenna
    Sheehy, Lisa
    Borg, Johan
    Pottie, Kevin
    Zhang, Wei
    PROTOCOL: Health, social care and technological interventions to improve functional ability of older adults: Evidence and gap map2019In: The Campbell collaboration library of systematic reviews, ISSN 1680-2012, E-ISSN 1891-1803, Vol. 15, no 4Article in journal (Refereed)
    Abstract [en]

    This is a protocol for a Campbell Evidence and Gap Map. The objectives are to identify and assess the available evidence on health, social care and technological interventions to improve functional ability among older adults.

  • 1852.
    Wennerlund Abdelli, Céline
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Dahlström, Sara
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Upplevd förberedelse inför mötet med föräldrar som förlorat barn på grund av intrauterin fosterdöd: En kvalitativ studie med barnmorskestudenter2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Every year 440 intrauterine fetal deaths are reported in Sweden. Practicing midwives may encounter parents who have lost children due to intrauterine fetal death. Therefore, midwives need knowledge and understanding on how to, in the best way possible, work with parents who have been affected. Studies describe that student midwives are not always given adequate education to care for parents who have lost children due to intrauterine fetal death.

    Aim:

    To investigate whether student midwives perceives that they are prepared to care for parents who has lost children due to intrauterine fetal death.

    Method:

    A digital survey containing three open questions was sent to student midwives who was undergoing the final term of midwifery education in Sweden. A qualitative content analysis with inductive approach was chosen to analyze the study result.

    Results:

    After processing the data and further analyzing, five categories were identified who which answered to the purpose of the study. One overall theme emerged from the categories and its content: "It does not feel good to be unprepared".

    Conclusion:

    The student midwives did not feel prepared to meet parents affected by intrauterine fetal death. This was mainly due to the fact that they were not given the opportunity to participate in the care of parents who give birth to non-living children. There was a clear wish from the student midwives to receive practical preparation, supervision and support during the education's obstetric practice. Previous work in the field of care gave some of the student midwives some preparation to care for parents who lost children due to intrauterine fetal death.

  • 1853.
    Wentli, Teresa
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Barnmorskors och sjuksköterskors behov av stöd inom abortverksamhet: Intervjustudie2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Support in abortion care has a great significance for maintaining a professional approach at the meeting with the patient in abortion situation and provide professional care.

    Aim: The aim of this study was to describe midwives and nurses' needs for support in abortion activities.

    Method: Qualitative semi-structured interviews were conducted with nurses and midwives at the Swedish women's clinic to achieve the objectives of the study.

    Findings: The results showed that the needs of aid shifted, depending on the health care professionals of different education, work experience and personal qualities. The need for support could include knowledge, emotional support and ethical reflection. Interaction of the treatment team consisting of gynecologists, midwives, nurses and counselors were important in order to create the best possible working environment. In addition to initial education as a nurse or midwife would need more specific training in abortion care.

  • 1854.
    Westerberg, Ina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Svärd, Amanda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Viktiga faktorer i egenvårdsprogram som främjar livskvaliteten för personer med diabetes typ 2.: En litteraturöversikt2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Type 2 diabetes is an endocrine disorder and one of the major diseases in the

    world. Increase in blood sugar levels allows both small and large blood vessels are damaged

    and this leads to various complications such as heart attack, stroke and kidney damage. Using

    weight loss, diet control, regular physical activity, and monitoring of blood glucose levels, the

    risk of complications can be prevent. Preventing complications can promote the quality of life

    and improve the patient's daily life. In the diabetes care, self- management programs are a part

    where patients receives support and advice to manage their diabetes.

    Aim: Important factors in self-management programs that promote the quality of life for

    patients with diabetes type 2.

    Method: A literature review, the articles were searched in the databases CINAHL, PubMed

    and Web of Science. 14 quantitative articles were included.

    Results: The results showed that information, individual goal setting and follow-up where the

    key factors in self-care programs for promoting the quality of life in patients with diabetes

    type 2.

    Conclusion: Living with type 2 diabetes require precision and planning of daily life. Selfmanagement

    programs can reduce the risk of complications where adherence to self-care

    promotion and to promote quality of life.

  • 1855.
    Westergren, Jens
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    No difference in sprint cycling performance tests on a stationary and mobile ergometer2011In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 43, no 5, p. 161-161Article in journal (Other academic)
  • 1856. Westgård, Theresa
    et al.
    Ottenvall Hammar, Isabelle
    Holmgren, Eva
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wisten, Aase
    Ekdahl, Anne W
    Dahlin-Ivanoff, Synneve
    Wilhelmson, Katarina
    Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study2018In: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, article id 41Article in journal (Refereed)
    Abstract [en]

    Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.

    Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.

    Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].

    Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.

    Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.

  • 1857.
    Westin, Jerker
    et al.
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    Ghiamati Yazdi, Samira
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    Memedi, Mevludin
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    Nyholm, Dag
    Johansson, Anders
    Dougherty, Mark
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    Groth, Torgny
    A new computer method for assessing drawing impairment in Parkinson's disease2010In: Journal of Neuroscience Methods, ISSN 0165-0270, E-ISSN 1872-678X, Vol. 190, no 1, p. 143-148Article in journal (Refereed)
    Abstract [en]

    A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r = 0.87), and between the mean rating and the spiral score (r = 0.89). The 95% confidence interval for the method's prediction errors was +/- 1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

  • 1858.
    Westling, Caroline
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Rektorers erfarenheter av skolans sex och samlevnadsundervisning och samarbete med ungdomsmottagningen: En intervjustudie2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In Swedish schools sexual and relationship education should give adolescents´ knowledge about the body, sexuality, gender and relationships. The headmaster of each school is responsible for this education. Midwives at youth clinics around the country has over the year’s amassed extensive knowledge about adolescents´ conditions that are specific to the age group. The aim of this study was to describe the headmasters' experiences of sexual and relationship education and collaboration with the youth clinic. The study had a descriptive design. A convenience sample was applied as sampling method. Seven principals from schools in central Sweden participated in the study. Data were collected through semi-structured interviews and analyzed according to qualitative content analysis. The results were presented on the basis of six categories and 18 subcategories. The results showed that the headmasters´ had the experience of the teachers was a key factor for the sexual and relationship education to be good. Headmasters´ had the experience that young people's lifestyles and attitudes played a big role in how they transformed their theoretical knowledge of sex and relationship to practice. Headmasters´ had good experience of working with the youth clinic. The Headmasters´ highlighted socio-demographic challenges in sexual and relationship education. Headmasters´ had experiences that there was a lack of knowledge among the students in the subject. Headmasters´ felt that it was important that there was a balance between biology and value issues in sex education. Headmasters´ felt doubts about the form of the education.. The author's conclusion after interviewing seven headmasters is that Swedish schools need much clearer guidelines on how sexual and relationship education should be conducted so that the balance between biology and values can be created.

  • 1859. Westman, A.
    et al.
    Äng, Björn
    Free Fall Acrobatics to Reduce Neck Loads During Parachute Opening Shock: Evaluation of an Intervention (ACROPOSE)2016In: BMJ Open Sport & Exercise Medicine, E-ISSN 2055-7647, Vol. 2, no 1, p. e000108-Article in journal (Refereed)
  • 1860. Westman, A.
    et al.
    Äng, Björn
    Validation of a free fall acrobatics intervention protocol to reduce neck loads during parachute opening shock2015In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 1, no 1Article in journal (Refereed)
  • 1861.
    Westman, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gauermann, Fridele
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patientsäkerhet och sjuksköterskans arbetsmiljö påakutmottagning: -En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract:

    The working environment within emergency care is complex and constantly

    changing. The nurse is expected to handle high inflows of patients with variety of severity and

    care needs. In keeping with increasing workload, overcrowded hospitals, long waiting times

    and lack of nurses it is important to clarify the nurse´s work environment in emergency care

    and its influence on patients’ safety.

    Purpose: The purpose of the study was to compile

    nurse´s working environment research within the emergency department with a particular

    focus on patient’s safety.

    Method: The study was conducted as a descriptive literature study

    based on 14 scientific articles. The articles referenced were searched in Pubmed and Cinahl,

    as well as via a secondary search.

    Results: By identifying and categorizing patterns and key

    themes in the articles, fundamental aspects could be compiled. The analysis resulted in two

    main areas: “Nurse´s working environment within emergency departments” and “the work

    environments influence on patients’ safety”. In the nurses working environment, six different

    influencing factors are described; workload, experience, teamwork, communication,

    interruptions and organization.

    Conclusion: Several factors in the nurse's work environment

    within emergency care are important for patient safety. Factors like high workload can be

    both positive and negative depending on the nurse's skills, experience and personality.

    Furthermore, clear organizational allocation of responsibilities, well-functioning teamwork

    and objective, direct communication is of importance to the work environment and patient

    safety. There are often shortcomings in one or more work environments where the patient’s

    safety is compromised. The presence of well - functioning factors in the work environment

    provide beneficial conditions for quality of patient care and staff satisfaction.

  • 1862.
    Wiberg, Oskar
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Norell, Viktor
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnadsåtgärder sjuksköterskan kan använda för att stödja egenvård för patienter med hypertoni: En litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [en]

    Background: Most common cause of death in Sweden, 2015 was cardiovascular diseases. An elevated blood pressure doubles the risk of suffering a heart attack. Lifestyle and selfmanagement are significant factors for lowering blood pressure. It’s challenging for the nurse to identify various nursing care methods and single out different options. Aim: To illuminate the interventions nurses can utilize to support lifestyle change through selfmanagement for hypertensive patients. Method: Literature review Results: Empowerment and MI leads to a high degree of person-centering and supports patient self-management through lifestyle changes. Empowerment improved psychosocial aspects and contributes to a good health care quality. Personal counseling gave the patients the opportunity to receive adequate preparation to engage self-management strategies. The personal counseling with an educational program, individually or in groups, showed good prospects for selfmanagement through lifestyle changes and yielded; improved lifestyles, increased daily exercise, healthy diet and a decline in blood pressure. Conclusion: Nursing can use several nursing care methods to achieve lifestyle changes by supporting self-management.

  • 1863.
    Wickman, Fatima
    Dalarna University, School of Health and Social Studies, Caring Science. Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Patienters upplevelse av livskvalitet efter hjärtstopp samt hur livet påverkades hos närstående: En litteraturöversikt2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna systematiska litteraturstudie var att beskriva hur patienter upplevde sin livskvalitet efter ett hjärtstopp samt hur närstående upplevde att livet påverkades efter en anhörigs hjärtstopp. Metod: Sökningar efter artiklar skedde via PubMed, CINAHL och Medline. Inklusionskriterierna var att artiklarna skulle vara skrivna på svenska eller engelska, primärkällor samt publicerade i vetenskapliga tidskrifter mellan 2000-2012. Huvudresultat: Livskvaliteten påverkades inom flera områden hos patienterna. Det aktiva dagliga livet (ADL) och/eller den fysiska förmågan var försämrad, dock rapporterades en tillfredsställande livskvalitet och en god ADL nivå 15 år efter hjärtstoppet. Trötthet var uttalat hos patienterna vilket påverkade livskvaliteten negativt. Även närstående upplevde en ökad trötthet med tillägg av andra fysiska symtom. Posttraumatiskt stressyndrom (PTSD) var vanligt hos patienterna men påverkade endast den fysiska upplevelsen av livskvalitet. Oro, ångest och depression var vanligt förekommande hos patienter och var korrelerat till en sämre livskvalitet. Dessa symtom var även vanliga hos närstående. Sociala relationer upplevdes som viktiga hos både patienter och närstående. Livskvalitet upplevdes i relation med närstående. Kvinnor upplevde en sämre social funktion än män. Närstående kände sig isolerade och var rädda för att uppröra sin partner. Slutsats: Att överleva ett hjärtstopp påverkar patientens livskvalitet både fysiskt, psykiskt och socialt. Även närstående påverkas i hög grad. Både patienter och närstående skulle vara behjälpliga av stöd och vägledning tiden efter hjärtstopp. Stödgrupper för närstående i liknande situationer ansågs kunna minska den psykiska påfrestningen. Sjuksköterskans roll var att tidigt försöka identifiera patienter och närstående i riskzonen för att utveckla stressyndrom.

  • 1864.
    Widarsson, M.
    et al.
    Uppsala University, Uppsala, Sweden.
    Engström, G.
    Florida Atlantic University, United States.
    Tydén, T.
    Uppsala University, Uppsala, Sweden.
    Lundberg, P.
    Uppsala University, Uppsala, Sweden.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    'Paddling upstream': Fathers' involvement during pregnancy as described by expectant fathers and mothers2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1059-1068Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. Background: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. Design: A descriptive qualitative study was used. Methods: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. Results: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. Conclusion: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. Relevance to clinical practice: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.

  • 1865. Wikblad, K
    et al.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wibell, L
    Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes2004In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, no 5, p. 123-130Article in journal (Refereed)
  • 1866.
    Wiker, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Pregnant women’s use of coping strategies during early labour: A qualitative interview study2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Backgrund: Labour can be divided into different phases, the latent phase also named early labour can be the longest phase. During early labour, women may advantageously be at home. Different coping strategies can help women to more easily handle the situation.

    Objective: The aim of this study was to describe the coping strategies that pregnant women used during early labour at home.

    Design: A qualitative study design with inductive approaches was used, and based on interviews with a total of 16 women. Content analysis was used.

    Results: After analysis of the interview data an overall theme was shown: Use of internal and external resources for handling the situation. The result was then divided into four categories: To prepare and plan for childbirth, To bring new energy, To seek support from others and To find your own strategies for handling the situation.

    Conclusions: Result showeds that the use of coping strategies can help women to better manage early labour at home. Women should be aware of that the using of coping strategies can help them to better manage their labour. It is also an advantage for the midwifery profession to know about different kinds of coping strategies that can be used in the home during early labour in order to give women adequate advice and support.

  • 1867.
    Wiking, Linnea
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Svenns, Viktoria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Att vårda kvinnor som upplevt våld i en nära relation, en litteraturstudie om vårdpersonalens perspektiv2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Studies show that one of three women worldwide are exposed to intimate partner violence. Intimate partner violence exists in all social classes and is a global health problem. Healthcare professionals often come in contact with women who have experienced intimate partner violence. Many women lose their lives each year as a result from the violence. Purpose: To describe the healthcare professionals experience of taking care of women who have experienced intimate partner violence. Method: The method is a literature review. Data collection has taken place in databases Cinahl and PubMed. Results: The results is based on 15 scientific articles and three main areas emerged in the outcome: identification of women who lives with intimate partner violence, barriers to identifying the vulnerable women and healthcare professionals meeting with women who have experienced intimate partner violence. Healthcare professionals experience difficulties in identifying women who were exposed to intimate partner violence. Barrier to performing screening were primarily lack of knowledge and training in healthcare professionals. The healthcare professionals experienced it difficult to meet women who lived with intimate partner violence, due to the difficulty of distancing themselves from vulnerable women. Conclusions: From this study, the clue can be drown that guidelines, knowledge and training are needed, and also routines for screening, in order to identify women who are living with intimate partner violence.

  • 1868. Wikström, Ewa
    et al.
    Dellenborg, Lisen
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Göteborgs universitet; Karolinska institutet.
    Gillespie, Brigid M
    Erichsen Andersson, Annette
    The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action2019In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 47, no 3, p. 251-257Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques.

    METHODS: This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis.

    RESULTS: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process.

    CONCLUSIONS: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

  • 1869. Wilhelmson, Katarina
    et al.
    Hammar, Isabelle Andersson
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Niklasson, Johan
    Eckerblad, Jeanette
    Ekerstad, Niklas
    Westgård, Theresa
    Holmgren, Eva
    Åberg, N David
    Ivanoff, Synneve Dahlin
    Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed): A Randomised Controlled Study2020In: Geriatrics (Basel, Switzerland), ISSN 2308-3417, Vol. 5, no 1, article id E5Article in journal (Refereed)
    Abstract [en]

    The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.

  • 1870. Willers, Carl
    et al.
    Iderberg, Hanna
    Axelsen, Mette
    Dahlström, Tobias
    Julin, Bettina
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet.
    Lindberg, Agneta
    Lindgren, Peter
    Looström Muth, Karin
    Lilja, Mikael
    Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare.

    METHODS: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering ~65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors.

    RESULTS: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25.

    CONCLUSION: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

  • 1871. Williams, C. L.
    et al.
    Newman, D.
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Preliminary psychometric properties of the verbal and nonverbal interaction scale: An observational measure for communication in persons with dementia2017In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 38, no 5, p. 381-390Article in journal (Refereed)
    Abstract [en]

    Little attention has been given to sociable/unsociable communication in persons with dementia despite the importance of these behaviors in maintaining engagement in marital relationships. An observational measure of verbal and nonverbal communication in persons with dementia (Verbal and Nonverbal Interaction Scale-CR) who were engaged in conversations with spouses was tested for reliability and validity. Married persons with dementia were video-recorded at home conversing with spouses over 10 weeks (N = 118 recordings). Reliability [inter-coder (.92), test-retest (r =.61-.77), internal consistency (α =.65 -.79)] were adequate. Following an intervention, the Verbal and Nonverbal Interaction Scale-CR predicted improved communication over 10 weeks. The ratio of sociable to unsociable communication improved by 4.46 points per session [β = 4.46, t(10) = 1.96, p =.039]. VNVIS-CR is recommended to describe sociable and unsociable communication in persons with dementia as they engage in conversations with spouses.

  • 1872. Williams, Christine L
    et al.
    Newman, David
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Preliminary study of a communication intervention for family caregivers and spouses with dementia2018In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, no 2, p. E343-E349Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study was to designed to examine the feasibility and preliminary outcomes of CARE: Caring About Relationships and Emotions, a 10-week, home-based, intervention to support married couples affected by dementia.

    METHODS: Fifteen older couples participated in a single group repeated measures feasibility study. Weekly, video-recorded conversations over 10 weeks were used to rate communication using the Verbal/Nonverbal Interaction Scale for caregivers and care receivers.

    RESULTS: Accounting for mental status of care recipients, the ratio of social to unsocial communication showed a significant improvement across sessions-an average of 4.46 points per session [β = 4.46, t(10) = 1.96, p = .039]. Spouse caregiver (CG) communication showed a significant decrease in the number of disabling communications with approximately .65 decreased comments per session [β = 0.654, t(11) = -2.61, p = .024].

    CONCLUSIONS: At home dyadic, relationship-focused psychoeducational intervention to improve communication in spouses affected by dementia has the potential to improve communication outcomes. Creative ways of working with couples are needed to help them sustain their relationships and maintain their health.

  • 1873.
    Williams, Christine
    et al.
    Florida Atlantic University.
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Development of the Verbal and Nonverbal Interaction Scale for Persons with Dementia2016Conference paper (Other academic)
  • 1874. Williams, Cristine
    et al.
    Newman, David
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Communication Outcomes of a Program to Sustain Relationships in Couples Aff­ected by Dementia2017Conference paper (Refereed)
  • 1875.
    Winder Hansson, Naome
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Söderblom Emanuelsson, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer av betydelse i måltidsmiljön för välbefinnande och nutritionsstatus hos äldre på särskilt boende: Litteraturstudie2018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Meals form a social and cultural basis where people can meet in a state of well-being while at the same time consuming enough food to meet thier nutritional needs. Regardless of age, social relationships and the need for food have been linked to enhance the quality of life. Older adult´s poor nutritional status is a global problem that include risks for both cognitive conscious and cognitive impairment.Aim: The purpose of the study was to identify and describe the aspects that are of nutritional beneficial importance and the well-being of the elderly in residential homes.Method: A litterature study with a global perspective whereby scientific articles from Canada, America, Britain, Sweden, Denmark, New Zealand and Australia laid forth foundation of the key findings. Inclusion criterias were elderly over 65 years, cognitive consciousness and cognitive impairment, whom resided in residential homes with round the clock caregivers.Results: The meal provides a social and cultural ambience that strengthens relationships for both the reisdents and caregivers.Three themes emerged and these affected well-being and nutritional status. The possibility of applying person-centered care could be augmented according to the literature study. The literature study shows that social interactions during meals are intervalls for gathering as well as they are welcome intermisssions during the day.Conclusion: The mealtime situation is a complex situation where multiple aspects involved in the well-being and nutrition status of the elderly. Three main themes where identified, physical mealtime environment, person centered care and social interactions.

  • 1876.
    Winqvist, Louise
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Olsson, Linda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som påverkar patienters attityder till livsstilsförändring efter hjärtinfarkt: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    Myocardial infarction is a common disorder in which lifestyle affects risk. With

    lifestyle changes within physical activity, diets, tobacco use and alcohol

    consumption a great amount of myocardial infarction can be prevented. Patients´

    attitudes can be crucial in the process of lifestyle change.

    Aim

    The aim of the study was to describe the factors that influence patients´ attitudes to

    potential lifestyle change after myocardial infarction.

    Method

    The study is designed as a literature review based on 14 scientific articles with

    qualitative, quantitative and mixed methods.

    Results

    Ten factors emerged that separately or together affected patients´ attitudes to

    lifestyle change. The factors were fear, awareness, support, self-discipline, own

    priorities, physical obstacles, perspective of time, experience collected from the

    entourage, desire to return to past physical capacity and conception of life.

    Conclusion

    The participants’ attitudes were clearly affected by the emerged factors. A

    participant who had support, awareness, desire to return to past physical capacity

    and had self-discipline had increased motivation to implement lifestyle change

    after myocardial infarction. In contrast physical obstacles and perspective of time

    affected the attitude negatively to implement lifestyle change. Fear, own priorities

    and conception of life could affect attitudes to lifestyle change in both positive and

    negative direction.

  • 1877. Wisnuwardani, Ratih Wirapuspita
    et al.
    De Henauw, Stefaan
    Androutsos, Odysseas
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Umeå universitet.
    Gottrand, Frédéric
    Huybrechts, Inge
    Knaze, Viktoria
    Kersting, Mathilde
    Le Donne, Cinzia
    Michels, Nathalie
    Estimated dietary intake of polyphenols in European adolescents: the HELENA study.2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, no 6, p. 2345-2363Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Knowledge about polyphenols intakes and their determinants among adolescents might be helpful for planning targeted prevention strategies at an early age.

    METHODS: In the European multicenter cross-sectional HELENA study of 2006-2007, 2428 subjects (47% boys) had data on dietary intake of polyphenols from 2 non-consecutive 24 h recalls via linking with the Phenol-Explorer database. Differences by sex, age, country, BMI, maternal education, paternal education, family affluence, smoking status, alcohol use, and physical activity were explored by linear regression.

    RESULTS: Median, lower and upper quartiles of polyphenol intakes were 326, 167 and 564 mg/day, respectively. Polyphenol intake was significantly higher in the oldest (16-17.49 years), girls, non-Mediterranean countries, lowest BMI, highest paternal education, and alcohol consumers. Main food contributors were fruit (23%, mainly apple and pear, i.e., 16.3%); chocolate products (19.2%); and fruit and vegetable juices (15.6%). Main polyphenol classes were flavonoids (75-76% of total) and phenolic acids (17-19% of total). The three most consumed polyphenols were proanthocyanidin polymers (> 10 mers), hesperidin, and proanthocyanidin 4-6 oligomers.

    CONCLUSION: The current study provided for the first time numbers on the total polyphenol intake and their main food sources in a heterogeneous group of European adolescents. Major differences with adult populations are the lower polyphenol consumption and the major food sources, such as chocolate and biscuits. The discussed determinants and polyphenol types already point to some important population groups that need to be targeted in future public health initiatives.

  • 1878. Wisnuwardani, Ratih Wirapuspita
    et al.
    De Henauw, Stefaan
    Ferrari, Marika
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Umeå University.
    Gottrand, Frédéric
    Huybrechts, Inge
    Kafatos, Antonios G
    Kersting, Mathilde
    Knaze, Viktoria
    Michels, Nathalie
    Total Polyphenol Intake Is Inversely Associated with a Pro/Anti-Inflammatory Biomarker Ratio in European Adolescents of the HELENA Study2020In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, article id nxaa064Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although high dietary polyphenol intake is negatively associated with risk of certain inflammation-associated chronic diseases, the underlying mechanisms are not fully understood and few studies have explored this in adolescents.

    OBJECTIVE: This study aimed to evaluate the association between intakes of total polyphenols, polyphenol classes, and the 10 most commonly consumed individual polyphenols with inflammatory biomarkers in the blood of European adolescents.

    METHODS: In the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study, 526 adolescents (54% girls; 12.5-17.5 y) had data on inflammatory biomarkers and polyphenol intake from 2 nonconsecutive 24-h recalls via matching with the Phenol-Explorer database. Inflammatory biomarkers in serum were IL-1, IL-2, IL-4, IL-5, IL-6, IL-10, transforming growth factor β1 (TGF-β1), TNF-α, IFN-γ, soluble vascular adhesion molecule 1 (sVCAM-1), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin (sE-selectin), white blood cells, lymphocytes, T cells, and C-reactive protein. Multilevel linear models were used to test associations of polyphenol intake with a pro/anti-inflammatory biomarker ratio [(zTNF-α + zIL-6 + zIL-1)/3/zIL-10] as well as with separate inflammatory biomarkers, adjusted for sociodemographic variables, diet inflammation index, BMI z score, and serum triglycerides.

    RESULTS: The pro/anti-inflammatory biomarker ratio was linearly inversely associated with the intake of total polyphenols (β = -0.11, P = 0.040). When other inflammation biomarkers were considered, the serum IL-10 concentration was inversely associated with total polyphenol (β = -0.12, P = 0.017) and flavonoid (β = -0.12, P = 0.013) intakes, findings that were inconsistent with the biomarker ratio results. However, the anti-inflammatory capacity of polyphenols was confirmed by positive associations of IL-4 with phenolic acid (β = 0.09 P = 0.049) and stilbene (β = 0.13, P = 0.019) intakes and the negative association of IL-1, IL-2, and IFN-γ with lignan intake (β = -0.10, P = 0.034; β = -0.09, P = 0.049; β = -0.11, P = 0.023).

    CONCLUSIONS: The negative relation with the overall pro/anti-inflammatory biomarker ratio suggests a potential anti-inflammatory role of high polyphenol intakes among European adolescents. Nevertheless, associations are dependent on polyphenol type and the inflammatory biomarker measured.

  • 1879. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Sundquist, Jan
    Sundquist, Kristina
    Associations between relevant cardiovascular pharmacotherapies and incident heart failure in patients with atrial fibrillation: a cohort study in primary care2018In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 36, no 9, p. 1929-1935Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study association between relevant cardiovascular pharmacotherapy and incident congestive heart failure (CHF) in patients with atrial fibrillation treated in primary health care.

    METHODS: Study population included all adults (n = 7975) aged 45 years and older diagnosed with atrial fibrillation at 75 primary care centers in Sweden between 2001 and 2007. Outcome was defined as a first diagnosis of CHF post-atrial fibrillation diagnosis. Association between CHF and treatment with relevant cardiovascular pharmacotherapies (beta blockers, calcium blockers, digitalis, diuretics, RAS blockers, and statins) was explored using Cox regression analysis with hazard ratios and 95% CIs. Adjustments were made for age, sociodemographic variables, and comorbid conditions (with or without cardiovascular disorders).

    RESULTS: During a mean of 5.7 years (SD 2.3) of follow-up, totally 1552 patients (19.5%; 803 women and 749 men) had a recorded CHF diagnosis. Thiazides (hazard ratio 0.74, 95% CI 0.65-0.84), vessel-active calcium channel blockers (hazard ratio 0.76, 95% CI 0.67-0.86), and nonselective beta blockers (hazard ratio 0.84, 95% CI 0.72-0.98), with specifically sotalol representing 80% of nonselective beta blockers (hazard ratio 0.81, 95% CI 0.69-0.97), were associated with lower CHF risk in fully adjusted models. Loop diuretics (hazard ratio 1.41, 95% CI 1.25-1.57) were associated with a higher risk. Findings for thiazides and vessel-active channel blockers were consistent in the tested subgroups.

    CONCLUSION: In this clinical setting, we found that thiazides, vessel-active calcium channel blockers, and nonselective beta blockers (specifically sotalol) were associated with a lower risk of incident CHF among patients with atrial fibrillation. The findings of the present study need to be confirmed in other settings.

  • 1880.
    Wätterbjörk, Inger
    et al.
    School of Health and Medical Sciences, Örebro University, and Family Medicine Research Center, Örebro, Sweden.
    Häggström-Nordin, Elisabet
    epartment of Women's and Children's Health, Uppsala University, Uppsala, and School of Health, Care and Social Welfare, Mälardalen University, Sweden.
    Hägglund, Doris
    Family Medicine Research Center, Örebro, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Provider strategies for contraceptive counselling among Swedish midwives2011In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 19, no 5, p. 296-301Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that in contraceptive counselling the provider sets the agenda. The aim of this study was to describe how a group of Swedish nurse-midwives think and act in their role as contraceptive counsellors. Semi-structured questions were put to a convenience sample of 16 nurse-midwives. Data were analysed using qualitative content analysis. Five categories were identified: exploring the woman's situation; providing information about contraceptive methods; performing medical evaluation; guiding the decision-making process; and following up on the counselling. Results showed that the providers had developed their own strategies and suggest the use of interventions which combine counselling methods to provide information, with a theory for decision-making, to help in giving advice. This study could contribute to personal reflection on contraceptive counselling in practice, both for experienced counsellors and those new to the task

  • 1881. Ytterberg, Charlotte
    et al.
    Kristensen, Hanne Kaae
    Tistad, Malin
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    von Koch, Lena
    Factors related to met needs for rehabilitation 6 years after stroke2020In: PLoS ONE, E-ISSN 1932-6203, Vol. 15, no 1, article id e0227867Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Research on stroke rehabilitation mainly concerns the first year of recovery, and there is a lack of knowledge regarding long-term rehabilitation needs and associated factors.

    AIM: The aim was to explore the perceived needs for rehabilitation services of people six years after stroke and factors associated with having rehabilitation services needs met.

    METHODS: The study was a 6-year follow up of a prospective study on the rehabilitation process after stroke. Data on perceived needs for rehabilitation, personal factors, disease specific factors, and patient-reported disability were collected through face-to-face interviews in the participants' homes. Logistic regression models were created to explore associations between having rehabilitation services needs met in 11 problem areas (dependent variable) and the independent variables: involvement in decisions regarding care and treatment, sex, age, sense of coherence, self-defined level of private financing, stroke severity, frequency of social everyday activities, perceived impact of stroke, and life satisfaction.

    RESULTS: The 121 participants had a mean age of 63 years at stroke onset and 58% were men. In all problem areas the majority (53-88%) reported having needs met at six years after stroke, however 47% reported unmet needs regarding fatigue and 45% regarding mobility. A lower perceived impact on participation was found to be associated with having rehabilitation services needs met in seven problem areas: mobility, falls, pain, fatigue, concentration, memory, and sight. The strongest association for having needs met was found for the independent variable, involvement in care and treatment, within the three problem areas mobility, falls, and speaking.

    CONCLUSION: In a long-term perspective, there were several modifiable factors associated with having rehabilitation services needs met. The most prominent were perceived involvement in care and treatment, and perceived participation. These factors had a stronger association with having rehabilitation services needs met than disease specific factors six years after stroke.

  • 1882.
    Zadik, Tove
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Sterner, Kathy
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Exploring midwives’ experiences, attitudes and perceptions in relation to unsafe abortion and post abortion care: - a qualitative study with midwives in Kampala, Uganda.2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In the East African region abortion complications causes significant morbidity and mortality, impairing women´s and girls’ health and well-being. Health care provider shortages, physicians in particular, non-availability of safe and effective medicines and technology, and the fact that few midwives and nurses are trained in post abortion care (PAC), result in limited health care access. Stigma and legal repercussions further obstruct access to care and contributes to hesitance among health care providers to provide such care. Previous studies concerning women´s access to sexual and reproductive health (SRH) care in Uganda have revealed several barriers to health care access and limited quality of care. Aim: Exploring midwives´ experiences, attitudes and perceptions in relation to unsafe abortion and their experience of providing PAC. Method: In depth interviews were conducted with twelve midwives at Mulago Referall hospital, Uganda by using a semi- structured interview guide. The transcribed material was then developed through qualitative content analysis using a manifest approach. Result: The analysis resulted in two main categories: 1) stigma and social norms related to women´s sexuality and abortion and 2) quality of post abortion care. The result showed that unintended pregnancies, FP and abortions generally are viewed badly in Uganda and are highly stigmatized. The quality of PAC is perceived reduced due to lack of equipment, high work load and stigma surrounding abortions.

    Conclusion: Unsafe abortions are viewed negatively and is seen as a consequence to stigma surrounding FP and unplanned pregnancies, which is mainly affecting young unmarried women. Midwives experienced reduced quality of PAC due to limited resources. The study also shows that new knowledge and education about PAC can help reduce midwives prejudice towards abortion seeking women and broaden their views.

  • 1883.
    Zakrisson, Ann-Britt
    et al.
    Örebro universitet, Hälsoakademin.
    Engfeldt, Peter
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    Odencrants, Sigrid
    Örebro universitet, Hälsoakademin.
    Hasselgren, Mikael
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Theander, Kersti
    epartment of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden ; Department of Nursing, Karlstad University, Sweden.
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 1884.
    Zakrisson, Ann-Britt
    et al.
    Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hägglund, Doris
    Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 147-155Article in journal (Refereed)
    Abstract [en]

    The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

  • 1885. Zasloff, Eva
    et al.
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    Waldenström, Ulla
    First time mothers' pregnancy and birth experiences varying by age2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 11, p. 1328-1336Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to provide a comprehensive picture of the young to the old first time mother as she presents to the clinician in terms of background, expectations, experiences and outcome of labour.

    METHODS: A longitudinal cohort study was conducted, including 1,302 primiparous women recruited at their first booking visit, at 593 antenatal clinics in Sweden (97% of all clinics), during three 1-week periods, evenly spread over 1 year in 1999 and 2000. Two questionnaires were posted and completed: in the second trimester and 2 months after the birth. Women were divided into 5 age groups, with women aged 26-29 as reference.

    RESULTS: The very young women, aged 15-20 years, had the most negative expectations of the upcoming birth. During pregnancy they were more worried and a depressive mood was more common than in the reference group, as were social problems such as unemployment and lack of support. After the birth, they remembered being more afraid and experiencing more pain and lack of control during labour. In spite of this, their overall experience of childbirth did not differ from the reference group. In contrast, the oldest women, aged 35-43 years, did not have negative feelings about the upcoming birth during pregnancy, and did not remember being afraid or experiencing more pain than the reference group, but experienced childbirth overall as more difficult. Only 57% of the oldest women had a normal vaginal delivery compared with 77% of the youngest women. In addition, 7% of the newborns in the oldest group were transferred to the neonatal clinic after the birth, which was almost 3 times as often as in the reference group.

    CONCLUSION: This study showed that expectations and experiences of childbirth vary by maternal age. Whereas the youngest women were more exposed to social and psychological problems, which may have affected their expectations and experiences during labour, the oldest women may have suffered from the biological disadvantage of high maternal age, which is associated with a more complicated delivery. When looking back at labour and birth, the youngest women probably felt that the total experience was better than expected, whereas the opposite may have been the case for the oldest group.

  • 1886.
    Zembo, Jelena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Äldre invandrares från före detta Jugoslaviens förväntningar i mötet med sjuksköterskor i Sverige: -En kvalitativ intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Today's society is becoming increasingly multicultural which places greater

    demands on both the care system and the nurses involved. The nurses’ lack of

    knowledge incompetence of various regarding eventual cultural differences can

    create cultural clashes and misunderstandings that can result in and improper care.

    The purpose of this study was to investigate the expectations of the elder

    immigrants, from the former Yugoslavia, when meeting in their meetings with the

    nurses in Sweden professionally,

    Method: The study is a qualitative study, with an inductive approach, and is based

    on six interviews with elderly immigrants who originally came from the former

    Yugoslavia. Personal contact was made with the informants to participate in the

    investigation by Serbian / Bosnian / Croatian / Macedonian associations in

    southern Sweden where these compounds are. The author went to the unions and

    informed about the study and those who wanted to participate contacted the author.

    The collected materials were systematically analysed with using content analysis.

    Results The findings that the older immigrants expecting the meeting with the

    nurse are presented in the following five categories. To obtain confirmation of the

    expressed needs, Empathetic contact, Communication and dialogue in the meeting,

    Respect for their values and views on health and Safety. Conclusion: The care of

    older patients with a different cultural background requires both cultural

    competence and a professional approach. The nurses need to be able to identify

    patient care needs, and in this special situation case be able to cope with even pass

    the eventual language barriers, in order to and reach the patient and understand

    their needs.

  • 1887. Zhou, Bin
    et al.
    Bentham, James
    Di Cesare, Mariachiara
    Bixby, Honor
    Danaei, Goodarz Danaei
    Hajifathalian, Kaveh
    Taddei, Cristina
    Carrillo-Larco, Rodrigo M
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ezzati, Majid
    Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 3, p. 872-883Article in journal (Refereed)
    Abstract [en]

    Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.

    Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.

    Results: In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.

    Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

  • 1888. Zhou, Bin
    et al.
    Ezzati, Majid
    Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10064, p. 37-55Article in journal (Refereed)
    Abstract [en]

    Background

    Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.

    Methods

    For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.

    Findings

    We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.

    Interpretation

    During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

    Funding

    Wellcome Trust.

  • 1889.
    Zimonjic, Mirela
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bengtsson, Tina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patienters inställning till insulinbehandling vid typ 2-diabetes – En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Type 2 diabetes is a disease that has increased at an enormous rate

    over the past years, and is now addressed as a global epidemic. The disease is

    greatly influenced by lifestyle factors, and can therefore, to a large extent, be

    prevented or delayed using the patient

    ’s will power and self-care ability. Health

    enhancing self-care often needs to be completed by tablet treatment. One of the

    nurse

    ’s tasks is to identify the patient’s self-care needs, so that optimal conditions

    for good health can be created. Since type 2 diabetes is a progressive disease,

    many patients may need to make the transition to insulin treatment. This transition

    is perceived differently depending on the individual. Therefore, this study aspires

    to investigate the patients

    ’ experiences of the transition to insulin treatment.

    Aim:

    The aim of this literature review is to compile research based evidence

    regarding attitudes towards insulin, and identify factors to patients with type 2

    diabetes accepting insulin treatment.

    Method:

    A literature review based on 15 articles of qualitative and quantitative

    design.

    Result:

    The majority of the participants in all of the studies had a negative

    attitude towards insulin treatment. This could mainly be seen in patients that had

    not yet started insulin treatment. A strong contributing factor to these negative

    attitudes was a lack of knowledge. Individuals who had received satisfactory

    information about insulin treatment, and had experienced insulin treatment for a

    period of time, showed more positive attitudes.

    Conclusion:

    Insulin treatment is often perceived as something negative, and a

    great deal is due to the lack of knowledge. The key to finding a solution may lie

    in education. By applicating a person-centred approach in the nurse

    ’s work, the

    need for knowledge and education can be adjusted to the individual, so that the

    transition to insulin is more readily accepted by the patient. The subject requires

    more research.

  • 1890.
    Äretun Ulander, Amanda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Johansson, Daniel
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patientsäkerhet avseende läkemedelshantering i hemsjukvården: - En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    The number of patients receiving medical care in their own home is increasing. Home health care is a trend that is expected to continue. Patient safety is a national and international priority, where medical management is a risk area both in home and institutional care. Previous research has focused more on patient safety in institutional care. Highlighting patient safety and what nurses can do to increase patient safety in home care is therefore important.

    Aim:

    The aim of this study was to explore patient safety risks regarding medical management in home health care and what nurses can do to increase patient safety in the area.

    Method:

    This study was conducted as a literature review and the result is based on 14 scientific articles. The searches were performed in the databases Cinahl and PubMed.

    Result:

    Nine patient safety risks were identified where lack of competence, shortcomings in communication, the delegation process, comorbidity and information transfer are some of them. The identified risks were further linked to three main areas depending on the underlying cause: Nurses and other health professionals; Patient and the home environment; Organisation and systems.

    Conclusion:

    Medical management is a significant risk area in home health care where many factors affect patient safety. That nurses and other home care professionals are well aware of these risks provide a good prerequisite for preventing and minimizing the incidence of medical related adverse events.

  • 1891.
    Åberg, Anna Cristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Generell Motorisk Funktionsbedömning: GMF Manual2011Book (Other academic)
  • 1892.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Cedervall, Y
    Giedraitis, V
    Berglund, L
    Lennhed, B
    Rosendahl, E
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kilander, L
    Can Timed Up-and-GO (TUG) Dual Task Performance Aid Diagnosis of Dementia?2017Conference paper (Refereed)
  • 1893.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Cedervall, Y
    Lundberg, C
    Giedraitis, V
    Berglund, L
    Kilander, L
    Ingelsson, M
    Rosendahl, E
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Timed Up-and-Go dual-task performance in people with cognitive impairment2018Conference paper (Refereed)
  • 1894.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Örebro universitet.
    Inpatient geriatric care in Sweden: Important factors from an inter-disciplinary team perspective2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 172, p. 113-120Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care:

    • Interactive assessment processes,
    • A holistic care approach, and
    • Proactive non-hierarchical interaction

    Aspects of time and goal-orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment – which is possibly best provided by older-friendly hospitals – appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

  • 1895.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nordmark, S
    Lyhagen, J
    Lindberg, I
    Finch, T
    The Swedish version of the normalisation process theory measurement s-nomad: Translation, adaptation and pilot testing2018In: BMJ Evidence-Based Medicine, ISSN 2515-446X, Vol. 23, no Suppl 1, p. A33-A33Article in journal (Refereed)
  • 1896.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nordmark, S
    Lyhagen, J
    Lindberg, I
    Finch, T
    The Swedish version of the Normalization Process Theory Measure S-NoMAD: Translation, adaptation and pilot testing2018Conference paper (Refereed)
  • 1897.
    Åberg, Anna Cristina
    et al.
    The Swedish School of Sport and Health Sciences, Box 5626, SE-114 86 Stockholm, Sweden ; Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
    Elmgren Frykberg, Gunilla
    Uppsala universitet, Rehabiliteringsmedicin.
    Halvorsen, Kjartan
    Uppsala universitet, Reglerteknik; Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Medio-lateral stability of sit-to-walk performance in older individuals with and without fear of falling2010In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 31, no 4, p. 438-443Article in journal (Refereed)
  • 1898.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Grundström, A
    Cedervall, Y
    Dual-task timed up and go test as part of memory assessment: a pilot study2015Conference paper (Refereed)
  • 1899.
    Åberg, Anna Cristina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University.
    Halvorsen, Kjartan
    Uppsala University.
    From, Ingrid
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bergman Bruhn, Åsa
    Dalarna University, School of Technology and Business Studies, Occupational science.
    Oestreicher, Lars
    Uppsala University.
    Melander-Wikman, Anita
    Luleå University of Technology.
    A study protocol for applying user participation and co-learning: lessons learned from the eBalance project2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 5, article id 512Article in journal (Refereed)
    Abstract [en]

    The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project’s initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants’ reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.

  • 1900.
    Åberg, Anna Cristina
    et al.
    Uppsala universitet, Geriatrik ; Akademiska sjukhuset.
    Lundin-Olsson, Lillemor
    Umeå Universitet.
    Rosendahl, Erik
    Umeå Universitet.
    Nationell satsning för ökad patientsäkerhet: Fall och fallskador: åtgärder för att förebygga2011Other (Other academic)
3536373839 1851 - 1900 of 1919
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