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  • 2251.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kreicbergs, Ulrika
    Ersta Sköndal Bräcke högskola.
    Axelsson, Bertil
    Björk, Olle
    Lövgren, Malin
    Ersta Sköndal Bräcke högskola.
    Physicians working in oncology identified challenges and factors that facilitated communication with families when children could not be cured2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    Aim: We explored physicians’ experiences of communicating with families when their child had cancer and a cure was no longer an option, by focusing on barriers and facilitating factors.

    Methods: Physicians from the six cancer centres in Sweden took part in focus group discussions from December 2017 and May 2018 and the data were analysed using qualitative content analysis. Focus groups enabled us to gather individual and shared perspectives.

    Results: The 35 physicians (20 male) had a mean age of 47 (range 31-74) and a mean of 11 years’ experience in oncology, ranging from under one year to 43 years. They reported communication challenges when a cure was not possible, namely: emotional and mental drain, lack of mutual understanding and uncertainty about communication skills. They also reported facilitating factors: flexibility in complex conversations, the child’s position in the conversations, continuity and trusting relationships, support from colleagues and having discussed the potentially life-threatening nature of cancer from the very start of treatment.

    Conclusion: Physicians working in paediatric oncology perceived challenges and facilitating factors in their communication with families when a cure was not an option. Training to overcome communication issues could support the early integration of palliative care and curative treatment.

  • 2252.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. CKF, Centre for Clinical Research Dalarna, County Council of Dalarna, Falun.
    Lövgren, M
    Lundquist, G
    Axelsson, B
    Palliative care physicians' experiences of end-of-life communication: A focus group study2018In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 27, no 1, article id e12728Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore palliative home care physicians' experiences regarding end-of-life breakpoint communication (BPC). This is a qualitative study where focus group interviews were conducted and analysed using qualitative content analysis. The results show that the participants saw themselves as being responsible for accomplishing BPC, and they were convinced that it should be regarded as a process of communication initiated at an early stage, i.e. proactively. However, BPC was often conducted as a reaction to the patient's sudden deterioration or sometimes not at all. The barriers to achieving proactive BPC included physicians' uncertainty regarding the timing of BPC, primarily due to difficulties in prognostication in terms of time of death, and uncertainty as to what BPC should include and how it should best be approached. Furthermore, there was insufficient documentation regarding previous BPC, which impeded proactive BPC. Although our study shows that physicians are ambitious when it comes to the communication of information to patients and families, there is a need for further training in how to conduct BPC and when to initiate the BPC process. Furthermore, there should be documentation that different professionals can access as this would appear to facilitate a proactive BPC process.

  • 2253.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Lövgren, Malin
    P033 Physicians’ Perceptions of End-of-Life Breakpoint Communication: A Focus Group Study2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 6, p. e73-e74Article in journal (Refereed)
  • 2254.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. CKF (Centre of Clinical Research) County Council of Dalarna, Falun, Sweden.
    Lövgren, Malin
    The Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden. .
    Lundquist, Gunilla
    CKF (Centre of Clinical Research) County Council of Dalarna, Falun, Sweden.
    Axelsson, Bertil
    Research unit Östersund hospital, Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Physicians’ perceptions of end-of-life breakpoint communication: A focus group study2016Conference paper (Refereed)
  • 2255.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. CKF; Ersta Sköndal University College.
    Lövgren, Malin
    Ersta Sköndal University College; Karolinska.
    Sveen, Josefin
    Ersta Sköndal University College; Uppsala universitet.
    Bylund Grenklo, Tove
    Karolinska institutet.
    Alvariza, Anette
    Ersta Sköndal University College.
    Kreicbergs, Ulrika
    Ersta Sköndal University College.
    A nationwide study of young adults’ perspectives on participation in bereavement research2019In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Young adults represent a minority in research; they are often considered too young or too old for participation. There is sparse information, especially in bereavement research, regarding how this age group perceives research participation and what they consider beneficial or harmful.

    AIM:

    To explore how parentally bereaved and nonbereaved young adults perceive research participation.

    DESIGN:

    Qualitative analysis of free-text comments collected in a Swedish nation-wide survey.

    SETTING/PARTICIPANTS:

    Parentally cancer-bereaved and nonbereaved young adults between 18 and 25 years old living in Sweden.

    RESULTS:

    Five categories were identified from the free-text comments, three among the cancer-bereaved: (1) therapeutic to remember the deceased, (2) valuable to help others and improve care, and (3) short-term distressful-long-term beneficial, and two among the nonbereaved: (1) increased reflection and awareness about life, and (2) an opportunity to help others.

    CONCLUSIONS:

    It is important to invite young adults to participate in bereavement research. The results suggest that potential harm is minimal and that participating in bereavement research can have a beneficial effect on young adults.

  • 2256.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Melin Johansson, Christina
    Danielson, Ella
    Health care staff’s discussions of existential issues in cancer care2010In: Changing Health. 6th International Conference on Social Work in Health and Mental Health. 28th June - 2nd July 2010, Dublin, Ireland, Dublin, Ireland, 2010Conference paper (Refereed)
    Abstract [en]

    Objectives: A qualitative study was made to explore healthcare staff’s discussions about existential issues when caring for patients with cancer on a surgical ward, as described in supervision sessions. Methods: Secondary content analysis of twelve tape-recorded supervision sessions was used. The sessions lasted for two hours every third week during one year. The supervision sessions were conducted at a surgical clinic in a county hospital in the middle of Sweden. Twenty-one participants, 25 to 55 years of age (MD=38) who had worked on a surgical clinic for 1 to 30 years (MD=10) participated. Findings: The analysis showed that reflections about existential issues do exist among healthcare staff in surgical wards. There are barriers, in staff themselves as well as in the organisation hindering them to encounter patients’ existential needs which is illustrated by the domain: “Health care staff’s discussions of their existential dilemmas” and the themes “feelings of powerlessness”, “identifying with patients”, and “getting close or keeping a distance”. Staff observed that patients have existential needs which are illustrated by the domain: “Health care staff’s discussions of patients’ existential distress” and the themes “being in despair” and “feelings of isolation”. Conclusions: This study shows that healthcare staff in surgical wards is conscious of patients’ existential distress. Yet staff lack strategies to encounter patients’ existential issues. There is a need for knowledge about the meaning of existential issues and education for staff working in a surgical ward and how to encounter patients’ existential needs.

  • 2257.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Melin-Johansson, Christina
    Danielson, Ella
    Existential issues among health care staff in surgical cancer care: Discussions in supervision sessions2011In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 15, no 5, p. 447-453Article in journal (Refereed)
    Abstract [en]

    Purpose The aim was, through analysis of dialogues in supervision sessions, to explore if health care staff in surgical care discussed existential issues when caring for cancer patients. Method A secondary analysis of the content of twelve tape-recorded supervision sessions (18 h) was conducted. The study analysed the dialogue content in supervision sessions involving a group of eight participants who worked at a surgical clinic at a county hospital in central Sweden. The sessions were held every third week during the course of one year. Results The analysis showed that surgical health care staff contemplates existential issues. The staff discussed their existential dilemmas, which hindered them from meeting and dealing with patients’ existential questions. This is illustrated in the themes: “feelings of powerlessness”, “identifying with patients”, and “getting close or keeping one’s distance”. The staff also discussed the fact that patients expressed existential distress, which is illustrated in the themes: “feelings of despair” and “feelings of isolation”. Conclusions This study shows that there are existential issues at a surgical clinic which health care staff need to acknowledge. The staff find themselves exposed to existential dilemmas when caring for cancer patients. They are conscious of patients’ existential issues, but lack strategies for dealing with this. This study highlights a need to provide support to staff for developing an existential approach, which will boost their confidence in their encounters with patients.

  • 2258.
    Udo, Camilla
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Melin-Johansson, Christina
    Henoch, Ingela
    Axelsson, Bertil
    Danielson, Ella
    Surgical nurses€™ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues2014In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 4, p. 426-440Article in journal (Refereed)
  • 2259.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. Center for Clinical Research Dalarna, Falun.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Strömkvist, Ingegerd
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    A qualitative study of assistant nurses’ experiences of palliative care in residential care2018In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 4, p. 527-535Article in journal (Refereed)
    Abstract [sv]

    Aim

    To explore assistant nurses' experiences and perceptions of both positive and negative aspects of providing palliative care for older people in residential care facilities.

    Design

    A qualitative explorative study.

    Methods

    Critical incidents were collected through semi‐structured face‐to‐face interviews and analysed by performing a qualitative content analysis.

    Results

    A total of 40 critical incidents from daily work was described by assistant nurses. The results showed that close cooperation between unlicensed and licensed professionals was crucial to provide good care but was sometimes negatively affected by the organizational structure. The availability of professionals was identified as a critical factor in providing good care at the end of life in a consultative organization. The most prominent findings were those that indicated that, especially in a consultative organization, there seems to be a need for clear roles, comprehensive and clear care plans and a solid support structure to ensure continuity of care.

  • 2260.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Strömkvist, Ingegerd
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Assistant nurses’ experiences and perceptions of palliative care situations in residential care2016Conference paper (Refereed)
  • 2261.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Strömkvist, Ingegerd
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    P177 Assistant Nurses’ Experiences and Perceptions of Palliative Care Situations in Residential Care2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 6Article in journal (Refereed)
  • 2262.
    Udo, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. Center for Clinical Research Dalarna.
    Svenningsson, Irene
    Björkelund, Cecilia
    Hange, Dominique
    Jerlock, Margareta
    Petersson, Eva-Lisa
    An interview study of the care manager function: Opening the door to continuity of care for patients with depression in primary care2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 974-982Article in journal (Refereed)
    Abstract [en]

    Aim: To explore experiences among patients with depression of contact with a care manager at a primary care centre.

    Design: A qualitative explorative study.

    Methods: During spring and summer 2016, 20 individual face-to-face interviews were conducted with patients with experience of care manager contact. The material was analysed using systematic text condensation.

    Results: The participants described that having contact with a care manager was a support in their recovery process. Care became more available, and the structured continuous contact and the care manager's availability contributed to a trusting relationship. Having someone to share their burden with was a relief. However, it was described as negative when the care manager was perceived as inflexible and not open to issues that the participants felt a need to discuss. For the care manager contact to be successful, there is a need for flexibility and individually tailored contact.

  • 2263.
    Ullgren, Evelina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Tervo, Rebecka
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patientdelaktighet i vården vid bedsiderapportering: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Participation and person-centered care are key concepts in the care that are being given today. In order for the patient to participate, they must be involved in the daily work such as shift reporting. At each shift, reporting occurs from one nurse to another which often lacks patient involvement. A reporting model is bedside report, which means reporting takes place in the patient's presence.

    Aim

    : The aim of this study was to describe patient’s participation in care during bedside report.

    Method

    : A literature review.

    Results

    : Bedside report made patients feel more involved in their care, partly because they felt valued as a participant in the report. The patients were considered a person in the first hand. Both patients and nurses felt that the reporting method was crucial for the participation. Most patients appreciated being included in the reporting and that they received valuable information that they considered justifiable. However, not all patients wanted to participate, which was due, among other things, to the fact that the report was considered for the nurses.

    Conclusion

    : Bedside report increased patient involvement in care, according to both the patient and the nurse. However, not all patients wanted to participate and the reporting method were important for the level of participation.

  • 2264.
    Ullén, Matilda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bivesjö, Linda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskans erfarenheter kring omvårdnad av patienter med psykisk ohälsa på akutmottagningar: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Mental illness is increasing among the population and is today an extensive and serious public health problem. In nursing a patient with mental illness, it’s important that the nurse's first meeting with the patient is characterized by the patient being able to feel trust and hope towards the nurse. It is common for a patient with mental illness to have their first meeting within healthcare in the emergency department. The emergency department has a high rate of work that can make it difficult for the nurse to set aside time to build a relationship with the patient and the nursing requirements are different from nursing in psychiatric care.

    Aim:

    To describe nurses' experience in nursing patients with mental illness in the emergency department.

    Method:

    A literature review.

    Finding:

    There were five themes that had significance for the nurses' experiences: environment, time, attitudes, communication, knowledge and education. The findings showed that a busy environment was considered unsuitable for the care of patients. Furthermore, the results showed that a lack of time and lack of nurse’s knowledge affected communication and attitudes towards their patients.

    Conclusion:

    The literature review shows that nurses requires shortcomings in nursing patients with mental illness in emergency departments.

  • 2265. Unbeck, Maria
    et al.
    Förberg, Ulrika
    Ygge, Britt-Marie
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Petzold, Max
    Johansson, Eva
    Peripheral venous catheter related complications are common among peadiatric and neonatal patients2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 6, p. 566-574Article in journal (Refereed)
    Abstract [en]

    Aim: The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications. 

    Methods: We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses. 

    Results: Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99). 

    Conclusion: PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age.

  • 2266.
    Ursing, Johan
    et al.
    Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau, Malaria Research Laboratory, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Eksborg, Staffan
    Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Rombo, Lars
    Malaria Research Laboratory, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Centre for Clinical Research, Sörmland, Uppsala University, Sweden.
    Bergqvist, Yngve
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Blessborn, Daniel
    Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
    Rodrigues, Amabelia
    Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau.
    Kofoed, Poul-Erik
    Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau, Department of Paediatrics, Kolding Hospital, Kolding, Denmark.
    Chloroquine is grossly under dosed in young children with malaria: implications for drug resistance2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, article id e86801Article in journal (Refereed)
    Abstract [en]

    Background: Plasmodium falciparum malaria is treated with 25 mg/kg of chloroquine (CQ) irrespective of age. Theoretically, CQ should be dosed according to body surface area (BSA). The effect of dosing CQ according to BSA has not been determined but doubling the dose per kg doubled the efficacy of CQ in children aged <15 years infected with P. falciparum carrying CQ resistance causing genes typical for Africa. The study aim was to determine the effect of age on CQ concentrations.

    Methods and Findings: Day 7 whole blood CQ concentrations were determined in 150 and 302 children treated with 25 and 50 mg/kg, respectively, in previously conducted clinical trials. CQ concentrations normalised for the dose taken in mg/kg of CQ decreased with decreasing age (p<0.001). CQ concentrations normalised for dose taken in mg/m(2) were unaffected by age. The median CQ concentration in children aged <2 years taking 50 mg/kg and in children aged 10-14 years taking 25 mg/kg were 825 (95% confidence interval [CI] 662-988) and 758 (95% CI 640-876) nmol/l, respectively (p = 0.67). The median CQ concentration in children aged 10-14 taking 50 mg/kg and children aged 0-2 taking 25 mg/kg were 1521 and 549 nmol/l. Adverse events were not age/concentration dependent.

    Conclusions: CQ is under-dosed in children and should ideally be dosed according to BSA. Children aged <2 years need approximately double the dose per kg to attain CQ concentrations found in children aged 10-14 years. Clinical trials assessing the efficacy of CQ in Africa are typically performed in children aged <5 years. Thus the efficacy of CQ is typically assessed in children in whom CQ is under dosed. Approximately 3 fold higher drug concentrations can probably be safely given to the youngest children. As CQ resistance is concentration dependent an alternative dosing of CQ may overcome resistance in Africa.

  • 2267. Ursing, Johan
    et al.
    Kofoed, Poul-Erik
    Rodrigues, Amabelia
    Bergqvist, Yngve
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Rombo, Lars
    Chloroquine is grossly overdosed and overused but well tolerated in Guinea-Bissau2009In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 53, no 1, p. 180-185Article in journal (Refereed)
    Abstract [en]

    High chloroquine doses are commonly prescribed in Guinea-Bissau. Double-dose chloroquine has been shown to be more efficacious (92% efficacy) than the standard dose (80% efficacy). However, chloroquine is toxic when overdosed, and it was not known if the high doses prescribed in Guinea-Bissau were taken or whether they caused adverse effects. We aimed to determine the dosage of chloroquine commonly prescribed, the doses commonly taken, and whether concentration-dependent adverse events occurred in routine practice. Chloroquine prescriptions by eight physicians and chloroquine intake by 102 children were recorded. Chloroquine intake and adverse events were assessed by questioning. Chloroquine concentrations in whole blood were measured. The median total chloroquine dose prescribed and that reportedly taken were 81 and 77 mg kg(-1), respectively. The total dose was usually split into two to three daily doses of 6.6 mg kg(-1) each. These were taken unsupervised for a median of 5 days. Forty percent of the study children had chloroquine concentrations in the same range as those found in a previous study in which double the normal dose (50 mg kg(-1)) of chloroquine was taken. Only 3/102 children had Plasmodium falciparum in the blood at the time of diagnosis and treatment. No severe adverse events were reported. No adverse events were associated with higher chloroquine concentrations. High doses of chloroquine are commonly taken and well tolerated in Guinea-Bissau. Malaria diagnostics are poor, and chloroquine is commonly prescribed to children without parasitemia. Use of high-dose chloroquine is concurrent with an exceptionally low prevalence of chloroquine-resistant P. falciparum.

  • 2268. Ursing, Johan
    et al.
    Kofoed, Poul-Erik
    Rodrigues, Amabelia
    Blessborn, Daniel
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Thoft-Nielsen, Rikke
    Bjorkman, Anders
    Rombo, Lars
    Similar efficacy and tolerability of double-dose chloroquine and artemether-lumefantrine for treatment of Plasmodium falciparum infection in Guinea-Bissau: a randomized trial2011In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 203, no 1, p. 109-116Article in journal (Refereed)
    Abstract [en]

    Background. In 2008. Guinea-Bissau introduced artemether-lumefantrine for treatment of uncomplicated malaria. Previously, 3 times the standard dose of chloroquine, that was probably efficacious against Plasmodium falciparum with the resistance-associated chloroquine-resistance transporter (pfcrt) 76T allele, was routinely used. The present study compared the efficacy and tolerability of a double standard dose of chloroquine with the efficacy and tolerability of artemether-lumefantrine.

    Methods. In a randomized open-label clinical trial, artemether-lumefantrine or chloroquine (50 mg/kg) were given as 6 divided doses over 3 days to children aged 6 months - 15 years who had uncomplicated P. falciparum monoinfection. Drug concentrations were measured on day 7. P. falciparum multidrug resistance gene N86Y and pfcrt K76T alleles were identified.

    Results. The polymerase chain reaction adjusted day 28 and 42 treatment efficacies were 162 (97%) of 168 and 155 (97%) of 161, respectively, for artemether-lumefantrine and 150 (95%) of 158 and 138 (94%) of 148, respectively, for chloroquine. When parasites with resistance-associated pfcrt 76T were treated, the day 28 efficacy of chloroquine was 87%. No severe drug-related adverse events were detected. Symptom resolution was similar with both treatments.

    Conclusions. Both treatments achieved the World Health Organization recommended efficacy for antimalarials that will be adopted as policy. High-dose chloroquine treatment regimes should be further evaluated with the aim of assessing chloroquine as a potential partner drug to artemisinin derivatives.

  • 2269. Ursing, Johan
    et al.
    Rombo, Lars
    Bergqvist, Yngve
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Rodrigues, Amabelia
    Kofoed, Poul-Erik
    High-Dose Chloroquine for Treatment of Chloroquine Resistant Plasmodium falciparum Malaria2016In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 213, no 8, p. 1315-1321Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:  Due to development of multidrug resistant Plasmodium falciparum new antimalarial therapies are needed. In Guinea-Bissau, routinely used triple standard dose chloroquine remained effective for decades despite the existence of "chloroquine resistant" P. falciparum. This study aimed to determine the in vivo efficacy of higher chloroquine concentrations against P. falciparum with resistance conferring genotypes.

    METHODS:  Standard or double dose chloroquine was given to 892 children aged <15 years with uncomplicated malaria during three clinical trials (2001-2008) with at least 35 days follow up. The P. falciparum resistance conferring genotype (pfcrt 76T) and day seven chloroquine concentrations were determined. Data were divided into age groups <5, 5-9 and 10-14 years as concentrations increase with age when chloroquine is prescribed according to body weight.

    RESULTS:  Adequate clinical and parasitological responses were 14%, 38%, and 39% after standard dose and 66%, 84%, and 91% after double dose chloroquine in children aged <5, 5-9 and 10-14 years and infected with P. falciparum with chloroquine resistance conferring genotypes (n=195, p<0.001). In parallel, median chloroquine concentrations were 471, 688, and 809 (standard dose), 1040, 1494 and 1585 (double dose) nmol/l.

    CONCLUSIONS:  Chloroquine resistance is dose dependent and can be overcome by higher still well tolerated doses.

  • 2270.
    Usuda, Mie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Stöd till patienter med stomi:: En litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att studera vad stomiopereradepatienter får för stöd och vad de saknar för stöd för att

    patienten ska kunna anpassa sig till sitt nya liv med stomi.

    Metod: Studien är en litteraturöversikt som byggs på vetenskapliga artiklar som har tagits

    fram i databaserna CINAHL och PubMed.

    Resultat: Stöd som stomiopererade patienter får för att effektivt anpassa sig till sin stomi var

    psykosocialt stöd bland annat gruppbaserad interaktiv undervisning i stomivård samt stöd

    efter utskrivning bland annat stomiterapeutledd telefonuppföljning. Stöd som stomiopererade

    patienter saknar för att effektivt anpassa sig till sin stomi var framförallt pre- och postoperativ

    information samt information om sexualliv med stomi.

    Slutsats: Det fanns både befintligt och bristande stöd för stomiopererade patienter att

    effektivt anpassa sig till sin stomi. Sjuksköterskan har ett viktigt ansvar för att öka kunskap

    om var fokus för omvårdnaden för tarmstomiopererade patienter bör ligga för att effektivt

    hjälpa patienten att anpassa sig till sitt nya liv med stomi.

  • 2271.
    Vahtera, Elin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Einarsson, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation: –En litteraturöversikt2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Obesity and overweight have become more frequent in recent years and is

    today a major health problem worldwide. A lot of people find it difficult to lose weight on

    their own which has made surgery become more common in recent years. Gastric bypass

    surgery is currently the most common surgical method of weight loss and have shown good

    results. However, the health-related quality of life is affected as the operation demand a

    major lifestyle change.

    Purpose: The purpose of this study was to describe adults’ experience of health-related

    quality of life after a gastric bypass surgery.

    Method: The study contains 11 quantitative and 3 qualitative scientific articles describing

    the adults’ experience of health-related quality of life after a gastric bypass surgery.

    Results: Health-related quality of life (HRQOL) has shown an improvement in all studies

    after a gastric bypass surgery. HRQOL has had its peak after 1 month in all scales based on

    the SF-36 questionnaire.

    Conclusion: The major lifestyle change that people go through after a gastric bypass

    surgery has shown improvements in HRQOL in both long and short term. Contributing

    factors that may affect the improved health-related quality of life can among other things be

    fulfilled expectations of the surgery and physical activity.

  • 2272. van den Heuvel, Eleanor
    et al.
    Gilhooly, Mary
    Sutherland, Ian
    Jowitt, Felicity
    McKee, Kevin
    Dalarna University, School of Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Health and Social Studies, Social Work.
    Parker, Stuart
    Gaydecki, Patrick
    Ratcliffe, Norman
    Bichard, Jo-Anne
    Long, Adele
    Cotterill, Nikki
    Orme, Susie
    Tackling ageing continence through theory, tools and technology (TACT3)2013Report (Other academic)
  • 2273. van der Laan, S.W
    et al.
    Fall, T
    Soumaré, A
    Teumer, A
    Sedaghat, S
    Baumert, J
    Zabaneh, D
    van Setten, J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala university.
    Asselbergs, F. W
    Cystatin C and cardiovascular disease: A mendelian randomization study2016In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 68, no 9, p. 934-945Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Epidemiological studies show that high circulating cystatin C is associated with risk of cardiovascular disease (CVD), independent of creatinine-based renal function measurements. It is unclear whether this relationship is causal, arises from residual confounding, and/or is a consequence of reverse causation.

    OBJECTIVES: The aim of this study was to use Mendelian randomization to investigate whether cystatin C is causally related to CVD in the general population. METHODS We incorporated participant data from 16 prospective cohorts (n ¼ 76,481) with 37,126 measures of cystatin C and added genetic data from 43 studies (n ¼ 252,216) with 63,292 CVD events. We used the common variant rs911119 in CST3 as an instrumental variable to investigate the causal role of cystatin C in CVD, including coronary heart disease, ischemic stroke, and heart failure.

    RESULTS: Cystatin C concentrations were associated with CVD risk after adjusting for age, sex, and traditional risk factors (relative risk: 1.82 per doubling of cystatin C; 95% confidence interval [CI]: 1.56 to 2.13; p ¼ 2.12 1014). The minor allele of rs911119 was associated with decreased serum cystatin C (6.13% per allele; 95% CI: 5.75 to 6.50; p ¼ 5.95 10211), explaining 2.8% of the observed variation in cystatin C. Mendelian randomization analysis did not provide evidence for a causal role of cystatin C, with a causal relative risk for CVD of 1.00 per doubling cystatin C (95% CI: 0.82 to 1.22; p ¼ 0.994), which was statistically different from the observational estimate (p ¼ 1.6 105 ). A causal effect of cystatin C was not detected for any individual component of CVD.

    CONCLUSIONS: Mendelian randomization analyses did not support a causal role of cystatin C in the etiology of CVD. As such, therapeutics targeted at lowering circulating cystatin C are unlikely to be effective in preventing CVD. 

  • 2274.
    van der Maarel, Martin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Byqvist, Mikael
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Hur parkmiljöer kan påverka vardagsrörelse: en studie utifrån aktiva unga vuxnas uppfattningar2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Reduced movement in everyday life is a problem that is becoming increasingly common in the world today. Although people today are becoming more and more regularly physically active and conduct more planned exercise, the everyday movement that is needed to maintain a good health and reduce the risk of dying prematurely, is decreasing. Something that has been shown to increase everyday activity is the presence of park environments. Research has shown that where fewer parks existed, people were more sedentary and less active. The

    aim of this study was to investigate the relationship between everyday movement and park environments based on the view of physically active young adults. The method used in this study consisted of interviewing young adults (18-30 years of age). Why this selection was used was because this group of age were previously considered to have good health during their period of life, but new evidence shows that people of these ages are becoming increasingly inactive in their daily lives. Physically active people were chosen to see how their perceptions of movement in addition to their normal training meant to them. Six active young adults were recruited to the study and interviewed. The results showed that young adults understand the meaning of the positive effects of movement, but at the same time they were negatively motivated to visit park environments. The single movement in parks indicated by the participants was in the form of walks and jogging. Participants suggested that more types of activities (kiosks, outdoor gyms, etc.) should be available to increase the visitor level in park environments for a longer period of time, as well as conduct more daily living there.

  • 2275.
    van der Zijpp, T.
    et al.
    Fontys University.
    Niessen, T.
    Fontys University.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Hawkes, C.
    McMullan, C.
    Mockford, C.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McCormack, B.
    Rycroft-Malone, J.
    Seers, K.
    A bridge over turbulent waters: Illustrating the interaction between managerial leaders and facilitators when implementing research evidence2016In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    Background: Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process.

    Aims: To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people.

    Methods: Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs.

    Results: This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings.

    Linking evidence to action: Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.

  • 2276. Vegsund, H. -K
    et al.
    Rannestad, T.
    Reinfjell, T.
    Moksnes, U. K.
    Eilegård Wallin, Alexandra
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eilertsen, M. B.
    Translation and linguistic validation of a swedish study-specific questionnaire for use among Norwegian parents who lost a child to cancer2018In: Social Sciences, ISSN 2076-0760, E-ISSN 2076-0760, Vol. 7, no 10Article in journal (Refereed)
    Abstract [en]

    Research is needed on how to help cancer-bereaved parents, as they are considered to be a vulnerable population and they are at risk of developing ill health following the loss of a child to cancer. The purpose of the present study was to translate and linguistically validate a Swedish study-specific questionnaire that was developed for Swedish cancer-bereaved parents. The translated questionnaire will be used in a nationwide study in Norway. Methods: Forward and backward translations of the Swedish study-specific questionnaire were conducted, followed by linguistic validation based on telephone interviews with six Norwegian cancer-bereaved parents. Result: It was found that several medical terms and conceptual issues were difficult for the Norwegian parents to understand. There were also four issues regarding the response alternatives. Conclusions: Although Sweden and Norway have quite similar cultures and languages, the results off this pilot study show that, to ensure the quality of a translated questionnaire, linguistic validation as well as translation is necessary.

  • 2277. Vegsund, Hilde Kristin
    et al.
    Reinfjell, Trude
    Moksnes, Unni Karin
    Eilegård Wallin, Alexandra
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hjemdal, Odin
    Eilertsen, Mary-Elizabeth Bradley
    Resilience as a predictive factor towards a healthy adjustment to grief after the loss of a child to cancer2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 3, article id e0214138Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Grief among bereaved parents is known to cause psychological distress and physical illness, but knowledge concerning factors that can contribute to health promotion after bereavement is scarce. Childhood cancer remains the most common non-accidental cause of death among children in Norway. The aim of the present study was to explore if resilience factors among cancer-bereaved parents could predict whether they will be able to come to terms with their grief 2-8 years following the loss.

    METHODS: A Norwegian cross-sectional national survey was conducted among 161 cancer-bereaved parents using a study-specific questionnaire. Logistic regression was used to explore whether resilience factors predicted parents' grief outcome 2-8 years after their loss.

    RESULTS: On the Resilience Scale for Adults (RSA), three of the resilience factors contributed significantly in predicting whether the parents in the present study would come to terms with their grief 2-8 years after the loss their child: "Perception of self "(OR 2.08, p = .048), "Social resources" (OR 2.83, p = .008) and "Family cohesion" (OR .41, p = .025). The results showed a negative relationship between time since loss (2-6 years) and whether the parents answered that they had come to terms with their grief (p = < .05). The loss of a parent (OR .30, p = .030) combined with the loss of their child had a negative and significant effect on whether they indicated that they had processed their grief.

    CONCLUSION: The total score of RSA and three of the six resilient factors contributed significantly in predicting whether cancer-bereaved parents in the present study indicated that they had come to terms with their grief to a great extent. The present study supports hypotheses that regard resilience as an important contribution in predicting healthy outcomes in people exposed to adverse life events.

  • 2278. Velasquez, Ilais Moreno
    et al.
    Kumar, Jitender
    Bjorkbacka, Harry
    Nilsson, Jan
    Silveira, Angela
    Leander, Karin
    Berglund, Anita
    Strawbridge, Rona J.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Melander, Olle
    Duffy antigen receptor genetic variant and the association with Interleukin 8 levels2015In: Cytokine, ISSN 1043-4666, E-ISSN 1096-0023, Vol. 72, no 2, p. 178-184Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to identify loci associated with circulating levels of Interleukin 8 (IL8). We investigated the associations of 121,445 single nucleotide polymorphisms (SNPs) from the Illumina 200K CardioMetabochip with IL8 levels in 1077 controls from the Stockholm Heart Epidemiology Program (SHEEP) study, using linear regression under an additive model of inheritance. Five SNPs (rs12075A/G, rs13179413C/T, rs6907989T/A, rs9352745A/C, rs1779553T/C) reached the predefined threshold of genome-wide significance (p < 1.0 x 10(-5)) and were tested for in silico replication in three independent populations, derived from the PIVUS, MDC-CC and SCARF studies. IL8 was measured in serum (SHEEP, PIVUS) and plasma (MDC-CC, SCARF). The strongest association was found with the SNP rs12075 A/G, Asp42Gly (p = 1.6 x 10(-6)), mapping to the Duffy antigen receptor for chemokines (DARC) gene on chromosome 1. The minor allele G was associated with 15.6% and 10.4% reduction in serum IL8 per copy of the allele in SHEEP and PIVUS studies respectively. No association was observed between rs12075 and plasma IL8. Conclusion: rs12075 was associated with serum levels but not with plasma levels of IL8. It is likely that serum IL8 represents the combination of levels of circulating plasma IL8 and additional chemokine liberated from the erythrocyte DARC reservoir due to clotting. These findings highlight the importance of understanding ILS as a biomarker in cardiometabolic diseases.

  • 2279.
    Vestergren, Tommy
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Josefsson, Jesper
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Muskelaktivering under farmers walk, marklyft, trapbarmarklyft (high-bar) och trapbar marklyft (low-bar): En Deskriptiv Studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    SubjectThe purpose of this descriptive study was to examine the mean muscle activation rate in the exercises farmers walk, conventional deadlifts, trapbar deadlift (high bar) and trapbar deadlift (low bar).MethodsThe participants were five healthy men with no injuries or diseases, with at least two years of prior experience in general strength training and the four specific test exercises; and able to perform at least five repetitions of 150 kilos conventional deadlift. Their average age, height and body weight was 25 ± 4 years, 180 ± 3 cm and 85 ± 4 kg. The EMG-apparatus used in the study was a Biometrics Datalog (Cumfelinfach, Gwent, UK) with associated surface electrodes and knee goniometer. The analysis of the recorded data was done with the software Biometrics DATALOG PC software (v: 7.50). The compilation of all data used Microsoft Excel 2010. The data are presented in mean ± standard deviation in relation to mean maximum voluntary contraction (MVIC). In the study, participants performed a number of pre-tests, for the so called MVIC, which then was used as a normalization of the EMG-data. The main test in the study were four different exercises; conventional deadlift, trapbar deadlift (high bar) and trapbar deadlift (low-bar) and farmers walk. During the test participants used 150 kg for five repetitions on the deadlifts and 150 kg for fifteen meters on the farmers walk.ResultsThe results presented here for the deadlift is in line with previous results presented for various deadlift variations in relation to MVIC for all muscles tested in previous studies. The greatest normalaized mean EMG-activation rate was achieved in the lower body muscles; vastus lateralis, gluteus medius; and the erector spinae muscles. While the torso muscles—with the teres Major muscles as an outliner—was active to a lesser extent. We found similar results with the other two deadlift versions with the trapbar (High and lowbar). Farmers walk showed similir degree of muscle activation in the lower body as the deadlifts, while the exercise showed a higher mean EMG-activation rate of the upper body muscles.ConclusionThe three different deadlift versions have similar activation patterns, while the farmers walk activates the upper body to a greater degree. Each exercise achieves a high degree of mean EMG-activation and can be used to stimulate strength increases, both for muscle-endurance and too some extent maximum strength.

  • 2280.
    Vilagi, Christopher
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Munter Ribeiro, Philip
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Självupplevd skadeförekomst vid Crossfitutövning iSverige: En retrospektiv kohortstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective

    The objective of this study is to map the self-perceived injury frequency in Swedish Crossfit participants.

    Design

    Retrospective cohort study.

    Method

    An electronic survey was made and distributed in the Facebook group ”CF Sweden”, a group for Swedish Crossfit participants consisting of about 8000 members. The survey identified demographic data, training attributes and injury frequency in Swedish Crossfit participants. To be included in the study the participants had to be >18 years old and had to train at an affiliated Crossfit gym/box.

    Results

    305 individuals answered the survey, of which only 274 were included in the study because they didn’t fulfill the inclusion criteria’s. Of those included 137 (50 %) were men and 137 (50 %) were women, the majority of the participants were in the age category 28-37 years, 89 (32,5 %) followed by the category 38-47 years, 86 (31,4 %) and most participants answered that they had practiced Crossfit for more than 25 months, 162 (59,1%). The results show how 162 (59,1 %) of the participants had injured themself during the last year and that shoulders, 82 (49,1 %) were the body part most likely to get injured during Crossfit, followed by the lower back, 42 (25,1 %) and knees, 34 (20,4 %). The majority of the Crossfit participants answered that they had injured themselves during a WOD, 94 (56,6 %) followed by weightlifting, 51 (30,7 %).

    Conclusion The injury frequency in Crossfit does not differ disproportionately from other sports. The results of the study show very similar results to previous research that strengthen this study's ability to its findings.

  • 2281.
    Vildebrandt, Ems
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnadsdiagnoser hos militärpersonal i relation till militärt etos – En litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background The International Council of Nurses (ICN) states in it’s ethical code that the nurse practitioner is responsible for giving each patient correct and culturally adapted care. Military culture is unique and comes with its own challenges and needs of nursing care. Aim The aim is to find the prominent nursing diagnoses in military personnel in relation to the military ethos. Method A literature review of twenty articles found through searches in PubMed, Cinhal and Summon. Results The prominent nursing diagnoses were risk-prone health behavior together with pain issues and sleep disturbances. Two thirds of military personnel consumed high amounts of alcohol, pain issues was the most prevalent, up to half of all personnel experienced sleep disturbances and willingness to seek care was low. Stress, depression, consequences of pain and effects on the family process was also found. Result of military duty could also be infections, wounds, dermatological problems, hearing impairment and diarrhea. Conclusion Military culture is unique and reports health differently than the civilian population. Because of this it is important to know the prominent diagnoses to be able to give this patient group appropriate nursing interventions and competent care.

  • 2282.
    Vildelöt, Sandra
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Edman, Karin
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Personalens förväntningar inför sammanslagning av förlossnings-, BB- och neonatalavdelningen och att samtidigt införa samvård: Kvalitativ studie med fokusgruppsintervjuer2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The bonding between child and parent is aided when child and parent can be together as soon as possible from delivery. Teamwork improves quality and contributes to a holistic-perspective on nursing. A good work environment and good cooperation between staff is important for the efficiency of family-centered care. It is significant to investigate the expectations of the staff before introducing a new way of working, since it may reflect in the quality of care later given.The aim of this study was to illustrate the staffs’ expectations on the fusion of care units and whilst introducing family-centered care.The method was a qualitative method, with three focusgroup interviews of a total of 14 participants. Data was analyzed using qualitative content analysis.The result was summarized with the theme “safe and common or new and uncertain – the balance of change” that described the feelings of the staff before the fusion. The categories “achieving a good environment for parents and staff”, “to cooperate focusing on the family”, “uniting two clinics and cultures” and “to experience a change in establishment” described the expectations and fears of the staff.Conclusions: Results showed expectations of improved care- and work environment, and that the cooperation between clinics would become more efficient. It was important having a clear flow of information, to feel participant and to have a straight-forward management in order to create a functioning way of work in family-centered care.

  • 2283.
    Vinberg, Stig
    et al.
    National Institute for Working Life, Sweden.
    Gelin, Gunnar
    Daphne Research.
    Sandberg, Karl W
    Mittuniversitetet, Institutionen för informationsteknologi och medier.
    ICT-development, job content and profit levels in small and medium sized enterprises2000In: Proceedings fra Nordiska Ergonomisälskapets Årskonferanse, 2000, 2000, p. 189-192Conference paper (Refereed)
  • 2284.
    Vinberg, Stig
    et al.
    National Institute for Working Life, Sweden.
    Gelin, Gunnar
    National Institute for Working Life, Sweden.
    Sandberg, Karl W
    Mittuniversitetet, Institutionen för informationsteknologi och medier.
    Networks, ICT level and social consequences – an integrated model for small and medium sized enterprises.2000In: Proceedings of the XIVth Triennial Congress of the International Ergonomics Association and 44th Annual Meeting of the Human Factors and Ergonomics Association, 'Ergonomics for the New Millennium', San Diego, 2000, p. 567-570Conference paper (Refereed)
    Abstract [en]

    This paper focus on conditions and relationships between factors in small and medium sized enterprises related to organizational change and information technology level using an integrated and empirically founded model. Data comes from a study of small and medium sized enterprises in the northern part of Sweden. The design combines a quasi-experimental approach with ideas on concept-driven development and network building research. Concepts and data analysis are multi-level - an individual level with leaders and co-workers in the enterprises as units, and an organizational level, with the enterprises as units. Empirical results of network activities, ICT-level, change competencies, ergonomic and psychosocial tension are presented and related to other relevant research.

  • 2285.
    Vinberg, Stig
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Sandberg, Karl W
    Models for Competence and Health Development in Small Business Enterprises1999In: Proceedings 10th Year Anniversary MSc Ergonomics Conference, 1999, p. 178-184Conference paper (Refereed)
  • 2286.
    Vinberg, Stig
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Sandberg, Karl W
    Mittuniversitetet, Institutionen för informationsteknologi och medier.
    Hydén, Katarina
    Schönbäck, Catharina
    Förbättringsprocesser: vägar till arbetsglädje, hälsa och effektivitet2006Book (Other academic)
  • 2287.
    Visnevska, Lauma
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Hassel, Frida
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Varför avslutas en elitidrottssatsning i ungdomsåren?: En intervjustudie kring vilka de vanligaste faktorerna som bidrog till en avslutad elitidrottssatsning i ungdomsåren.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to examine the most common reasons why young elite athletes dropped out their sport at the top level. To study this case, we collected our data with an interview as a method and Interpretative Phenomenological Analysis as instrument to interpreted participants citations into the factors. These factors later were categorized under different themes: Other, Internal and External factors, Sickness and Injuries. The most common reasons quoted was exhaustion (psychological) and fatigue (physical), too high performance requirement, environmental change, conflict of interest, too demanding training environment and lack of leadership skills.

  • 2288.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Acupuncture for labour pain2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC).

    Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records.

    Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported.

    Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

  • 2289.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Acupuncture for Labour Pain2015Conference paper (Other academic)
  • 2290.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Acupuncture with manual and electrical stimulation for labour pain: A longitudinal randomised controlled trial2014Conference paper (Other academic)
    Abstract [en]

    Background Acupuncture using manual stimulation (MA) of the needles is commonly used to reduce labour pain despite contradictory results from studies of its effectiveness. A combination of manual and electrical stimulation (EA) could reduce labour pain more effectively than MA alone, by a higher treatment intensity.The aim was to evaluate the effectiveness of MA and EA compared with standard care without any acupuncture (SC) in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than SC, and that EA was the most effective.

    Methods

    Nulliparous women (n=303) with a normal pregnancy were equally randomized to three groups receiving 40 minutes of either MA, EA or to SC. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals.

    The primary outcome was women’s assessment of labour pain; before and after the first treatment, every 30 minutes for five hours, and thereafter every hour until birth, or until epidural analgesia was administered. For the primary outcome, a linear mixed model for repeated measures was performed to investigate associations between treatment (MA, EA, SC) and pain scores on VAS over time. A difference of 15 mm on the visual analogue scale (VAS) was regarded as clinically relevant, and this required 41 women per group, and compensating for dropouts, in total 101 women in each group.

    Data on the primary outcome were obtained from 253 women: MA n=83, EA n=87, and SC n=83.

    Results

    Primary outcome:

    Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95 % confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95%CI] -3.6-4.8).

    Secondary outcomes:

    Use of epidural analgesia: MA 61%, EA 46%, SC 70%. EA vs SC: odds ratio (OR) 0.35; (95% CI) 0.19-0.67.

    EA vs MA: OR 0.57 (95% CI) 0.31-1.06.

    Duration of labour (min): MA 619, EA 500, SC 615. EA vs SC: Hazard Ratio (HR) 1.44; (95% CI) 1.06-1.97. EA vs MA: HR 1.41; (95% CI) 1.03-1.91.

    Sufficient pain relief (day after partus): MA 77%, EA 81%, SC 74% (ns).

    Positive experience of the midwife (day after partus): MA 100%, EA 97.5%, and SC 98.7% (ns).

    Support from the midwife to a high extent (day after partus): MA 77.2%, EA 83.5%, and SC 80% (ns).

    Conclusions

    Acupuncture does not reduce women’s experience of labour pain, however, women receiving a combination of manual and electro-acupuncture (EA) used less additional pain relief, including epidural analgesia, and had shorter labour than women in the standard care group (SC). Despite the lower use of other pain relief, a majority of the women who used EA were equally satisfied with their pain relief as the women receiving manual acupuncture alone (MA) or SC. They were also equally satisfied with the support from the midwife.

     

  • 2291.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Acupuncture with manual and electrical stimulation for labour pain: A longitudinal randomised controlled trial2014Conference paper (Other academic)
  • 2292.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Associations between maternal characteristics and women’s responses to acupuncture during labour: a secondary analysis from a randomised controlled trial2017In: Acupuncture in Medicine, ISSN 0964-5284, E-ISSN 1759-9873, Vol. 35, no 3, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Background Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown.

    Aim To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward.

    Methods Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation.

    Results In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) −13.2, 95% CI −23.4 to −2.9; and MD −5.0, 95% CI −9.6 to −0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD −11.8, 95% CI −19.6 to −3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found.

    Conclusions This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour.

    Trial registration number NCT01197950; Post-results.

  • 2293.
    Vixner, Linda
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Manual and electroacupuncture for labour pain. Study design of a longitudinal randomized controlled trial2013Conference paper (Other academic)
    Abstract [en]

    Introduction: Results from previous acupuncture studies for labour pain are contradictory and lack important information on methodology. The sample sizes are in general small, information about the intervention such as needle placement, number of acupuncture points, type of stimulation, and duration of treatment, is often sparse or lacking However, studies indicate that acupuncture has a positive effect on women’s experiences of labour pain.

     

    Aim: The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain. Our hypothesis is that acupuncture with manual or electrical stimulation is more effective than standard care in the relief of labor pain, and that acupuncture with electrical stimulation is the most effective.

    Outcome measures: Primary outcome: Labour pain measured with visual analogue scale (VAS). Secondary outcomes are use of epidural analgesia, experience of relaxation, labour outcomes and infant outcomes. Biochemical markers of proinflammatory cytokines, memory of labour pain and overall childbirth experience.

    Methods: The study was designed as a randomized controlled trial based on Western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. VAS was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment.

    At the conference, information on the design of the study will be presented and the considerations of whether to use placebo controls or not will be discussed.

    ClinicalTrials.gov: NCT01197950

  • 2294.
    Vixner, Linda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Mårtensson, Lena B
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience.2015In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 15, article id 180Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In a previous randomised controlled trial we showed that acupuncture with a combination of manual- and electrical stimulation (EA) did not affect the level of pain, as compared with acupuncture with manual stimulation (MA) and standard care (SC), but reduced the need for other forms of pain relief, including epidural analgesia. To dismiss an under-treatment of pain in the trial, we did a long-term follow up on the recollection of labour pain and the birth experience comparing acupuncture with manual stimulation, acupuncture with combined electrical and manual stimulation with standard care. Our hypothesis was that despite the lower frequency of use of other pain relief, women who had received EA would make similar retrospective assessments of labour pain and the birth experience 2 months after birth as women who received standard care (SC) or acupuncture with manual stimulation (MA).

    METHODS: Secondary analyses of data collected for a randomised controlled trial conducted at two delivery wards in Sweden. A total of 303 nulliparous women with normal pregnancies were randomised to: 40 min of MA or EA, or SC without acupuncture. Questionnaires were administered the day after partus and 2 months later.

    RESULTS: Two months postpartum, the mean recalled pain on the visual analogue scale (SC: 70.1, MA: 69.3 and EA: 68.7) did not differ between the groups (SC vs MA: adjusted mean difference 0.8, 95 % confidence interval [CI] -6.3 to 7.9 and SC vs EA: mean difference 1.3 CI 95 % -5.5 to 8.1). Positive birth experience (SC: 54.3 %, MA: 64.6 % and EA: 61.0 %) did not differ between the groups (SC vs MA: adjusted Odds Ratio [OR] 1.8, CI 95 % 0.9 to 3.7 and SC vs EA: OR 1.4 CI 95 % 0.7 to 2.6).

    CONCLUSIONS: Despite the lower use of other pain relief, women who received acupuncture with the combination of manual and electrical stimulation during labour made the same retrospective assessments of labour pain and birth experience 2 months postpartum as those who received acupuncture with manual stimulation or standard care.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT01197950.

  • 2295.
    Vixner, Linda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Mårtensson, Lena B
    Stener-Victorin, Elisabet
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet.
    Manual and electroacupuncture for labour pain: study design of a longitudinal randomized controlled trial2012In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, article id 943198Article in journal (Refereed)
    Abstract [en]

    Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950.

  • 2296.
    Vixner, Linda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13A, 171 77 Stockholm, Sweden.
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Centre for Clinical Research Dalarna, Nissers väg 3, 791 82 Falun, Sweden.
    Stener-Victorin, Elisabet
    Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, 405 30 Gothenburg, Sweden.
    Waldenström, Ulla
    Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13A, 171 77 Stockholm, Sweden.
    Pettersson, Hans
    Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden.
    Mårtensson, Lena B.
    School of Health and Education, University of Skövde, P.O. Box 408, 541 28 Skövde, Sweden.
    Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial2014In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 14, article id 187Article in journal (Refereed)
    Abstract [en]

    Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective. 

    Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals. 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women. 

    Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67). 

    Conclusions: Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.

  • 2297. Vogel, G
    et al.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Evidence as a basis for clinical practice guidelines on mechanical ventilation in intensive care in Sweden.2012Conference paper (Refereed)
  • 2298.
    Von Baltzer, Camilla
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Att vårda palliativa hjärtsviktspatienter inom kommunal hemsjukvård - Distriktsköterskors upplevelser: - En kvalitativ studie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    District nurses in the community health service are one of the main providers of palliative care. Chronic heart failure patients could suffer from lack of treatment or correct care in comparison to other groups of palliative care patients. Lack of experience, education in health professionals and the leadership within the organisation are one of several factors for palliative chronic heart failure patients to not receive tailor dressed care

    Aim:

    To explore district nurses view of caring for palliative chronic heart failure patients in community health service

    Method

    : Quality design and interviews were analyzed by a quality content analysis.

    Result:

    The results resulted in two categories; The organizations influence public health nurses daily work with two subcategories, The competence, development and team work of the public health nurses and the palliative care organisations and leadership. The second category was, Public health care nurses’ professional approach with subcategories Public health care nurse’s treatment of patients and relatives and Public health care nurse’s experiences of care plans.

    Conclusion:

    District nurses need continuously education enabling to feel secure and satisfaction in the care and reception of palliative heart failure patients and relatives. It´s important to enhance the teamwork to create a positive work environment for the District nurses. Care plan systems must be suitable and user friendly to improve the palliative care for chronic heart failure patients.

  • 2299. Vos, Theo
    et al.
    Allen, Christine
    Arora, Megha
    Barber, Ryan M
    Bhutta, Zulfiqar
    Brown, Alexandria
    Carter, Austin
    Casey, Daniel C
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala university.
    Murray, Christopher J. L
    Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 20152016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10053, p. 1545-1602Article in journal (Refereed)
    Abstract [en]

    Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. 

    Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. 

    Findings We generated 9.3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17.2 billion, 95% uncertainty interval [UI] 15.4-19.2 billion) and diarrhoeal diseases (2.39 billion, 2.30-2.50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2.36 billion (2.35-2.37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. 

    Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.

  • 2300.
    Välilä, Jaana
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskornas beskrivning av sväljbedömninghos äldre personer med misstänkt dysfagi inomkommunal hälso- och sjukvård: En kvalitativ intervjustudie2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim:

    The aim of this study was to investigate Registered Nurses’ (RNs) description of swallowing

    assessments in older people with suspected dysphagia in municipal health care.

    Method:

    The method was a qualitative interview study.

    Results:

    The results demonstrated the following categories “ Observation of symtoms”, "A practical

    assessment", "Attendance at mealtime", ”Adapting food", "Adaptation of care", “Supervision of staff

    " , "Team meetings had significance for planning of health care" ,

    and "Lack of knowledge and assessment

    instruments".

    Conclusion:

    RNs describe that swallowing assessment is an important task in the daily work. The

    RNs presence and collaboration will help to guide staff so that no inappropriate methods are used, as

    well as to attend meals and observing a patient's swallowing function. RNs who work in municipal

    health care need more knowledge about swallowing assessments and management of an assessment

    instrument.

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