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  • 451.
    Cedervall, Ylva
    et al.
    Uppsala universitet.
    Åberg, Anna Cristina
    Uppsala universitet, Geriatrik.
    ”If I don’t exercise; I don’t feel good. That’s it.”: Physical activity among people with Alzheimer’s disease2010Conference paper (Refereed)
  • 452.
    Cedervall, Ylva
    et al.
    Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Åberg, Anna Cristina
    Uppsala universitet, Geriatrik.
    Physical activity and implications on well-being in mild Alzheimer's disease: A qualitative case study on two men with dementia and their spouses2010In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 26, no 4, p. 226-239Article in journal (Refereed)
    Abstract [en]

    To improve the understanding of experiences of people with mild Alzheimer's disease (AD) and their significant others, related to the physical activity of the afflicted persons and its perceived importance. A qualitative case study design was used. The study comprised two men with mild AD and their wives. Data were collected by qualitative interviews and participant observations. Data analysis followed a thematic guideline as described by Braun and Clarke ( 2006 ). Three central themes of experiences related to physical activity in AD were identified: 1) physical activity as health reinforcement; 2) barriers to physical activity; and 3) adaptation strategies. Important motivations for outdoor walks were enjoyable experiences of nature, body movement, and positive attitudes toward physical activity. Several factors were experienced as barriers to physical activity (e.g., tiredness, difficulties in finding one's way, and "peculiar behavior"). Significant others made considerable adjustments in everyday life to enable their partners to retain a physically active lifestyle. The findings indicate that in persons with AD, physical activities such as outdoor walking can play an important part in everyday life by creating meaningful routines and improving experienced well-being and health.

  • 453.
    Cerny, Jonna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Karlsson, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Personer med HIV och/eller AIDS upplevelser av hälso- och sjukvårdens bemötande: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    HIV is a retrovirus and, like many other retroviruses, HIV has its own enzyme. HIV develops to AIDS unless antiretroviral medicinal products are used. At present, it is estimated that 36.7 million of the population in the world is living with the disease and the predominant way to get infected is through unprotected sexual intercourse. Persons who are told they are HIV positive often react/experience a personal crisis. It is essential to meet the infected person with understanding and empathy, as well as receiving additional support from the healthcare professional. It is common that the care for HIV-infected people to suffer because of fear healthcare professionals have to get infected.

    Aim:

    Describe how people with HIV and AIDS experience the care from healthcare professionals.

    Method:

    The study has been carried out as a literature review and the result has been based on 15 scientific articles. The searches have been performed in Cinahl and PubMed. Two of the articles were found through secondary search.

    Result:

    This literature review describes how people with HIV and AIDS experience the care from healthcare professionals. The result is presented in six main categories: The need for support in connection with diagnosis, prejudice, discrimination and stigmatization, treatment, confidentiality, trust for caregiver and participation.

    Conclusion:

    The healthcare professionals' response to people living with HIV and / or AIDS is inadequate. They often suffer prejudice, stigmatization and discrimination, which contributes to unnecessary care for these people. More knowledge and education is necessary for healthcare professionals to improve their treatment and provide safe and equal care.

  • 454.
    Chakma, Krishna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Chakma, Sumana
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Social barriers for midwives to provide quality midwifery care in Bangladesh: A focus group discussion study with Midwifery Students2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Midwifery is central in addressing maternal and newborn health. Social barriers may prevent midwives from providing midwifery care with quality, which in the end can lead to, besides poor maternal and newborn health, burnout and midwives leaving the profession. Midwifery students are placed in the intersection between theory and practice, and their perspectives are vital when identifying these barriers in Bangladesh where the midwifery profession is newly established.

    Aim:

    To describe midwifery students’ perceptions on midwives realities in Bangladesh from social perspectives.

    Methods:

    A qualitative design in which deductive focus group discussions are held with 67 participants and analyzed with qualitative content analysis.

    Results:

    Several social factors that affected quality midwifery care were identified; gender inequality, physical and emotional violence, lack of safety and security, the role of tradition and the importance of education. Gender inequality was a major barrier that affected Bangladeshi midwives possibilities to provide quality midwifery care both directly and indirectly.

    Conclusion:

    In this male dominated society, women are disadvantaged in relation to men and feel insecure due to violence, particularly in rural areas, which affect the provision of quality midwifery care. To improve this, it is necessary to pay attention to all barriers, specially gender inequality and traditional and religious beliefs and practice.

    Clinical application:

    This result can be useful to design effective strategies to improve quality midwifery care which can reduce maternal mortality in the future. The study suggests that further studies should evaluate the effects of education of women to reduce barriers and improve quality midwifery care.

  • 455. Charise, A
    et al.
    Witteman, H
    Whyte, S
    Sutton, E
    Massimi, M
    Stephens, L
    Bender, L
    Evans, J
    Logie, C
    Mirza, R
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making2011In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 14, no 2, p. 115-132Article in journal (Refereed)
    Abstract [en]

    Objective: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.

    Background: Decision-making processes and outcomes may be shaped by a range of non-medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide-ranging research for health decision-making purposes.

    Methods: To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions.

    Findings: We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasses health-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided.

    Conclusions: These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research.

  • 456.
    Chiragli, Nigar
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Larsson, Lina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Kvinnors rätt att bestämma över sin egen kropp: En intervjustudie om hur yrkesverksamma barnmorskor i Sverige främjar kvinnors rätt2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The Swedish midwife work with health promotion according to international standards. They promote the women’s right to decide about her own body. How midwives work to promote women’s right to decide about her own body in Sweden today is, to our knowledge, hardly described from midwives own perspective.

    The aim of this study was to describe how midwives in Sweden perceive that they in their profession promote women's right to decide about her own body.

    Method: Semi-structured interviews were conducted with eight midwives active in different areas of the midwife profession. The material was analyzed inspired by Martons phenomenographic approach where midwives' different perceptions of how they in their profession promote women's right to decide about her own body was the centre for the analysis.

    Result: The midwives' perceptions of how they in their profession promoted the right of women to decide about her own body were described in two categories with 4 collective conceptions. Midwives strengthen women in decisions and midwives support women in gaining access to their rights. Four collective perceptions are described: 1) individualizes care, 2) raise awareness among women of their rights, 3) empower women and 4) challenge heteronormativity.

    Conclusion: Swedish midwives perceived that they in their profession promoted the right of women to decide over her own body. This was the core value of the profession. Clinical applicability: The result may be used in the clinical practice to illuminate and highlight the Swedish midwife's role in the promotion of women's right to decide over her own body. The content of the Swedish Midwives’ profession can be given further attention nationally and globally, considering that the Swedish midwives have a unique competence area globally when it comes to promotion of women's right to decide over her own body.

  • 457. Christidis, Nikolaos
    et al.
    Ghafouri, Bijar
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Mannerkorpi, Kaisa
    Bileviciute-Ljungar, Indre
    Löfgren, Monika
    Bjersing, Jan
    Kosek, Eva
    Ernberg, Malin
    Comparison of the levels of pro-inflammatory cytokines released in the vastus lateralis muscle of patients with fibromyalgia and healthy controls during contractions of the quadriceps muscle - A microdialysis study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12, article id e0143856Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Fibromyalgia is associated with central hyperexcitability, but it is suggested that peripheral input is important to maintain central hyperexcitability. The primary aim was to investigate the levels of pro-inflammatory cytokines released in the vastus lateralis muscle during repetitive dynamic contractions of the quadriceps muscle in patients with fibromyalgia and healthy controls. Secondarily, to investigate if the levels of pro-inflammatory cytokines were correlated with pain or fatigue during these repetitive dynamic contractions.

    MATERIAL AND METHODS: 32 women with fibromyalgia and 32 healthy women (controls) participated in a 4 hour microdialysis session, to sample IL-1β, IL-6, IL-8, and TNF from the most painful point of the vastus lateralis muscle before, during and after 20 minutes of repeated dynamic contractions. Pain (visual analogue scale; 0-100) and fatigue Borg's Rating of Perceived Exertion Scale; 6-20) were assessed before and during the entire microdialysis session.

    RESULTS: The repetitive dynamic contractions increased pain in the patients with fibromyalgia (P < .001) and induced fatigue in both groups (P < .001). Perceived fatigue was significantly higher among patients with fibromyalgia than controls (P < .001). The levels of IL-1β did not change during contractions in either group. The levels of TNF did not change during contractions in patients with fibromyalgia, but increased in controls (P < .001) and were significantly higher compared to patients with fibromyalgia (P = .033). The levels of IL-6 and IL-8 increased in both groups alike during and after contractions (P's < .001). There were no correlations between pain or fatigue and cytokine levels after contractions.

    CONCLUSION: There were no differences between patients with fibromyalgia and controls in release of pro-inflammatory cytokines, and no correlations between levels of pro-inflammatory cytokines and pain or fatigue. Thus, this study indicates that IL-1β, IL-6, IL-8, and TNF do not seem to play an important role in maintenance of muscle pain in fibromyalgia.

  • 458.
    Christine Amoran, Folake
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mekonnen, Aklilu
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    God munhälsa och munvård hos äldre personer på särskilt boende; kunskap, attityd och utbildning bland vårdpersonal: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    The normal aging process deteriorates the body`s function, which means that more elderly people need help and support with their daily care such as oral care. Studies have shown that oral care for elderly people in nursing homes is often inadequate, and always result to oral health problems. Because of this, knowledge and attitudes regarding oral health need to be compiled.

    Aim:

    The aim of this literature review is to compile nursing staffs` knowledge and attitude towards oral health in nursing homes and what measures have been taken regarding improvement of oral care.

    Materials and methods:

    This study was carried out as a literature review. The result is based on a total of 15 scientific articles, n=8 quantitative and n=7 qualitative. These articles were collected from databases CINAHL and PubMed.

    Results:

    The results in this study revealed lack of knowledge in oral care among nursing staff in nursing homes and factors affecting nursing staffs' attitudes towards performing good oral care. Educational programs and oral assessment showed significant improvements in the care residents oral status and increased nursing staff's knowledge in oral care.

    Conclusion:

    Nursing staffs’ knowledge and attitude to oral care were the main contributing factors to the fact that the oral care was not performed efficiently. On the other hand, oral care education has shown positive improvements in care residents.

  • 459.
    Clazon, Carl
    et al.
    Dalarna University, School of Education, Health and Social Studies.
    Näslund, Fredrik
    Dalarna University, School of Education, Health and Social Studies.
    Handdominans inom ishockey och dess relation till poängproduktionen inom Elitserien2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 460. Cleeve, Amanda
    et al.
    Byamugisha, Josaphat
    Gemzell-Danielsson, Kristina
    Mbona Tumwesigye, Nazarius
    Atuhairwe, Susan
    Faxelid, Elisabeth
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Women's acceptability of misoprostol treatment for incomplete abortion by midwives and physicians: secondary outcome analysis from a randomized controlled equivalence trial at district level in Uganda2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians.

    METHODS: This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14-28 days following treatment. Analysis of women's overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024.

    RESULTS: From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded.

    CONCLUSIONS: Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT01844024.

  • 461. Cleeve, Amanda
    et al.
    Faxelid, Elisabeth
    Nalwadda, Gorette
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda2017In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 19, no 11, p. 1286-1300Article in journal (Refereed)
    Abstract [en]

    Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women's sexual and reproductive health needs and protect their rights. Enabling young women's agency through access to safe abortion and contraception is paramount.

  • 462. Cleeve, Amanda
    et al.
    Nalwadda, Gorette
    Zadik, Tove
    Sterner, Kathy
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Morality versus duty - A qualitative study exploring midwives' perspectives on post-abortion care in Uganda2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 77, p. 71-77Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care.

    DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis.

    SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings.

    FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication.

    KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions impeded quality of care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.

  • 463. Cleeve, Amanda
    et al.
    Oguttu, Monica
    Ganatra, Bela
    Atuhairwe, Susan
    Larsson, Elin C
    Makenzius, Marlene
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Paul, Mandira
    Kakaire, Othman
    Gemzell-Danielsson, Kristina
    Time to act - comprehensive abortion care in east Africa2016In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 4, no 9, p. e601-e602Article in journal (Refereed)
  • 464. Conradsson, D.
    et al.
    Friden, C.
    Nilsson-Wikmar, L.
    Äng, Björn
    Ankle-joint mobility and standing squat posture in elite junior cross-country skiers. A pilot study2010In: Journal of Sports Medicine and Physical Fitness, ISSN 0022-4707, E-ISSN 1827-1928, Vol. 50, no 2, p. 132-8Article in journal (Refereed)
  • 465. Coresh, Josef
    et al.
    Heerspink, Hiddo J L
    Sang, Yingying
    Matsushita, Kunihiro
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Astor, Brad C
    Black, Corri
    Brunskill, Nigel J
    Carrero, Juan-Jesus
    Gansevoort, Ron T
    Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies.2019In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 7, no 2, p. 115-127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Change in albuminuria as a surrogate endpoint for progression of chronic kidney disease is strongly supported by biological plausibility, but empirical evidence to support its validity in epidemiological studies is lacking. We aimed to assess the consistency of the association between change in albuminuria and risk of end-stage kidney disease in a large individual participant-level meta-analysis of observational studies.

    METHODS: In this meta-analysis, we collected individual-level data from eligible cohorts in the Chronic Kidney Disease Prognosis Consortium (CKD-PC) with data on serum creatinine and change in albuminuria and more than 50 events on outcomes of interest. Cohort data were eligible if participants were aged 18 years or older, they had a repeated measure of albuminuria during an elapsed period of 8 months to 4 years, subsequent end-stage kidney disease or mortality follow-up data, and the cohort was active during this consortium phase. We extracted participant-level data and quantified percentage change in albuminuria, measured as change in urine albumin-to-creatinine ratio (ACR) or urine protein-to-creatinine ratio (PCR), during baseline periods of 1, 2, and 3 years. Our primary outcome of interest was development of end-stage kidney disease after a baseline period of 2 years. We defined an end-stage kidney disease event as initiation of kidney replacement therapy. We quantified associations of percentage change in albuminuria with subsequent end-stage kidney disease using Cox regression in each cohort, followed by random-effects meta-analysis. We further adjusted for regression dilution to account for imprecision in the estimation of albuminuria at the participant level. We did multiple subgroup analyses, and also repeated our analyses using participant-level data from 14 clinical trials, including nine clinical trials not in CKD-PC.

    FINDINGS: Between July, 2015, and June, 2018, we transferred and analysed data from 28 cohorts in the CKD-PC, which included 693 816 individuals (557 583 [80%] with diabetes). Data for 675 904 individuals and 7461 end-stage kidney disease events were available for our primary outcome analysis. Change in ACR was consistently associated with subsequent risk of end-stage kidney disease. The adjusted hazard ratio (HR) for end-stage kidney disease after a 30% decrease in ACR during a baseline period of 2 years was 0·83 (95% CI 0·74-0·94), decreasing to 0·78 (0·66-0·92) after further adjustment for regression dilution. Adjusted HRs were fairly consistent across cohorts and subgroups (ie, estimated glomerular filtration rate, diabetes, and sex), but the association was somewhat stronger among participants with higher baseline ACR than among those with lower baseline ACR (pinteraction<0·0001). In individuals with baseline ACR of 300 mg/g or higher, a 30% decrease in ACR over 2 years was estimated to confer a more than 1% absolute reduction in 10-year risk of end-stage kidney disease, even at early stages of chronic kidney disease. Results were generally similar when we used change in PCR and when study populations from clinical trials were assessed.

    INTERPRETATION: Change in albuminuria was consistently associated with subsequent risk of end-stage kidney disease across a range of cohorts, lending support to the use of change in albuminuria as a surrogate endpoint for end-stage kidney disease in clinical trials of progression of chronic kidney disease in the setting of increased albuminuria.

    FUNDING: US National Kidney Foundation and US National Institute of Diabetes and Digestive and Kidney Diseases.

  • 466. Cornelis, Marilyn C
    et al.
    Gustafsson, Stefan
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Elmståhl, Sölve
    Söderberg, Stefan
    Sundström, Johan
    Michaëlsson, Karl
    Lind, Lars
    Ingelsson, Erik
    Targeted proteomic analysis of habitual coffee consumption2018In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 2, p. 200-211Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Coffee drinking has been implicated in mortality and a variety of diseases but potential mechanisms underlying these associations are unclear. Large-scale systems epidemiological approaches may offer novel insights to mechanisms underlying associations of coffee with health.

    OBJECTIVE: We performed an analysis of known and novel protein markers linked to cardiovascular disease and their association with habitual coffee intake in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS, n=816) and followed-up top proteins in the Uppsala Longitudinal Study of Adult Men (ULSAM, n=635) and EpiHealth (n=2418).

    METHODS: In PIVUS and ULSAM, coffee intake was measured by 7-day dietary records while a computer-based food frequency questionnaire was used in EpiHealth. Levels of up to 80 proteins were assessed in plasma by a proximity extension assay.

    RESULTS: Four protein-coffee associations adjusted for age, sex, smoking and BMI, met statistical significance in PIVUS (FDR<5%, P<2.31×10(-3) ): leptin (LEP), chitinase-3-like protein 1 (CHI3L), Tumor necrosis factor (TNF) receptor 6 and TNF-related apoptosis-inducing ligand. The inverse association between coffee intake and LEP replicated in ULSAM (β, -0.042 SD per cup of coffee, P=0.028) and EpiHealth (β, -0.025 SD per time of coffee, P=0.004). The negative coffee-CHI3L association replicated in EpiHealth (β, -0.07, P=1.15×10(-7) ), but not in ULSAM (β, -0.034, P=0.16).

    CONCLUSIONS: The current study supports an inverse association between coffee intake and plasma LEP and CHI3L1 levels. The coffee-CHI3L1 association is novel and warrants further investigation given links between CHI3L1 and health conditions that are also potentially influenced by coffee. 

  • 467. Corsonello, Andrea
    et al.
    Roller-Wirnsberger, Regina
    Di Rosa, Mirko
    Fabbietti, Paolo
    Wirnsberger, Gerhard
    Kostka, Tomasz
    Guligowska, Agnieszka
    Tap, Lisanne
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University; Karolinska Institutet.
    Lattanzio, Fabrizia
    Estimated glomerular filtration rate and functional status among older people: A systematic review2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, no SI, p. 39-48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes.

    METHODS: We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed.

    RESULTS: We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longitudinal studies provided comparative data: two studies reported similar association with disability for different creatinine-based eGFR equations; one study showed that creatinine-based eGFR was not associated with frailty, but a not significant trend for association was observed with cystatin C-based eGFR; one study showed that cystatin C-based but not creatinine-based eGFR may predict incident mobility disability, while both methods may predict gait speed decline. High heterogeneity was observed in regard to confounders included in reviewed studies. None of them included the most recently published equations.

    CONCLUSION: Available data do not support the superiority of one of the eGFR equations in terms of measuring or predicting functional decline.

  • 468. Corsonello, Andrea
    et al.
    Tap, Lisanne
    Roller-Wirnsberger, Regina
    Wirnsberger, Gerhard
    Zoccali, Carmine
    Kostka, Tomasz
    Guligowska, Agnieszka
    Fuentes, Lara Guardado
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet; Karolinska institutet.
    Lattanzio, Fabrizia
    Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study.2018In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, no 1, article id 260Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decline of renal function is common in older persons and the prevalence of chronic kidney disease (CKD) is rising with ageing. CKD affects different outcomes relevant to older persons, additionally to morbidity and mortality which makes CKD a relevant health burden in this population. Still, accurate laboratory measurement of kidney function is under debate, since current creatinine-based equations have a certain degree of inaccuracy when used in the older population. The aims of the study are as follows: to assess kidney function in a cohort of 75+ older persons using existing methodologies for CKD screening; to investigate existing and innovative biomarkers of CKD in this cohort, and to align laboratory and biomarker results with medical and functional data obtained from this cohort. The study was registered at ClinicalTrials.gov, identifier NCT02691546, February 25th 2016.

    METHODS/DESIGN: An observational, multinational, multicenter, prospective cohort study in community dwelling persons aged 75 years and over, visiting the outpatient clinics of participating institutions. The study will enroll 2450 participants and is carried out in Austria, Germany, Israel, Italy, the Netherlands, Poland and Spain. Participants will undergo clinical and laboratory evaluations at baseline and after 12 and 24 months- follow-up. Clinical evaluation also includes a comprehensive geriatric assessment (CGA). Local laboratory will be used for 'basic' parameters (including serum creatinine and albumin-to-creatinine ratio), whereas biomarker assessment will be conducted centrally. An intermediate telephone follow-up will be carried out at 6 and 18 months.

    DISCUSSION: Combining the use of CGA and the investigation of novel and existing independent biomarkers within the SCOPE study will help to provide evidence in the development of European guidelines and recommendations in the screening and management of CKD in older people.

    TRIAL REGISTRATION: This study was registered prospectively on the 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).

  • 469. Craftman Gransjöm, Å
    et al.
    Swall, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Outcomes of education in using music and caregivers singing as a tool to person centered care when working with persons with dementia2018Conference paper (Refereed)
  • 470. Craftman, ÅG.
    et al.
    Swall, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Båkman, K.
    Grundberg, Å.
    Hagelin, C. L.
    Caring for older people with dementia reliving past trauma2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed)
  • 471.
    Craftman, Åsa
    et al.
    Sophiahemmet Högskola.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    von Strauss, Eva
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 201-210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

    AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

    METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

    RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

    CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

    IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

  • 472.
    Craftman, Åsa
    et al.
    Sophiahemmet Högskola.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    von Strauss, Eva
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Older people's experience of utilisation and administration of medicines in a health- and social care context2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 760-768Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

    AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

    DESIGN: A qualitative descriptive study.

    METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

    FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

    CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

    RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

  • 473.
    Crona, Malin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Bengtsson, Johanna
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Barnmorskor och undersköterskors behov av stöd vid möten med föräldrar som föder barn som inte lever: En kvalitativ intervjustudie med fokusgrupper2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    According to research health professionals are feeling grief, guilt and stress when they meet parents giving birth to stillborn babies. They are in need of support but research about what kind of support is limited.

    Aim:

    To identify midwives’ and assistant nurses’ need of support and what kind of support they need meeting parents giving birth to stillborn babies.

    Method:

    Eight midwives and five assistant nurses were interviewed and distributed in three focus groups. They were asked semi-structured questions based on a questionnaire. The analysis method was qualitative content analysis.

    Results:

    One theme and five categories were identified. The theme was: The will to do good. The categories were: Collegial support, Education, Support from the hospital management, Tutorial and Reflection and To be inexperienced.

    Conclusion:

    The need of support varied but all participants considered they were there for each other as a support and a need of continuity and education in their meetings with parents. They also wished for tutorials with regular occasions where they could meet with different professions in a group. Those participants with longer experience from childbirth care felt more secure in their meetings with parents giving birth to stillborn babies, compared with those with shorter experience.

    Clinical application:

    The study could lead to support being implemented in maternity units, which in the end could lead to better treatment for the affected parents.

  • 474. Cummings, Greta G
    et al.
    Estabrooks, Carole A
    Midodzi, William K
    Wallin, Lars
    Karolinska Institutet.
    Hayduk, Leslie
    Influence of organizational characteristics and context on research utilization2007In: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 56, no 4 Suppl, p. 24-39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite three decades of empirical investigation into research utilization and a renewed emphasis on evidence-based medicine and evidence-based practice in the past decade, understanding of factors influencing research uptake in nursing remains limited. There is, however, increased awareness that organizational influences are important.

    OBJECTIVES: To develop and test a theoretical model of organizational influences that predict research utilization by nurses and to assess the influence of varying degrees of context, based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, on research utilization and other variables.

    METHODS: The study sample was drawn from a census of registered nurses working in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (n = 6,526 nurses; 52.8% response rate). Three variables that measured PARIHS dimensions of context (culture, leadership, and evaluation) were used to sort cases into one of four mutually exclusive data sets that reflected less positive to more positive context. Then, a theoretical model of hospital- and unit-level influences on research utilization was developed and tested, using structural equation modeling, and 300 cases were randomly selected from each of the four data sets.

    RESULTS: Model test results were as follows--low context: chi2= 124.5, df = 80, p <. 001; partially low: chi2= 144.2, p <. 001, df = 80; partially high: chi2= 157.3, df = 80, p <. 001; and partially low: chi2= 146.0, df = 80, p <. 001. Hospital characteristics that positively influenced research utilization by nurses were staff development, opportunity for nurse-to-nurse collaboration, and staffing and support services. Increased emotional exhaustion led to less reported research utilization and higher rates of patient and nurse adverse events. Nurses working in contexts with more positive culture, leadership, and evaluation also reported significantly more research utilization, staff development, and lower rates of patient and staff adverse events than did nurses working in less positive contexts (i.e., those that lacked positive culture, leadership, or evaluation).

    CONCLUSION: The findings highlight the combined importance of culture, leadership, and evaluation to increase research utilization and improve patient safety. The findings may serve to strengthen the PARIHS framework and to suggest that, although it is not fully developed, the framework is an appropriate guide to implement research into practice.

  • 475.
    Custerson, Ann-Louise
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Effekter av massage/beröring hos dementa respektive icke dementa äldre personer: Systematisk litteraturstudie med empiriskt tillägg2009Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Föreliggande systematiska litteraturstudie syftade till att kartlägga vad som fanns beskrivet i litteraturen om effekter av massage/beröring hos dementa respektive icke dementa äldre personer. Syftet var även att kartlägga personalens inställning till massage/beröring och denna omvårdnads- åtgärds effekter empiriskt. Artiklarna har sökts i Högskolan Dalarnas fulltextdatabas ELIN för vidare granskning. Artiklarna som valdes var från åren 1999-2009. Sökorden som användes var massage, older, elder, old*, geriatric, demen*, touch, effects, tactil. Av resultatet framkom att i större delen av studierna har massage/beröring en positiv effekt på välmående hos äldre dementa och icke dementa människor. Särskilt kunde noteras att massage kunde vara en metod att minska agiterat beteende och vandrande hos dementa personer. Personalens inställning till massage/beröring sågs som positiv i den bemärkelsen att massage/beröring gynnade patientens välmående och att personalen kunde interagera med patienten på ett mer positivt sätt. I det empiriska tillägget var huvudfyndet att massage/ beröring hade bättre effekt för sömnen för dementa än för icke dementa. Uttryckt i Martinsens omvårdnadsteoretiska termer måste omvårdnaden ha som utgångspunkt den andres bästa. För att komma fram till vad som är bäst för den andre måste man vara öppen och närvarande hos honom samt sträva efter att tolka hans situation och behov. Föreliggande studies resultat bidrar till kunskap om massage/beröring som metod för äldre med särskild betoning på demens.

  • 476. Dahl, Kari Elisabeth
    et al.
    Wang, Nina J.
    Skau, Irene
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Oral health-related quality of life and associated factors in Norwegian adults2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 4, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate associations between oral health-related quality of life assessed with the Oral Health Impact Profile (OHIP)-14 and demographic factors, number of teeth present, dental visits, dental health behaviour and self-rated oral health in a representative sample of 20-80-year-old Norwegians.

    Material and methods. The study was conducted in a stratified random sample of 3538 individuals. Questionnaires including questions on demographic factors, number of remaining teeth, dental visits, dental health behaviour, self-rated oral health and OHIP-14 were mailed to the sample. Bivariate and multivariate analyses were performed.

    Results. The response rate was 69%. The mean OHIP-14 score was 4.1 (standard deviation = 6.2). No problem was reported by 35% of the respondents. The most frequently reported problems were: physical pain (56%), psychological discomfort (39%) and psychological disability (30%). When the effect of all independent variables was analysed in multivariate analysis, self-rated oral health, frequency of dental visits, number of teeth, age and sex were significantly (P < 0.05) associated with the prevalence of having problems and frequent problems. Self-rated oral health had the strongest association with having problems [ odds ratio (OR) 4.5; 95% confidence interval (CI) 3.4-6.0] and with having frequent problems (OR 4.0; 95% CI 2.7-5.8). Dental health behaviour, use of floss and toothpicks and oral rinsing were not associated with having problems related to oral quality of life in multivariate analyses.

    Conclusion. In this Norwegian adult sample, self-rated oral health, frequency of dental visits, number of teeth, age and sex were associated with having problems as estimated using the OHIP-14.

  • 477. Dahl, KE
    et al.
    Wang, N
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Does oral health matter in people’s daily life?: Oral health-related quality of life in adults 35–47 years of age in Norway2012In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 10, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to assess the effect of oral health on aspects of daily life measured by the Dental Impact Profile (DIP) in 35- to 47-year-old individuals in Norway, and to study associations between reported effects and demographic variables, subjectively assessed oral health, general health, oral health behaviour and clinical oral health.

    Material and methods: A stratified randomized sample of 249 individuals received a questionnaire regarding demographic questions, dental visits, oral hygiene behaviour, self-rated oral health and general health and satisfaction with oral health. The DIP measured the effects of oral health on daily life. Teeth present and caries experience were registered by clinical examination. Bi- and multivariate analyses and factor analysis were used.

    Results: Items most frequently reported to be positively or negatively influenced by oral health were chewing and biting, eating, smiling and laughing, feeling comfortable and appearance. Only 1% reported no effects of oral health. Individuals with fewer than two decayed teeth, individuals who rated their oral health as good or practised good oral health habits reported more positive effects than others on oral quality of life (P = 0.05). When the variables were included in multivariate analysis, none was statistically significant. The subscales of the DIP were somewhat different from the originally suggested subscales.

    Conclusions: This study showed that most adults reported oral health to be important for masticatory functions and confirmed that oral health also had impacts on other aspects of life.

  • 478. Dahl, KE
    et al.
    Wang, NJ
    Holst, D
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Oral health-related quality of life among adults 68-77 years old in Nord-Tröndelag, Norway2011In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 9, no 1, p. 87-92Article in journal (Refereed)
    Abstract [en]

    Dental health has mostly been measured by dental staff disregarding patient’s experiences. However, clinical conditions alone do not fully indicate how people feel affected by their oral status. The aim of this study was to investigate how clinical recorded dental health, self-rated dental health, satisfaction with dental health were related to oral health-related quality of life (OHRQoL) assessed by Oral Health Impact Profile (OHIP-14) in 68–77 years old. A total of 151 individuals completed a questionnaire on self-rated dental health, satisfaction with dental health and the short form of OHIP-14. Clinical examination was performed registering number of teeth and dental caries. In total 63% of the individuals rated their dental health as good, and 59% were satisfied with their dental health. Using the OHIP-14 42% reported no problems or oral discomfort at all. The proportion of individuals reporting problems or discomfort varied between 13% and 43% according to the dimensions of OHIP-14. The most frequently reported problems were physical pain (43%), psychological discomfort (28%) and psychological disability (28%). Individuals who rated their dental health as poor and those who were dissatisfied with their dental health had significantly lower OHRQoL than other individuals. The study showed relationship between self-evaluations of dental health and OHRQoL in 68–77 years old. Individuals with few teeth reported lower OHRQoL than others, but no association between clinical caries status and OHRQoL could be found.

  • 479. Dahlberg, ER
    et al.
    Spets, E
    Svedbo Engström, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Sahlgrenska Academy, Institute of Medicine, University of Gothenburg.
    Larshans, M
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Medical Sciences, Uppsala University.
    Experiences of Hypoglycaemia in Adults with Diabetes Mellitus2017In: Journal of Diabetes and Treatment, article id J111Article in journal (Refereed)
    Abstract [en]

    Aims: To describe adults’ experiences of hypoglycaemia in diabetes mellitus, and the consequences of hypoglycaemia in daily life.

    Methods: This study was conducted using qualitative content analysis with an inductive approach. It was performed as a secondary analysis of semi-structured interviews. A total of 29 people participated in the study: 15 with type 1 diabetes and 14 with type 2 diabetes.

    Results: The theme that emerged was: Hypoglycaemia is an ever-present risk that manifests itself in different ways. The following categories were identified: Symptoms of hypoglycaemia can appear like a bolt from the blue. Knowledge comes from life experiences. Training and exercise today often have consequences tomorrow. Self-management may be perceived as a feeling of not being free. Family support can provide security in the illness.

    Conclusion: Hypoglycaemia is perceived as an ever-present risk that can come like a bolt from the blue, which in turn causes fear and problems in the daily life of people with diabetes. Better support, help and information from specialist nurses is needed. Family members should also be given more knowledge and information, in order to reduce the fear and discomfort of hypoglycaemia.

  • 480.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work. Karolinska Institutet; Stockholm University.
    Ageing in a changing place: a qualitative study of neighbourhood exclusion2019In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779Article in journal (Refereed)
    Abstract [en]

    An inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are particularly vulnerable to neighbourhood change. The aim of this study was to explore older adults’ experiences of neighbourhood exclusion within the context of neighbourhood change. Focus groups were undertaken in the urban and rural areas of a metropolitan borough in England involving a total of 41 older adults, with data analysed via thematic analysis. Urban areas in the borough studied have transformed following the closure of the mining industry, with a high level of deprivation in many areas, while some rural areas have undergone gentrification. Within the context of structural neighbourhood change, four themes were identified: community cohesion, political agency, feelings of safety and the physical environment. The themes were interlinked, which calls for collaboration across traditional lines of professional responsibility, and for research that encompasses different aspects of neighbourhood exclusion. This study contributes with knowledge on older adults’ experiences of exclusion, including novel findings on the importance of political agency and collective memory, and identifies actions to combat exclusion. An active involvement of older adults in the development of initiatives to tackle social exclusion is recommended.

  • 481.
    Dahlberg, Råger
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Spets, Ewa
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erfarenheter och upplevelser av hypoglykemi hos vuxna med diabetes mellitus: En kvalitativ intervjustudie2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Approximately one third of people with diabetes suffer episodes of hypoglycaemia with a loss of consciousness as a result. The incidence of hypoglycaemia is unpleasant and patients attempt to avoid this event, which often results in higher plasmaglucose values. Dedicated nursing care involves helping people to cope with unpleasant experiences of hypoglycaemia in daily life.

    Aim: To describe adults' experiences of hypoglycaemia in diabetes mellitus, and the consequences hypoglycaemia leads to daily life.

    Method: This study was conducted with a qualitative content analysis with an inductive approach. The study was conducted as a secondary analysis of semi-structured interwievs. The number of study participants were a total of 29 of which 15 with Type 1 diabetes and 14 with Type 2 diabetes.

    Results: The theme that emerged was: Hypoglycaemia is an ever present risk and is shaped differently with the following categories. Symptoms of hypoglycaemia could come as a bolt from the blue. Knowledge comes from life experiences. Training and exercise today - often have consequences tomorrow for patients. Self management could be perceived as a feeling of not being free. Family support – could mean security in illness.

    Conclusion: The incidence of hypoglycaemia is a common event and is perceived as unpleasant and unsafe event and causing fear in people suffering from diabetes. Undertreatment was seen as a consequence. Better support, help and information from the specialist nurses were needed. Knowledge and information, even to family members, was considered important to reduce the fear and discomfort of hypoglycaemia.

  • 482.
    Dahlberg, Tom
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Kroppsideal via Instagram2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective

    The advanced technology of today’s society has brought on a heavy uprising of social media where images of training and bodies are a common phenomenon. The aim of this study was to examine how body ideals are created on the internet, with focus on social media. Two questions were used to help with this objective: How do male fitness profiles portrait themselves and their bodies on the net based service Instagram? Do connections exist between these profiles portraits of the body and specific body ideologies? (Rosenmann & Kaplan, 2014).

    Method

    The study was carried out with a nethnographic method, a method specifically focused on qualitative research regarding the internet. Three male fitness profiles and five of their images each were selected based on popularity on Instagram to be examined and analyzed in relation to body ideal.

    Results

    The images had similar attributes which included that they, often in a gym environment, showed undressed, extremely muscular bodies with emphasized focus on the upper body. Differences were present in the images but not to any significant extent. The profiles were defined by the body ideology of metrosexuality and consumer masculinity (Rosenmann & Kaplan, 2014).

    Conclusion

    The representation of the images of these fitness profiles translate well into the current muscular body ideal that contains a lean, muscular, well defined body. Clear connections could be made to Rosenmann’s och Kaplan’s (2014) body ideology of metrosexuality and consumer masculinity.

  • 483.
    Dahlgren, Gereon
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Vinnare tack vare tidigt födelsedatum: En studie om relativa ålderseffekten inom svensk juniorishockey medfokus på TV-pucken2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 484. Dahlin Ivanoff, Synneve
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ekdahl, Anne
    Eklund Grönberg, Annika
    Oredsson, Sven
    Sjöstrand, Fredrik
    Stavenow, Lars
    Wisten, Aase
    Akutvården måste klara också sköra åldringar2014In: Dagens Nyheter, ISSN 1101-2447, no 2014-01-03Article in journal (Other (popular science, discussion, etc.))
  • 485.
    Dahlkvist, Sara Erica
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Molinder, Rosa-Lill Eleonor
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Nepali men’s perceptions of the role of the man in family planning, during pregnancy and childbirth: A qualitative interview study2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Nepal has a rich culture and tradition in which family life and marriage are generally controlled by patriarchal norms, sanctions, values and gender differences. Despite global efforts to initiate midwifery education beneficial to women’s reproductive health in Nepal, the initiation is still pending.

    Objective: To describe Nepali men´s perceptions of the role of the man in family planning, during pregnancy and childbirth.

    Methods: A qualitative interview study with open questions was conducted with 15 Nepalese men in urban and rural areas. The material was analyzed by inductive content analysis.

    Results: The main category was, `He leads – She follows´. Six subcategories were presented under the category `supporting women in family planning, during pregnancy and childbirth´. Six subcategories formed the category `withdraw from supporting women in family planning, during pregnancy and childbirth´.

    Conclusion: The role of the man in Nepal was supportive and yet support was withdrawn in maybe the woman’s most vulnerable time of life.

    Clinical implications: With men playing such an important role in family planning, during pregnancy and childbirth, inviting him to knowledge sessions might improve women’s and girls’ sexual and reproductive health and rights.

    Further research: Proposal for further research that could capture the whole picture should be implemented with a more extensive quantitative research in Nepal.

  • 486.
    Dahlqvist Jönsson, Patrik
    et al.
    Region Halland.
    Sandlund, Mikael
    Umeå Universitet.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Svedberg, Petra
    Högskolan i Halmstad, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    The meaning of Shared decision making for persons with long-term mental illness2013Conference paper (Refereed)
  • 487.
    Dahlqvist-Jönsson, Patrik
    et al.
    Region of Halland; Halmstad University.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Rosenberg, David
    Umeå University.
    Sandlund, Mikael
    Umeå University.
    Svedberg, Petra
    Halmstad University.
    Service users’ experiences of participation in decision making in mental health services2015In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 22, no 9, p. 688-697Article in journal (Refereed)
    Abstract [en]

    Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a ‘struggle to be perceived as a competent and equal person’ while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.

  • 488. Dahlström, Ann-Charlotte
    et al.
    Mulder, Linn
    Sjuksköterskors erfarenheter av hot och våld på akutmottagningar: En litteraturöversikt2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att beskriva sjuksköterskor erfarenheter av hot och våld på akutmottagningar, sett ur ett internationellt perspektiv.

    Metod: Studien har genomförts som en litteraturstudie. Databassökningar har utförts på databaserna PubMed och CINAHL, originalpublicerade kvantitativa och kvalitativa forskningsstudier har kvalitetsgranskats och sammanställts.

    Resultat: Studien visade att sjuksköterskor hade erfarenhet av verbalt och fysiskt hot och våld i stor utsträckning. De verbala hoten och våldet bestod av svordomar och kränkningar. Det fysiska våldet visade sig genom att sjuksköterskorna blev spottade på, får knuffar, slag och sparkar. De som utövade hot och våld kunde vara patienten själv, närstående eller andra anhöriga.

    Slutsats: Sjuksköterskor på akutmottagningar världen över drabbas av olika typer av hot och våld. Detta påverkar både övriga patienter och övrig personal negativt. Ur arbetsmiljösynpunkt inkräktar hot och våld på patientsäkerheten. Bristande kommunikation som även kan feltolkas kan leda till hot och våld från patienter. Genom att genomföra förbättringsåtgärder och skapa strategier för bättre kommunikation kan hot och våld förebyggas.

  • 489.
    Dahné, Ylva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Thorin, Emma
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskan och patienter med strokeinduceradafasi – En litteraturöversikt om kommunikation ochpersoncentrering2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Stroke is a collective term for cerebral infarction and cerebral

    hemorrhage. Stroke often causes lifelong detrimental effects, such as aphasia.

    Aphasia means a reduced ability to understand spoken/written language and/or a

    reduced ability to express oneself adequately. To enable a good and person-centred

    care for the patients, an effective communication is a prerequisite.

    Aim: The aim of

    this study is to describe the factors that influence the person-centred care and

    communication between the nurse and patients affected by stroke induced aphasia.

    Method:

    The study is a literature review on bachelor level. The study is based on 15

    scientific articles that have been red and analyzed and where common themes have

    been identified.

    Result: The results revealed a number of strategies that promoted

    and hindered good communication between the nurse and people affected by stroke

    induced aphasia. These strategies concern seven areas:

    Verbal communication, Nonverbal

    communication, Seeing the patient as a competent and unique individual,

    Attention and involvement, The time aspect of communication with patients with

    aphasia, The importance of the surrounding environment for communication

    and The

    personnel's education and skills

    . Conclusion: There is no standard answer to how

    communication shall be achieved, each individual is unique and every situation

    requires a different solution. However, there are a number of aspects and methods

    that are important and useful when communicating with aphasic people. These are

    used to different degrees in health care.

  • 490. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wall, Stig
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 491.
    Dammgård, Emelie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Pernhall, Lina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Distriktssköterskors erfarenheter av att främja hälsosamma levnadsvanor hos patienter med diabetes typ 2: En empirisk studie med kvalitativ ansats2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Diabetes is a people's disease that increases in society and in the world. Diabetes type 2 can be prevented, delayed or alleviated using healthy living habits, such as diet and exercise. Lifestyle treatment is therefore essential for achieving this.

    Purpose:

    To describe the district nurse's experience of promoting healthy living habits, diet and exercise, in type 2 diabetes patients.

    Method:

    An empirical study with qualitative interview method where seven district nurses participated in interviews.

    Results:

    The study highlighted the importance of district nurses' experiences and views on promoting healthy living habits, diet and exercise, to help and motivate patients with type 2 diabetes. To promote healthy living habits, in type 2 diabetes patients, are described as the basis of treatment. A very important task that is necessary to prevent as well as reduce the risk of complications to the disease. District nurses have experience and opportunities to promote healthy living habits in a variety of ways. Work on promoting healthy living habits is done individually, in groups and with the help of written information. District nurses also have experience and are aware of various obstacles to promote healthy living habits.

    Conclusion:

    District nurses should see each patient as a unique individual and then adjust the work to promote healthy living habits. Follow-up and continuity are needed to give the patient motivation for lifestyle changes and maintain them.

  • 492. Danehorn, Emil
    Sjuksköterskors uppfattningar av patienters lidande vid psykossjukdom: En fenomenografisk studie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att beskriva sjuksköterskors uppfattningar av lidande hos

    patienter med psykossjukdom. Metod: Fenomenografisk ansats med semistrukturerade

    intervjuer. Resultat: Analysen av det insamlade materialet visade att sjuksköterskorna i

    studien uppfattade lidande hos patienter med psykossjukdom på tre kvalitativt skilda sätt.

    Med synen observerade sjuksköterskorna patientens fysiska förändringar, förändringar i

    aktivitet och självdestruktiva handlingar. Genom hörseln uppfattade sjuksköterskan hur

    patienten talar, ber om hjälp eller ger uttryck för att inte förstå sin sjukdom. Med sitt luktsinne

    uppfattade sjuksköterskorna att patienten hade slutat sköta sin hygien. Konklusion: En

    psykossjukdom kan medföra lidande för en patient, samtidigt som förmågan att kommunicera

    och uttrycka sig verbalt kan vara nedsatt till följd av psykosens symtom, vilket kan leda till

    svårigheter för patienten att förmedla lidande på ett sätt som kan förstås av sjuksköterskan.

    Det finns skäl att anta att lidande, när det inte kan förmedlas med ord, tar andra skepnader och

    uttryck, som kan uppfattas genom att sjuksköterskan är uppmärksam på synbara, hörbara och

    luktbara förändringar hos patienten, genom dessa förändringar kan sjuksköterskan identifiera

    och få en uppfattning om patientens lidande.

  • 493.
    Danielsson, Charlotta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Malin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som kan försvåra möjligheten för sjuksköterskor att ge personcentrerad vård – en litteraturöversikt.2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: According to the new patient law, patients' involvement in their own care will be expanded and strengthened further. As part of this work, personcentred care has been introduced in several Swedish regions and county councils. Positive effects of person-centred care have been proven to exist for both patients and healthcare providers. Aim: To describe factors that can complicate the ability for nurses to provide person-centred care. Methods: The thesis project was conducted as a literature review. Ten scientific articles published between 2010-2016 were included in the study. The articles were searched in the CINAHL and PubMed databases, as well as through Google Scholar free text search. Results: There were several themes with associated factors that could complicate the possibility for nurses to provide a person-centred care. Prominent factors include the attitude of the nurse and his or her view of the profession and the patient, lack of patient participation, lack of teamwork and communication, weak support from organization and management, poor environment and education, and high workload. Conclusion: Several factors that could make it difficult for the nurse to provide person-centred care were discovered, some of which were perceived to be more crucial than others. In order for nurses to be able to provide care based on patient participation, it is very important that awareness of these aggravating factors is increased. By working with a person-centred approach already during nursing education, the likelihood of successful implementation of person-centred care in Swedish healthcare increases

  • 494. Danielsson, Evelina
    et al.
    Oddsson, Kristjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Fredriksson, Mårten
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Ovendal, Alexander
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Wahlgren, Lina
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Hultgren, Staffan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Andersson, Eva
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Hälsoprojekt med ledarledd fysisk aktivitet för äldre2012Conference paper (Other academic)
    Abstract [sv]

    Bakgrund och syfte. Syftet med hälsoprojektet under 8-12 veckor för äldre är att ge ledarledd fysisk aktivitet 2 gånger/vecka samt att utvärdera upplevd hälsa, förändring av livsstilssvanor samt fysisk kapacitet. Hälsoprojektet är ett fortlöpande samarbete mellan Solna stad och Gymnastik- och idrottshögskolan (GIH) och utförs under vårterminerna sedan ett flertal år.

    Metod. Individerna anmäler sitt deltagande själva. Det kostnadsfria hälsoprojektet utförs inom undervisningen i Folkhälsa i regi av GIH-studenter under handledning av verksamhetschefen i Solna stad och lärare/läkare på GIH. Den ledarledda fysiska aktiviteten utgörs primärt av stavgång, motionsgymnastik, vattengymnastik samt styrketräning. Initialt och i slutet av perioden besvarar deltagarna en hälsoenkät angående upplevd hälsa och livsstilsvanor om fysisk aktivitet, kost, sömn, rökning och alkohol samt utför några olika fysiologiska tester i samband med ett hälsosamtal.

    Resultat. Exempel på sammanställda resultat ges här för de 117 äldre som fullföljde hela projektet under en vårtermin (för kvinnorna var antalet samt medelvärden för ålder och BMI 99, 74år och 26 respektive för männen 18, 73år och 25). Efter avslutat projekt sågs för gruppen som helhet generellt en signifikant förbättrad upplevd fysisk och mental hälsa, kondition och styrka i buk-, ben- och armmuskulatur. För kvinnorna observerades även en ökad balansförmåga och uthållighet i ryggmusklerna. Enkätfrågorna angående fysiska aktivitetsvanor och stillasittande visade på, efter avslutat projekt, en förändring till en mer aktiv livsstil.

    Slutsats/Diskussion. Således kan utvärderade 8-12 veckors hälsoprojekt med ledarledd fysisk aktivitet för äldre bidra till förbättrad upplevd hälsa, ökade fysiska aktivitetsvanor, minskat stillasittande och bättre fysiska kapaciteter såsom kondition, styrka och balans som är positivt korrelerade till ökad livslängd och minskad förekomst av en mängd olika folksjukdomar och skador. Fler projekt och studier behövs framöver med ytterligare uppföljningar, jämförelser och för att vidareutveckla olika fysiologiska tester och andra hälsoparametrar som kan ha positiva samband med ökad hälsa.

  • 495.
    Danielsson, Johan
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Nykvist, Karin
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Mäns upplevelser av miktionsproblem och erektil dysfunktion efter radikal prostatektomi: En litteraturöversikt2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet var att beskriva hur män upplever att de påverkats av miktionsproblem och erektil dysfunktion efter radikal prostatektomi. Metod: Examensarbetet utfördes som en litteraturöversikt med tio vetenskapliga studier. Resultat: Upplevelsen av förlorad kontroll vid miktionsproblem var det som främst påverkade männen samt medförde att det sociala livet blev lidande. Männen beskrev hur de var tvungna att planera inför olika sociala tillställningar, vilket upplevdes som stressande och ångestfyllt. Det framkom också att männen oroade sig för urinläckage, stark odör och upplevde möten med oförstående människor som frustrerande. Erektil dysfunktion var den vanligaste komplikationen efter behandling, men miktionsproblem var det som orsakade mest besvär. Det upplevdes som att männen förlorat sin självständighet. Det framkom även att erektil dysfunktion upplevdes av vissa män som den komplikation som gav störst besvär. Erektil dysfunktion påverkade männen och var mycket svårt att hantera. Det var svårt att finna en acceptans för att den erektila dysfunktion kunde vara bestående. Många av männen beskrev att en viktig del i deras liv förlorats, en del av deras maskulinitet. De kände sig ofullständiga och det fanns en rädsla för att förlora sin partner. Slutsats: Studier visar att erektil dysfunktion och miktionsproblem i samband med radikal prostatektomi ger upphov till stress, oro, ångest samt en känsla av ofullständighet.

  • 496.
    Danielsson, Madeleine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Lind, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Barnmorskors strategier för att främja fysisk aktivitet under graviditeten: En Kvalitativ Intervjustudie2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Physical activity should be recommended to all women during pregnancy. Midwives have an important role in the health promotion practice. There are recommendations about physical activity during pregnancy, although studies show that few pregnant women actually follow them. The midwife experience difficulties in counselling and there is a need to find strategies that can be used to promote physical activity. The aim of this study was to describe the midwives strategies to promote physical activity during pregnancy. The study was conducted by qualitative method and semistructured interviews were used to collect data. The data was analysed by thematic analysis. Several strategies emerged that the midwives used to promote physical activity during pregnancy; To advice, To motivate, To seek support in the surroundings, To individualize, To take care of the relationship and To elaborate. Another finding in the study was that promotion of physical activity was perceived as important but difficult by the midwives. These strategies can be used by midwives and other healthcare providers to promote physical activity during pregnancy.

  • 497.
    Dannberg, Isabella
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Ivarsson, Emma
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Alkoholutbildning på svenska riksskidgymnasium: En kvalitativ undersökning om hur skidgymnasietränare arbetar med att utbilda sina adepter i alkoholfrågor2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose The purpose of the study is to examine whether and if so how special sports teachers / trainers on the cross-country high schools are working to educate trainees about alcohol. The study results to promote the Swedish cross-country operations and, if possible, spreading good educational example to other sports college. Method A qualitative study has been carried out through a half-structured telephone interview. The sample covered a total survey of all 16 national ski school coaches in Sweden in the sport cross-country skiing. Participants were contacted through an information letter and then determined time for the interview. The results were then analyzed using a content analysis. Results The results showed that all RIG-ski school in Sweden conducting some form of education through theory lessons in a more or less degree. Two of the ski high schools had a specific lecture on the effects of alcohol on performance. Besides this, the result could indicate that the ski school coaches educate their students to a much greater extent through the open dialogue between coach and trainee than through theory lessons. This by having individual assessment interview, which the coach informs in a deeper way what alcohol intake has consequences on athletic performance, thus coaches are trying to create an environment where students themselves take the decision to refrain alcohol. Conclusions The results showed that all RIG-ski school in Sweden is working to educate their adepts in alcohol matters through theory lessons, but mostly in the open dialogue between student and coach. Theory lessons are something that exists in the curriculum for special sports and effects of alcohol on performance. In the open dialogue coaches educates students in a deeper way about alcohol, for example, through individual assessment interview.

  • 498.
    Das, Lucky
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Chowdhury, Merry
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mapping of eight education sites and exploration of feasible requirements in an accreditation tool to ensure quality midwifery education in Bangladesh: A questionnaire study in Barisal, Chittagong and Sylhet divisions2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    An important component to ensure sustainable quality midwifery education is to have a country specific accreditation tool in place, based on evidence. In Bangladesh with a recently initiated new cadre of professional midwives, the accreditation system is in process of being developed. Objective: The objective of this thesis is twofold. First, to map eight midwifery education sites in Barisal, Chittagong and Sylhet divisions prior the development of an accreditation tool. Second, to explore requirements for the accreditation tool from the perspective of the midwifery faculty to ensure quality midwifery education in Bangladesh. Methods: This study is part of a national wide study. Thirty-six participants filled a semi-structured questionnaire with both open and closed response alternatives. Data were analyzed through essentially non-parametric statistics and qualitative descriptions. Results: The mapping showed that the proportion theory in relation to practice was 40% theory and 60% practice at the eight education sites. The content of a midwifery education that should be delivered in clinical placement by a midwifery clinical teacher or preceptor, mentoring the midwifery students, was identified as a main challenge. The possible solutions were having sufficient amount of well-trained midwifery teacher; negotiating with Gynecology and Obstetrics department and the policy makers on how mentoring of midwifery students could happen smoothly; and negotiating the need for training of trainers to head nurses of all labor wards. The relation between the education site and the clinical site was suggested to be included in an accreditation tool to improve the fulfillment of a midwifery education. Conclusion: The need of an accreditation tool was, perceived by midwifery faculty, as important in order to ensure sufficient standard in the midwifery education. Clinical implications: The clinical implication of this study lies in the development of strategies to increase the number of clinical mentors and trained midwifery teachers, and provision of training of trainers to the clinical nurse midwifes at all labor wards.

  • 499. de Alwis, M. P.
    et al.
    Lo Martire, R.
    Äng, Björn
    Garme, K.
    Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, p. e011681-Article in journal (Refereed)
  • 500. de Alwis, M.P.
    et al.
    Garme, K:
    Martire, R. Lo
    Kåsin, J.I.
    Äng, Björn
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Centre for Clinical Research Dalarna, Falun, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Crew acceleration exposure, health and performance in high-speed operations at sea2017Conference paper (Refereed)
    Abstract [en]

    The presented research program investigates the association between working conditions aboard High-Speed Craft (HSC) and its outcomes in terms of acceleration exposure and crew health and systems performance respectively. The aim is to identify the related risk factors and further, to use them to improve the assessment criteria in a simulation-based-design framework. The investigation initially document a seaborne population by a web-based questionnaire tailored for High-Performance Marine Craft Personnel (HPMCP) and similar populations. Then data is collected during regular service by measuring craft acceleration and through another questionnaire especially resolute on perceived work-exposure, health and performance. Exposure and performance data is collected daily and health data weekly, depending on seaborne frequency. The population repeats the prevalence questionnaire about a year later enabling a longitudinal follow-up for identifying long-term effects of exposure. The paper reports the two questionnaires´ development and pilot test as well as the first application for baseline data collection in the target group. The results indicate health and performance characteristics of the study population and data shows a promising correlation between the self-reported subjective exposure and the measured objective acceleration. Data indicates a comparatively higher prevalence of musculoskeletal pain in the study population than that of the general population.

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