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51.
  • Macassa, Gloria, et al. (författare)
  • Inequalities in under-five mortality in Mozambique : differentials by region of residence and ethnic affiliation of the mother
  • 2006
  • Ingår i: East African Medical Journal. - : African Journals Online (AJOL). - 0012-835X. ; 83:5, s. 259-266
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To explore regional and ethnic differentials in under-five mortality in Mozambique in relation to other determinants.DESIGN: Retrospective follow-up study.SETTING: Mozambique.RESULTS: Compared to children of Xitsonga mother's, children of Emakua and Cisena mother's had a mortality risk of 1.47 (CI = 1.06-1.90) and 1.21 (CI = 1.00-1.62) respectively. The excess mortality risks were partly explained by demographic, household environment, socioeconomic factors including region of residence.CONCLUSION: Ethnic affiliation of the mother (measured by the first language the mother spoke) was statistically associated with under-five mortality in Mozambique. Children of mothers of Emakua and Cisena ethnic affiliations and living in the North and Central regions had the worst survival chances. The relation between mother's ethnicity and under-five mortality was largely explained by demographic, socioeconomic and environmental factors.
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52.
  • Macassa, Gloria, et al. (författare)
  • Trends in infant and child mortality in Mozambique during and after a period ofconflict
  • 2003
  • Ingår i: Public Health. - 0033-3506 .- 1476-5616. ; 117:4, s. 221-227
  • Tidskriftsartikel (refereegranskat)abstract
    • This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973–1997) by mother's place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988–1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother's place of residence.
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53.
  • Magnusson, Peter, et al. (författare)
  • Health-related quality of life in patients with implantable cardioverter defibrillators in Sweden : a cross-sectional observational trial
  • 2021
  • Ingår i: BMJ Open. - : BMJ Journals. - 2044-6055. ; 11:7
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Decisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population.DESIGN: Cross-sectional observational trial.SETTING: Swedish ICD cohort.INTERVENTIONS: Short form 36 (SF-36) questionnaires from ICD recipients implanted 2007-2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES).RESULTS: In total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23-0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986).CONCLUSIONS: Patients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age.
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54.
  • Mamhidir, Anna-Greta, et al. (författare)
  • Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity
  • 2012
  • Ingår i: The Journal of Nutrition, Health & Aging. - Paris, France : Springer. - 1279-7707 .- 1760-4788. ; 16:10, s. 891-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period.Methods: A cross-sectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population.Results: The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis.Conclusion: Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations.
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55.
  • Olin, Karolina, et al. (författare)
  • Mapping registered nurse anaesthetists' intraoperative work : tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study
  • 2022
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.Objective To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.Methods Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.Results High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.Conclusion The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.
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56.
  • Olsson, Annakarin, et al. (författare)
  • A scoping review of complexity science in nursing
  • 2020
  • Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons, Ltd. - 0309-2402 .- 1365-2648. ; 76:8, s. 1961-1976
  • Forskningsöversikt (refereegranskat)abstract
    • Abstract: Aim To describe how complexity science has been integrated into nursing.Design: A scoping review. Data source/review method Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. Results Four categories were found in the included 89 articles: 1) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; 2) patients? symptoms, illness outcome and safety as characteristics of complexity science in nursing; 3) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and 4) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development.Conclusion: The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education.Impact: Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
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57.
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58.
  • Richter, Hans, 1961-, et al. (författare)
  • Trapezius muscle activity increases during near work activity regardless of accommodation/vergence demand level
  • 2015
  • Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 115:7, s. 1501-1512
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo investigate if trapezius muscle activity increases over time during visually demanding near work.MethodsThe vision task consisted of sustained focusing on a contrast-varying black and white Gabor grating. Sixty-six participants with a median age of 38 (range 19–47) fixated the grating from a distance of 65 cm (1.5 D) during four counterbalanced 7-min periods: binocularly through −3.5 D lenses, and monocularly through −3.5 D, 0 D and +3.5 D. Accommodation, heart rate variability and trapezius muscle activity were recorded in parallel.ResultsGeneral estimating equation analyses showed that trapezius muscle activity increased significantly over time in all four lens conditions. A concurrent effect of accommodation response on trapezius muscle activity was observed with the minus lenses irrespective of whether incongruence between accommodation and convergence was present or not.ConclusionsTrapezius muscle activity increased significantly over time during the near work task. The increase in muscle activity over time may be caused by an increased need of mental effort and visual attention to maintain performance during the visual tasks to counteract mental fatigue.
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59.
  • Sandgren, Anna, 1970-, et al. (författare)
  • Family members' expressions of dignity in palliative care : a qualitative study
  • 2021
  • Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:3, s. 937-944
  • Tidskriftsartikel (refereegranskat)abstract
    • Living and dying with dignity are fundamental values in palliative care, not only for the patient but also for family members. Although dignity has been studied from the different perspectives of patients in need of palliative care and their family members, family members' thoughts and feelings of dignity have not been given sufficient attention. Therefore, the aim was to describe family members' expressions of dignity in palliative care. The study had a qualitative design; semi-structured individual interviews were conducted with 15 family members of patients in palliative care in a county with a specialist palliative advisory team. Data were analysed using inductive content analysis. The results showed that family members' expressions of dignity are multifaceted and complex. For family members in palliative care, dignity means living as a respected human being in relation to oneself and others. Dignity also includes being able to maintain one's identity, feeling connected to significant others, and being comfortable with the new situation. Two contextual aspects affect family members' dignity: the two-headed paradox and reciprocal impact. Thetwo-headed paradoxmeans that family members want to stay close to and care for the ill person, at the same time want to escape the situation, but when they escape, they want to be close again.Reciprocal impactmeans that family members' feelings and experiences of the situation are closely intertwined with those of the ill person. These results may increase healthcare professionals' understanding and be used in dignified care practices that do not threaten, but instead aim to preserve family members' sense of dignity.
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60.
  • Sellberg, Fanny, et al. (författare)
  • A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery : study protocol for a randomized controlled trial
  • 2018
  • Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482 .- 1471-2482. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.METHODS: The ongoing RCT, the "WELL-GBP"-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients' baseline characteristics are presented in this protocol paper.DISCUSSION: A total of 259 RYGB female patients has been enrolled in the "WELL-GBP"-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.TRIAL REGISTRATION: The trial was registered on February 23th 2015 with registration number ISRCTN16417174.
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