| 61. |
- Anskär, Eva, 1957-, et al.
(författare)
-
Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings
- 2018
-
Ingår i: BMC Health Services Research. - : BIOMED CENTRAL LTD. - 1472-6963. ; 18
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. Methods: This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. Results: All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. Conclusions: This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.
|
|
| 62. |
|
|
| 63. |
- Appelberg, Jonas, 1964-, et al.
(författare)
-
Lung aeration during sleep in patients with obstructive sleep apnoea
- 2010
-
Ingår i: Clinical Physiology and Functional Imaging. - Oxford : Blackwell Publishing. - 1475-0961 .- 1475-097X. ; 30:4, s. 301-307
-
Tidskriftsartikel (refereegranskat)abstract
- P>Background: Previous studies have indicated that patients with obstructive sleep apnoea (OSA) have altered ventilation and lung volumes awake and the results suggest that this may be a determinant of severity of desaturations during sleep. However, little is known about regional lung aeration during sleep in patients with OSA. Methods: Twelve patients with OSA were included in the study. Computed tomography was used to study regional lung aeration during wakefulness and sleep. Lung aeration was calculated in ml gas/g lung tissue in four different regions of interest (ROI1-4), along the border of the lung from ventral to dorsal. Results: Lung aeration in the dorsal (dependent) lung region (ROI4) was lower during sleep compared to wakefulness 0 center dot 78 +/- 0 center dot 19 versus 0 center dot 88 +/- 0 center dot 19 (mean +/- SD) ml gas/g lung tissue (P = 0 center dot 005). Associations were found between awake expiratory reserve volume and change in lung aeration from wakefulness to sleep in ROI4 (r = -0 center dot 69; P = 0 center dot 012). In addition, the change in lung aeration in the dorsal region correlated to sleep time (r = 0 center dot 69; P = 0 center dot 014) but not to time in supine position. The difference in lung aeration between inspiration and expiration (i.e. ventilation), was larger in the ventral lung region when expressed as ml gas per g lung tissue. In two patients it was noted that, during on-going obstructive apnoea, lung aeration tended to be increased rather than decreased. Conclusions: Aeration in the dorsal lung region is reduced during sleep in patients with OSA. The decrease is related to lung volume awake and to sleep time.
|
|
| 64. |
- Austeng, Dordi, et al.
(författare)
-
Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
-
Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
|
|
| 65. |
- Axelsson, Arvid, et al.
(författare)
-
Exploring Multispectral ALS Data for Tree Species Classification
- 2018
-
Ingår i: Remote Sensing. - : MDPI AG. - 2072-4292. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- Multispectral Airborne Laser Scanning (ALS) is a new technology and its output data have not been fully explored for tree species classification purposes. The objective of this study was to investigate what type of features from multispectral ALS data (wavelengths of 1550 nm, 1064 nm and 532 nm) are best suited for tree species classification. Remote sensing data were gathered over hemi-boreal forest in southern Sweden (58 degrees 2718.35N, 13 degrees 398.03E) on 21 July 2016. The field data consisted of 179 solitary trees from nine genera and ten species. Two new methods for feature extraction were tested and compared to features of height and intensity distributions. The features that were most important for tree species classification were intensity distribution features. Features from the upper part of the upper and outer parts of the crown were better for classification purposes than others. The best classification model was created using distribution features of both intensity and height in multispectral data, with a leave-one-out cross-validated accuracy of 76.5%. As a comparison, only structural features resulted in an highest accuracy of 43.0%. Picea abies and Pinus sylvestris had high user's and producer's accuracies and were not confused with any deciduous species. Tilia cordata was the deciduous species with a large sample that was most frequently confused with many other deciduous species. The results, although based on a small and special data set, suggest that multispectral ALS is a technology with great potential for tree species classification.
|
|
| 66. |
- Axelsson, Arvid, et al.
(författare)
-
Tree species classification using Sentinel-2 imagery and Bayesian inference
- 2021
-
Ingår i: International Journal of Applied Earth Observation and Geoinformation. - : Elsevier BV. - 1569-8432 .- 0303-2434. ; 100
-
Tidskriftsartikel (refereegranskat)abstract
- The increased temporal frequency of optical satellite data acquisitions provides a data stream that has the potential to improve land cover mapping, including mapping of tree species. However, for large area operational mapping, partial cloud cover and different image extents can pose challenges. Therefore, methods are needed to assimilate new images in a straightforward way without requiring a total spatial coverage for each new image. This study shows that Bayesian inference applied sequentially has the potential to solve this problem. To test Bayesian inference for tree species classification in the boreo-nemoral zone of southern Sweden, field data from the study area of Remningstorp (58°27′18.35″ N, 13°39′8.03″ E) were used. By updating class likelihood with an increasing number of combined Sentinel-2 images, a higher and more stable cross-validated overall accuracy was achieved. Based on a Mahalanobis distance, 23 images were automatically chosen from the period of 2016 to 2018 (from 142 images total). An overall accuracy of 87% (a Cohen’s kappa of 78.5%) was obtained for four tree species classes: Betula spp., Picea abies, Pinus sylvestris, and Quercus robur. This application of Bayesian inference in a boreo-nemoral forest suggests that it is a practical way to provide a high and stable classification accuracy. The method could be applied where data are not always complete for all areas. Furthermore, the method requires less reference data than if all images were used for classification simultaneously.
|
|
| 67. |
- Axelsson, Christoffer, et al.
(författare)
-
The use of dual-wavelength airborne laser scanning for estimating tree species composition and species-specific stem volumes in a boreal forest
- 2023
-
Ingår i: International Journal of Applied Earth Observation and Geoinformation. - : Elsevier BV. - 1569-8432 .- 1872-826X. ; 118
-
Tidskriftsartikel (refereegranskat)abstract
- The estimation of species composition and species-specific stem volumes are critical components of many forest inventories. The use of airborne laser scanning with multiple spectral channels may prove instrumental for the cost-efficient retrieval of these forest variables. In this study, we scanned a boreal forest using two channels: 532 nm (green) and 1064 nm (near infrared). The data was used in a two-step methodology to (1) classify species, and (2) estimate species-specific stem volume at the level of individual tree crowns. The classification of pines, spruces and broadleaves involved linear discriminant analysis (LDA) and resulted in an overall accuracy of 91.1 % at the level of individual trees. For the estimation of stem volume, we employed species-specific k-nearest neighbors models and evaluated the performance at the plot level for 256 field plots located in central Sweden. This resulted in root-mean-square errors (RMSE) of 36 m3/ha (16 %) for total volume, 40 m3/ha (27 %) for pine volume, 32 m3/ha (48 %) for spruce volume, and 13 m3/ha (87 %) for broadleaf volume. We also simulated the use of a monospectral near infrared (NIR) scanner by excluding features based on the green channel. This resulted in lower overall accuracy for the species classification (86.8 %) and an RMSE of 41 m3/ha (18 %) for the estimation of total stem volume. The largest difference when only the NIR channel was used was the difficulty to accurately identify broadleaves and estimate broadleaf stem volume. When excluding the green channel, RMSE for broadleaved volume increased from 13 to 26 m3/ha. The study thus demonstrates the added benefit of the green channel for the estimation of both species composition and species-specific stem volumes. In addition, we investigated how tree height influences the results where shorter trees were found to be more difficult to classify correctly.
|
|
| 68. |
- Axelsson, Lena, et al.
(författare)
-
End-of-life and palliative care of patients on maintenance hemodialysis treatment : a focus group study
- 2019
-
Ingår i: BMC Palliative Care. - : BioMed Central. - 1472-684X. ; 18:1, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite complex illness trajectories and a high symptom burden, palliative care has been sub-optimal for patients with end-stage kidney disease and hemodialysis treatment who have a high rate of hospitalization and intensive care towards end of life. There is a growing awareness that further development of palliative care is required to meet the needs of these patients and their family members. In this process, it is important to explore healthcare professionals' views on provision of care. The aim of this study was therefore to describe nurses' and physicians' perspectives on end-of-life and palliative care of patients treated with maintenance hemodialysis. Methods: Four focus group interviews were conducted with renal nurses (17) and physicians (5) in Sweden. Qualitative content analysis was used to analyze data. Results: Participants were committed to giving the best possible care to their patients, but there were challenges and barriers to providing quality palliative care in nephrology settings. Professionals described palliative care as end-of-life care associated with hemodialysis withdrawal or palliative dialysis, but also identified care needs and possibilities that are in line with an earlier integrated palliative approach. This was perceived as complex from an organizational point of view. Participants identified challenges related to coordination of care and different perspectives on care responsibilities that impacted symptom management and patients' quality of life. Communication issues relating to the provision of palliative care were revealed where the hemodialysis setting was regarded as an impediment, and personal and professional experiences, beliefs and knowledge were considered of major importance. Conclusions: Nurses and physicians identified a need for the improvement of both late and earlier palliative care approaches. The results highlighted a requirement for and possibilities of training, counselling and support of health care professionals in the dialysis context. Further, multi-professional palliative care collaborations should be developed to improve the coordination and organization of end-of-life and palliative care of patients and their family members. A climate allowing conversations about advance care planning throughout the illness trajectory may facilitate the gradual integration of palliative care alongside life-prolonging treatment for improved support of patients and families.
|
|
| 69. |
- Axelsson, Lena, et al.
(författare)
-
Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives
- 2020
-
Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:2, s. 419-432
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
|
|
| 70. |
- Axelsson, Malin, et al.
(författare)
-
Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland : The Nordic EpiLung Study
- 2021
-
Ingår i: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 58:9, s. 1196-1207
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
|
|
