234851. |
- Wennstig, Anna-Karin, et al.
(författare)
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The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors
- 2019
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Ingår i: Radiation Oncology. - : BMC. - 1748-717X .- 1748-717X. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTo assess the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC).MethodsThe study population consisted of 182 women treated for BC in Sweden between 1992 and 2012. All women received 3DCRT and subsequently underwent coronary angiography due to a suspected coronary event. CA segments were delineated in the patient's original planning-CT and radiation doses were recalculated based on the dose distribution of the original radiotherapy (RT) plan. The location of the CA stenosis that required intervention was identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Logistic regression analysis was used to assess the relationship between CA radiation doses and risk of a later coronary intervention at this specific location.ResultsThe odds ratio (OR) varied by radiation dose to the mid left anterior descending artery (LAD) (p=0.005). Women receiving mean doses of 1-5 Gray (Gy) to the mid LAD had an adjusted OR of 0.90 (95% CI 0.47-1.74) for a later coronary intervention compared to women receiving mean doses of 0-1Gy to the mid LAD. In women receiving mean doses of 5-20Gy to the mid LAD, an adjusted OR of 1.24 (95% CI 0.52-2.95) was observed, which increased to an OR of 5.23 (95% CI 2.01-13.6) for mean doses over 20Gy, when compared to women receiving mean doses of 0-1Gy to the mid LAD.ConclusionsIn women receiving conventional 3DCRT for BC between 1992 and 2012, radiation doses to the LAD remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible. Minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis.
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234852. |
- Wennstig, Mats, et al.
(författare)
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Levnadsberättelser i Blekinges särskilda boende för äldre
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- BakgrundDemenssjukdom och liknande tillstånd innebär att en person efterhand får allt svårare att delge information om sig själv och sitt liv. En dokumenterad levnadsberättelse kan för dessa personer utgöra ett av de viktiga redskapen för att få en personcentrerad vård och omsorg. Eftersom det i Blekinge fanns en osäkerhet kring levnadsberättelsens användning i särskilt boende beslutades att genomföra en kartläggning i länet. Syftet med undersökningen var att kartlägga förekomsten av levnadsberättelser i särskilt boende, graden av ifyllnad och vissa kvalitetsmått i befintliga levnadsberättelser. Syftet var även att beskriva undersköterskors uppfattning kring användandet av levnadsberättelsen i deras dagliga arbete.MetodUndersökningen bestod av två delar; en personalenkät till 701 undersköterskor samt en granskning av 77 enheter med totalt 873 brukare. Resultatet presenteras i form av beskrivande statistik och kommentarer. I analysen har även samband undersökts.ResultatResultatet visade att 38 % av brukarna i särskilt boende har en dokumenterad levnadsberättelse. I de fall det finns en tydlig rutin för levnadsberättelsen används den i högre grad som ett arbetsredskap i vård och omsorg. En klar majoritet (94 %) av undersköterskorna i undersökningen anser att levnadsberättelsen skulle kunna användas mer i vardagen. Rutiner på boendet kring ifyllandet av levnadsberättelsen, användning av levnadsberättelsen i arbetsgruppen och användning av levnadsberättelsen som underlag för genomförandeplanen visar sig ha samband med hur den enskilda undersköterskan fyller i och använder sig av levnadsberättelsen i vården och omsorgen kring den äldre som bor på boendetSlutsatsEnbart en tredjedel av brukarna i denna undersökning har en dokumenterad levnadsberättelse, samtidigt som nästan all personal anser att den skulle kunna användas mer i samband med brukarens vård och omsorg. Den relativt låga implementeringen av levnadsberättelsen tillskrivs bristen av rutiner på arbetsplatsen. Eftersom levnadsberättelsen kan ha stor betydelse för den enskilde personens vård och omsorg i vardagen, anser vi att det är angeläget att den implementeras i högre grad i Blekinges särskilda boenden. I vidare studier skulle det vara värdefullt att undersöka levnadsberättelsens effekter på den enskildes hälsa, men framförallt, undersöka orsaker till det låga användandet presenterad i denna rapport och testa olika arbetssätt ämnade att öka levnadsberättelsens användande i särskilda boende samt säkerställa inflyttningsprocessen.
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234853. |
- Wennstrom, Inga-Lill, et al.
(författare)
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Gender affects self-evaluation in children with cystic fibrosis and their healthy siblings.
- 2005
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 94:9, s. 1320-1326
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To determine whether self-esteem among children with cystic fibrosis (CF) and their healthy siblings differs from that of a healthy reference group and whether there are differences within and between sibling pairs. Methods: All Swedish CF children 6–14 y old with a healthy sibling in the same age range (n=65) were invited to participate, 55 sibling pairs and their parents taking part in the study. Five aspects of the children's self-concept—physical characteristics, skills and talents, mental well-being, relations to parents and family, and relations to others—were assessed by the "I think I am" self-evaluation questionnaire. Severity of illness was assessed by means of the Shwachman Clinical Evaluation System. Results: Whereas self-evaluation did not differ between groups at a general level, healthy girls as well as those with CF scored lower than girls in the reference group on the "mental well-being" and "relations to parents and family" subscales. Comparison of gender combinations (sick girl/healthy boy, sick girl/healthy girl, sick boy/healthy boy, sick boy/healthy girl) suggested that girls pay a cost of a lesser sense of psychological well-being and feelings of inadequacy in relation to their parents and family. The Shwachman score of the sick child was not related to the level of self-esteem. Conclusion: When CF is present among siblings, girls seem to carry more of the family pain than boys, a finding that calls for an increased awareness of the girls' situation by members of care teams.
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234854. |
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234855. |
- Wennström, Anette, 1975, et al.
(författare)
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Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: repeated cross-sectional surveys 1968-2004
- 2013
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 13:63
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral diseases are a health problem worldwide. Differences in oral health status may vary with geographical locations, but also within the same country and between groups with different social backgrounds. The specific aims were to describe secular trends in oral health status regarding number of remaining teeth and also to describe differences in socio-economic status, among 38- and 50-year-old women, over a 36-year period. Methods: Cross-sectional health surveys were performed at four occasions; 1968/69 (n = 746), 1980/81 (n = 532), 1992/93 (n = 165) and 2004/05 (n = 500), including randomly selected women aged 38 and 50 years. The number of teeth was determined using panoramic radiographs and self-reported measures of marital status, social class, educational level, and income were recorded. Results: The mean number of teeth among women has increased significantly. The educational level has increased while fewer women are married/cohabiting over time. There has been a shift in the social group the women belong to, where proportionally more women were categorized in a higher social group in 2004/05 than in 1968/69. Moreover, there is a significant relationship between fewer teeth and a lower social group, and among the 50-year-old women, this was irrespective of examination year. However, multivariate analyses showed that the risk to be edentulous or not, or to have fewer remaining teeth was significantly higher for women of lower social group, or living alone, in all studies over the 36 year-period. This was independent of age group, even though the risk diminished over the study period. Conclusions: Cohort comparisons of women aged 38 and 50 years during 36 years showed that dental status improved, with (i) a decreasing prevalence of edentulism and, (ii) an increasing number of remaining teeth in dentate individuals over time. Differences due to social group and education were still present, with more remaining teeth in the women in the higher social group. A time trend analysis indicated that in the later examination years the individuals had fewer teeth lost, irrespective of age, marital status and, social group.
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234856. |
- Wennström, Berith, et al.
(författare)
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Being Caught in a Vicious Circle : An Interview Study of Individuals Suffering From Grade II–IV Hiatal Hernia
- 2023
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Ingår i: Gastroenterology Nursing. - : Wolters Kluwer. - 1042-895X .- 1538-9766. ; 46:6, s. 489-496
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Tidskriftsartikel (refereegranskat)abstract
- Large paraesophageal hernias are related to life-threatening complications that warrant immediate surgery. Whether the long-standing chronic symptoms related to the disease in individuals without hernia incarceration motivate surgical treatment is still a subject for discussion. The aim of this study was to explore how individuals suffering from Grade II–IV hiatal hernia describe their symptoms and health, as well as how the disease affects their life. Semistructured interviews were performed with 22 individuals planning to undergo surgery for a large paraesophageal hernia. The data were analyzed using qualitative content analysis and resulted in one main theme “Being caught in a vicious circle” and six subthemes “Distressing and uncertain times,” “The symptoms have seized control over my health,” “Loss of energy and strength,” “Strategies for managing daily life,” “Loss of social life,” and “Moments of hope despite failing health.” Central to the participants’ descriptions is their commitment to strategies for managing the ever-present and unpredictable symptoms that have seized control over their health. They were trapped in a hopeless and isolated existence, that is, a vicious circle, from which they were unable to escape. Despite the low incidence of volvulus and incarceration, the symptom burden and effect on general health motivate treatment in these individuals.
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234857. |
- Wennström, Berith, et al.
(författare)
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Bodily and verbal expressions of postoperative symptoms in 3- to 6-year-old boys.
- 2008
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Ingår i: Journal of pediatric nursing. - : Elsevier BV. - 0882-5963 .- 1532-8449. ; 23:1, s. 65-76
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate how small boys between 3 and 6 years of age describe bodily and verbal expressions of postoperative symptoms. The data collection was carried out at a large general hospital in Sweden and included both participant observations and semistructured interviews. The results provided a description of how 3- to 6-year-old boys bodily and verbally express postoperative symptoms. The results also showed that small children have difficulties in distinguishing pain, nausea, and anxiety and that postoperative discomfort was experienced in many different ways.
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234858. |
- Wennström, Berith, et al.
(författare)
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Child drawings and salivary cortisol in children undergoing preoperative procedures associated with day surgery
- 2013
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 28:6, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPerioperative procedures in children can impair their emotional status negatively with stress and/or anxiety. Cortisol concentrations and drawings could be helpful in gaining information about a child's levels of stress and/or anxiety when attending the hospital for surgery.PurposeThe purpose of this study was to determine the degree of anxiety and stress as well as to explore the association between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children's drawings) as interpreted by the Swedish version of the Child Drawing: Hospital manual.MethodsA total of 93 children scheduled for day surgery were included. Salivary cortisol was sampled preoperatively on the day of surgery at which time the children were also requested to make a drawing of a person at the hospital.ResultsResults showed no association between salivary cortisol concentration and the CD:H score.ConclusionThe drawings and salivary cortisol concentration preoperatively on the day of surgery reflect different components of the conditions of fear, anxiety, or stress emerging in the situation.
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234859. |
- Wennström, Berith, et al.
(författare)
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Evaluation of the Swedish version of the Child Drawing : Hospital Manual
- 2011
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:5, s. 1118-1128
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of psychometric testing of the Swedish version of the Child Drawing: Hospital Manual.Background. Drawings have shown to be useful in assessing emotional status and anxiety in children because they generally speak to us more clearly and openly through their drawings than they are willing or able to verbally.Method. The Child Drawing: Hospital Manual was translated into Swedish according to World Health Organization guidelines (a routine procedure for translation of English instruments) in order to assess anxiety by analysing the drawings of 59 children (5–11 years), of whom nine were girls and 50 boys undergoing day surgery during 2007–2009.Results. Inter-rater reliability (five independent scorers) was high and internal consistency reliability was good (coefficient alpha = 0.77). Parts A and C, as well as the total scale score of the Child Drawing: Hospital Manual, discriminated anxiety significantly between the group of children undergoing day surgery and a comparison group of school children, indicating adequate construct validity.Conclusion. For the Swedish version of the Child Drawing: Hospital Manual, our study demonstrates evidence for adequate construct validity in Parts A and C (and total scale score), high inter-rater reliability and acceptable internal consistency reliability. However, some improvements are needed before the instrument will be a clinically useful assessment of anxiety in children undergoing day surgery.
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234860. |
- Wennström, Berith
(författare)
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Experiences, symptoms and signs in 3-11 year old children undergoing day surgery within the context of the perioperative dialogue
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgical interventions create real, imagined, or potential fear or anxiety in many children, thus highlighting a need for the health professionals who work with them to increasingly act as facilitators. The overall aim of the present thesis was to gain a deeper understanding of 3-11 year-old children’s perioperative symptoms, signs, experiences and main concerns when attending hospital for day surgery and of how they manage this situation. Paper I explores bodily and verbal expressions of postoperative symptoms using a qualitative and descriptive methodology. Fourteen boys between 3-6 years of age were interviewed and observed. The participant observation method was the primary source of data and the domains and subdomains together showed how bodily and verbal expressions could be intertwined. For boys of this age, distinguishing pain, nausea and distress is diffi cult, and they also have different ways of communicating the ‘correct’ words in clarifying a symptom. For paper II, a grounded theory (GT) study was carried out based on data from 15 boys and 5 girls (aged 6-9 years) scheduled for day surgery. The aim was to explore what it means for children to attend hospital for day surgery. Data were collected using tape-recorded interviews, participant observations and pre- and postoperative drawings. The analysis showed that the main concern for children undergoing day surgery was that they were forced into an unpredictable and distressful situation.They perceived a “breaking away from daily routines” and were “facing an unknown reality”. A conceptual model was generated, including a core category, “enduring infl icted hospital stress”, which explains how the situation was handled. Initially, the children tried to “gain control” over the situation. However, during the perioperative period they experienced a “loss of control” and “cooperated despite fear and pain”. Post-operatively they “breathed a sigh of relief” and tried to “regain normality in life” again. Paper III presents a psychometric test of the Swedish version of the Child Drawing: Hospital Manual (CD:H), which intends to assess hospital anxiety in children. Drawings from 59 children (aged 5-11) undergoing day surgery were analyzed and compared to drawings from 71 school children (aged 5–11) in a comparison group. The results showed that the Swedish version of the CD:H has adequate construct validity (Parts A, C and total scale score), high inter-rater reliability and acceptable internal consistency reliability. In paper IV, the effi cacy of the perioperative dialogue was investigated by analysing salivary cortisol in 5-11 year old children undergoing day surgery. Seventy-nine boys and 14 girls (n=93) scheduled for day surgery were randomly recruited into three groups with different types of perioperative care: Standard perioperative care (control group) (n=31), Standard perioperative care including preoperative information (n=31), and the Perioperative Dialogue (PD) (n=31). Postoperatively, the PD group had signifi cantly lower saliva cortisol concentrations than the other two groups and these levels continuously decreased during the day of surgery. Among the children who received analgesics, the PD group received signifi cantly less morphine related to bodyweight. Irrespective of group, there was a positive correlation between morphine consumption and salivary cortisol concentration. In paper V, associations between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children’s drawings) are investigated. The sample included 93 children (79 boys and 14 girls) scheduled for elective day surgery requiring general anaesthesia. The results showed no signifi cant associations between children’s saliva cortisol concentration (stress) and their drawings (anxiety) in any of the parts of the CD:H or individual items. In conclusion, the studies contribute to a deeper understanding of how 3-11 year-old children undergoing day surgery experience and express their situation, symptoms and physiological stress in the context of the PD. Keywords; anxiety, children, cortisol, day surgery, drawings, nursing, perioperative dialogue, stress, symptoms
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