| 21. |
- Oldaéus, Göran
(författare)
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Cows' milk hydrolysates : Prevention and treatment of cows' milk allergy
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cows' milk allergy (CMA) develops early in infancy and the incidence is 2-5% in developed countries. The onset of symptoms is in most cases related to the introduction of a cows' ntilk based formula. The treatment of choice is total avoidance of cows' milk proteins and, at least in infancy, replacement with a whole protein soy or a hydrolysed cows' milk based formula (HP). The hypoallergenicity of HPs has been questioned, and studies evaluating remaining antigenicity and allergenicity as well as the allergy preventive effect of early feeding with HFs have been prompted.In vivo allergenicity of HPs was studied by skin prick tests and double-blind placebo controlled oral challenges in cows' milk allergic children, and in vitro allergenicity was analysed by RAST, RAST inhibition, immunoblotting and dot immunobinding. The protein content of the HPs was analysed by chromatography, electrophoresis, and determination of i)-lactoglobulin by ELISA (I,Il). The allergy preventive effect of feeding a partially (pHF) and an extensively HP (eHF) compared with a regular cows' milk formula from the start of weaning up to 9 months of age, was evaluated in a randomised, blinded study including infants from families with a history of allergy. The children were followed from birth up to 18 months of age (Ill). The antibody response to cows' milk antigens was analysed at 9 months of age with a chemiluminometric assay (IgE) and a sensitive ELISA (IgG) in a subgroup of these infants, who were fed a randomised formula for at least 3 months (IV). The presence of cord blood IgE, IgG, IgG1 and IgG4 antibodies to cows' milk antigens in relation to subsequent cows' milk sensitisation or allergic disease was evaluated (V).All tested HPs retained some allergenicity, but it was higher for pHPs than for eHPs, both in vivo and in vitro. The content of i)lactoglobulin was more than 2000 times higher in a pHF than in the eHFs. An allergy preventive effect was seen for the eHP but not the pHP on the develop-ment of cumulative atopic symptoms and atopic dermatitis. The lgG response to i)-lactoglobulin was more pronounced in the pHP than in the eHP fed group, but markedly reduced in both groups compared with the regular formula group. Cows' milk specific IgE antibodies were detected in 14% of cord blood sera, but the predictive capacity of these antibodies to detect subsequent cows' milk sensitisation and atopic disease up to 18 months of age was poor.In conclusion, all HPs may retain antigens capable of eliciting allergic reactions, but eHPs are far less allergenic than pHFs. Only eHPs should be recommended for treatment and prevention of cows' milk allergy.
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| 22. |
- Olsen, Karen Ege
(författare)
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Localized and systemic AL-amyloidosis : Aspects on protein structure, fibril formation and analytical methods
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AL-amyloidosis is a protein storage disease and one of the most common types of amyloidosis. The precursor protein is a monoclonal immunoglobulin light chain which originates from plasma cell dyscrasia in systemic AL-amyloidosis and is probably produced by a local plasma cell clone in localized AL-amyloidosis. Systemic AL-amyloidosis is a fatal disease, but the prognosis is improved by early diagnosis. The process leading to AL-amyloid fibril formation is not clear, but changes in the primary protein structure, associated substances and local tissue factors play a role. In order to interfere with amyloid deposition, it is necessary to understand the factors implicated in amyloid fibril formation.In this work, biochemical and immunological methods have been used to analyze AL-proteins and other factors involved in amyloid fibril formation. Conventional analytical methods have been extended, and a new method for typing of systemic amyloidosis has been developed. With our finding of immunoglobulin light chain of subgroup ')..V as anAL-protein, it has now been shown that the subgroups Ki-N and AI-VI of immunoglobulin light chains are capable of amyloid formation. By amino acid sequence analysis of several AL-proteins, unique amino acid substitutions were found, in addition to a remarkable pattern of amino acid substitutions in pairs. In localized AL-amyloidosis, giant cells were constantly associated with the amyloid deposits, in contrast to systemic AL-amyloidosis where giant cells only occurred in some lymph nodes with a different amyloid deposition pattern. The constant region of the light chain was found as the main component in an AL-protein as frequent constituent of ALamyloid. These fragments were found in gel filtration fractions generally not expected to contain protein material. An ELISA (enzyme linked immunosorbent assay) method was developed for typing of systemic amyloidoses from amyloid material extracted from subcutaneous adipose tissue, a simple method with no risk and little discomfort for the patient. In addition, it was shown that the subcutaneous tissue is a source for material for further AL-protein studies.Amyloid fibril formation is probably a process involving the interaction of many factors, some of which have been studied, and better understood as a result of these experiments. The interpretation of the results is discussed in the context of a multifactorial pathogenesis of AL-amyloidosis.
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| 23. |
- Ryding, Elsa Lena
(författare)
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Psychological Aspects of Emergency Cesarean Section
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- According to earlier research, emergency cesarean section (Em CS) can have a deleterious effect on maternal psychological well-being. Whether the women thus delivered already had more psychological problems during pregnancy than other women, is not known.ln our pilot study of 25 women who underwent EmCS, we found that the concept of post-traumatic stress was relevant to the subject.In the main study, 1,981 Swedish-speaking women completed questionnaires concerning fear of childbirth, general anxiety, and coping with stress at about 32 weeks' gestation. Those 97 women who were subsequently delivered by Em CS were compared with 194 controls, matched for age and parity.All told, 124 women, who underwent Em CS, participated in the study postpartum. Fiftythree of these were randomized for early postpartum counselling, which began with an interview about the delivery experience. The remainder (n = 71) participated in comparisons with women who underwent other types of delivery. Those delivered by elective cesarean section (n = 70) or who had an instrumental vaginal delivery (n = 89) participated, as did 96 of those who had a completely normal vaginal delivery. Questionnaires inquiring into the birth experience, post-traumatic stress reactions, and general mental distress were filled in a few days and again at one month postpartum. The Em CS groups also completed questionnaires 6 months postpartum. Altogether 79 women who underwent EmCS completed questionnaires, both during pregnancy and up to one month postpartum.Healthy pregnant women with a serious fear of childbirth appeared to be at greater risk of subsequent EmCS. The degree of fear of childbirth during pregnancy was the best predictor of the degree of maternal well-being after an Em CS. Many of the women had experienced during the delivery an intense fear for their own life and health and/or for that of their baby. Thus, the trauma of EmCS may well meet the stressor criterion of the Diagnostic and Statistical Manual of Mental Disorders. Appraisal of the delivery was more negative after an EmCS than after other modes of deliveries. The women reported more post-traumatic stress reactions following Em CS as well as after instrumental vaginal delivery, than after elective cesarean section or normal vaginal birth. Generally speaking, early postpartum counselling had a beneficial effect on maternal well-being and especially on appraisal of delivery. The women with most frequent symptoms of post-traumatic stress reactions and mental distress did not get adequate help by our mode of counselling.In conclusion, an emergency cesarean section is often a traumatic experience. Antenatal fear of childbirth may increase the risk of an Em CS. More intense fear of childbirth late during pregnancy is associated with a more negative appraisal of an experienced EmCS, and also with more frequent symptoms of post-traumatic stress reactions and general mental distress following a surgical delivery. The psychological well-being of mothers is generally not so good after EmCS or an instrumental vaginal delivery, as after elective cesarean section or normal vaginal birth.
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| 24. |
- Skamris Matthiesen, Leif, 1954-
(författare)
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Immune Changes in Pregnancy : A Survey of some Immunological Variables in Normal and Complicated Pregnancies
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The maternal systemic immune response during pregnancy is only fragmentarily understood. An adequate immune response to the gestational product is of vital importance for a successful pregnancy. Research in the field of reproductive immunology could clarify whether there is a difference between the immune responses in women with normal pregnancies and women with complicated pregnancies.The present thesis is a survey of selected immunological variables in non-pregnant women and in women with uncomplicated and complicated pregnancies. This was done by studying Jymphocyte populations, the proliferative capacity of lymphocytes as stimulated with mitogcns and immunomodulating drugs, the presence of iL-4 and JFN-g secreting cells, and the presence of certain autoantibodies in a low-risk pregnant population.Normal pregnancies were characterised by decreased levels of B cells (CD19+),_ NK cells (CD56+), expression of the IL-2 Receptor on lymphocytcs (CD25+) as well as HLA-DR+ on T cells (CD3+) and increased level of inactivated CD4+CD45RA+ T cells. Increased levels of NK cells, expression ofHLA-DR on T cells and antigen activated CD4+CD45R0+ T cells was found in preeclamptic patients compared with normal pregnancies. Thus, the immunosuppression that was found in normal pregnancies was not seen in pregnancies complicated by prccclampsia.Addition ofmitogens to cell cultures in either autologous or AB serum culture media demonstrated the existence of serum and cell mediated suppressor activity. The lymphoprolifcrative response to mitogens was reduced during nmmal pregnancies, possibly mediated by PGE2 and the presence ofT lymphocytes with suppressor function. The lymphoproliferative response in pregnancies complicated with severe precclampsia was further reduced as compared with normal pregnancies.Circulating IFN-g and IL-4 secreting cells increased during nonnal pregnancies. By the use of a mixed lymphocyte culture test it was found that paternal lymphocytes as stimulator-cells generated an elevated IL-4 secretion from maternal responder cells. These results indicate that the maternal immune response is shifted towards humoral immunity (TH2) by the recognition of the paternal allo-antigens, possibly to avoid maternal allo-reactivity against the fetus. The present findings also indicate that cell-mediated immunity (THl) to antigens were allowed to occur.The prevalence of anticardiolipin antibodies (aCL, IgG, ELISA), antinuclear antibodies (ANA, Indirect immunofluorescence) and rheumatoid factor (RF, agglutination test) in a low-risk pregnant population was low. However, there was an association, albeit weak, between ANA and women with preeclampsia.In summary, the maternal systemic immune response is characterised by suppression and non-aggression in nmmal human pregnancies. In women with pregnancy complications, such as preeclampsia, this suppression and inactivation is only partially achieved.
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| 25. |
- Skargren, Elisabeth, 1948-
(författare)
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Evaluation of Physical exercise, Physiotherapy and Chiropractic in the Management of Back Pain
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The lack of evidence concerning the effectiveness of most existing interventions for back pain, has created room for the expansion of a variety of interventions and the need to evaluate these.The general aim of this thesis was to assess three interventions used for health promotion (exercise programme) and treatment (chiropractic and physiotherapy) of musculoskeletal pain, primarily back pain, and to identify potential predictors of long-term outcome in the treatment of back pain.The thesis consists of material from two studies. Firstly, a health promotion study assessing the effects of a moderate weekly exercise programme among nursing personnel (n=86), during work time, using a cross-over design. Self-reported questionnaires were used to follow the effects on perceived musculoskeletal and psychosomatic symptoms and work conditions. As a complement, physical capacity was tested. Secondly, a randomised, pragmatic treatment study comparing the short-term and long-tenn (one-year) effects and costs of chiropractic and physiotherapy as first-line treatment for 323 patients with back pain seeking care at ten primary health care centres. Self-reported questionnaires were used to follow the effects on perceived health (pain, function and general health) and costs.The exercise programme decreased the number of musculoskeletal symptoms and increased the physical capacity among the 50 subjects who participated regularly. The effects were primarily explained by the subgroups: those who were non-regular exercisers in their spare time and those ~40 years of age, i.e. those who initially had low physical capacity. The results suggested a relationship between the number of musculoskeletal symptoms and physical capacity as well as a relationship between changes in these factors that need further evaluation. Besides the positive effect, a negative effect was seen in perceived work planning, suggesting that exercise during work time must be well organised so as not to add extra stress.Chiropractic and physiotherapy resulted in significant effects. The effects and costs were equal at short-term and long-term follow-ups. In other words neither strategy was more cost-effective than the other according to the total groups. However, subgroup analyses showed that patients with acute back pain (duration of current episode ≤ week) benefit more from chiropractic and patients with chronic back pain (duration of current episode ≥ 1 month) benefit more from physiotherapy, and at similar costs. Chiropractic consisted mainly of spinal manipulation, and physiotherapy of a great variety of treatment forms. Recurrence was common among patients visiting primary health care for back pain, and a high proportion, higher in the chiropractic group than in the physiotheraPy group, consumed additional health care during the follow-up year. Five prognostic factors ("duration of current episode", "Oswestry score at entry", "number of localisations", "expectations of treatment" and "well-being") for disability at the one-year follow-up were identified. The factors were of similar importance in the two treatment strategies, chiropractic and physiotherapy.Both studies showed that the outcome differed among subgroups of subjects. This suggests that potential predictive factors for outcome need to be considered in the development of intervention policies and in clinical decision models conceming back pain patients.
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| 26. |
- Stankovics, Nenad
(författare)
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Cutaneous effects of nerve injury : An experimental study in the rat
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the most difficult tasks of the hand surgeon is to reach a satisfactory restoration of the nerve functions of the injuried hand. In spite of the use of meticulous microsurgery, the results of nerve repair are disappointing, particularly with respect to mixed nerve trunks. In order to understand better the factors influencing axon regeneration and to improve further the outcome of surgical nerve repair, experimental studies are imperative. Studies in the rat show that the number of axons crossing a sharp sciatic nerve lesion may be high at nerve trunk level, whereas the sensibility of the foot skin is very deficient. This mismatch led us to study, with immunohistochemistry, the restoration of nerve endings in rat foot skin after various nerve injuries. In addition, some effects of nerve injury on the non-nervous epidermal components are elucidated through histology, autoradiography and immunohistochemistry. The results show that the occurrence of epidermal protein gene product 9.5 (PGP 9.5) immunoreactive axon profiles in the skin of the foot is statistically normal3 months after a crush lesion, but deficient 3 months after sciatic neurotomy and suture. The epidermal axon profiles return late after neurotomy and suture. The occurrence of {putative sensory) calcitonin gene-related peptide- and/or substance P-immunoreactive profiles, and {putative sympathetic) tyrosine hydroxylase-immunoreactive axon profiles in rat foot skin is partly abnormal after sciatic nerve crush and very abnormal after sciatic neurotomy and suture, when the contralateral side is also affected. In rats subjected to sciatic neurotomy and suture or neurectomy, the plantar epidermis becomes abnormally thin, but this is not seen after nerve crush. The epidermal thinning concurs with a decreased occurrence of mitotic cells. Both sutured and neurectornized rats, but not crushed cases, showed a markedly abnormal gait. However, rats subjected to selective division of sciatic foot branches exhibited a normal postural and locomotor behavior. In these rats, the occurrence of mitotic epidermal cells was similar on the operated and contralateral sides. This indicates that the effect of sciatic nerve division on the epidennal thickness of rat plantar skin is indirect, probably being caused by an ab~onnal load situation. The presence of PGP 9.5-immunoreactive epidermal dendritic cells in rat plantar skin is statistically normal3 months after sciatic crush injury, but significantly increased 1 week-3 months after neurotomy and suture. Finally, we show that the epidermal PGP 9.5- imrnunoreactive dendritic cells present in rat plantar skin represent la-immunoreactive Langerhans cells and that the plantar skin of albino rats is devoid ofepidermal NKJ-immunoreactive melanocytes.
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| 27. |
- Stenninger, Erik, 1956-
(författare)
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Aspects of hypoglycaemia in newborns of diabetic mothers and in children with Type 1 diabetes
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The occurrence and possible causal factors of macrosomia and postnatal hypoglycaemia were investigated in infants of diabetic mothers. Acute neurophysiological effects, the long-term nemodevelopmental outcome, and the use of glucagon in prevention and treatment of hypoglycaemia, were also studied in children with insulin-dependent diabetes mellitus (IDDM) and infants of diabetic mothers.Infants born 1986-1993 of diabetic mothers, and children 7-12 years of age with !DD M, were investigated at Orebro Medical Centre Hospital. Macrosomia (birth weight>+ 2SD, adjusted for gender and gestational age) occurred in 27% of infants of mothers with gestational diabetes mellitus (GDM) and in 30% of those of mothers with !DD M. Postnatal hypoglycaemia (B-glucose < 1.5 rnmol/l) was observed in 38% of the infants. A highly positive con-elation was found between cord plasma insulin growth factor-! (IGF-l) and relative birth weight ratios in infants of diabetic mothers (r ~ 0.64, p < 0.0007), suggesting a role for IGF-I in the development of macrosomia in diabetic pregnancy. Early postnatal hypoglycaemia was related to cord serum C-peptide levels, supporting the theory of foetal hyperinsulinaemia as the most important pathogenetic factor. Maternal glucose concentration at labour was also related to cord C-peptide concentration, indicating that maternal glucose regulation close to delivery is important for postnatal glucose regulation in the infants. At follow-up at the age of 8 years, children with neonatal hypoglycaemia of diabetic mothers had a lower total developmental score than control children. More difficulties at an :MBD screening test and more behavioural problems were also noted in this group. At quantitative EEG analysis, children with neonatal hypoglycaemia of diabetic mothers more often showed a pattern similar to that in children with attention deficit hyperactivity disorders/attention deficit disorders compared with those who were "normoglycaemic" in the neonatal period.To treat neonatal hypoglycaemia, an injection of subcutaneous glucagon, 20 Jlg/kg, was given 3 hours postnatally in addition to early oral feeding. This caused a significant rise in blood glucose concentration lasting for up to 60 min (p < 0.01), compared to oral feeding alone, without major side-effects. However, the duration of the hyperglycaemic effect was too brief to eliminate the need for additional intravenous glucose infusion.IDDM children, with a short duration of disease and good metabolic control, showed no progressive neurophysiological effects, as measured by brainstem auditory evoked potentials (BAEP), during short-term induced hypoglycaemia (1.7 mmolll). This suggests that children with IDDM better adapt to low blood glucose levels than adult diabetic patients. Nor did the IDDM children show permanent BAEP changes during normoglycaemia, compared with a control group of healthy children of the same age.In treatment of hypoglycaemia in IDDM children intranasal administration of glucagon (1 mg) and subcutaneous glucagon injection (0.5 mg) had similar hyperglycaemic effects as observed for up to 30 minutes. Fewer side-effects, including nausea and vomiting, and only minor nasal irritation were reported after intranasal glucagon administration.
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| 28. |
- Ståhlbom, Bengt, 1956-
(författare)
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Dimethylethylamine and dimethylbenzylamine in foundries and the epoxy industry : Analysis, metabolism, biological monitoring, toxicological effects and occupational exposure
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dimethylethylamine (DMEA) and dimethylbenzylamine (DMBA) are tertiary aliphatic amines, used as catalysts e.g., in mould core manufacturing and heat cured epoxy systems. Health effects such as visual disturbances and respiratory irritation occur among workers handling DMEA and airway symptoms are recorded by many workers exposed to DMBA. In this thesis, gas chromatographic methods for the determination of DMEA and DMBA in air and DMEA, dimethylethylamine- N-oxide (DMEAO), DMBA and dimethylbenzylaminc-N-oxide (DMBAO) in urine have been developed in order to monitor the air concentration of the amines, to investigate the metabolism and to establish methods useful for biological monitoring. Studies have been performed on volunteers in experimental exposures and on workers in the industrial setting. Dose-effect and dose-response relations were investigated for both DMEA and DMBA. An exposurechamber was developed, using a permeation technique, for the generation of low air levels of DMBA.DMEA and DMBA were rapidly absorbed through the respiratory tract and quickly distributed in the body. DMEA was to a large extent (90 %) metabolised into DMEAO and DMEA and DMEAO (SumDMEA) were excreted into the urine following a biphasic pattern. DMBA was metabolised to nearly 100 % and eliminated into the urine with a half-life of 4.3 h. More than 50 % was eliminated within 2 hours after the exposure. There was a significant correlation between the time-weighted average exposure level (TWA) of the two amines and the concentration of the amines and their metabolites (SumDMEA, SumDMBA) in the post-shift urine, in both the experimental and industrial study. Thus, both U-SumDMEA and U-SumDMBA may become important biomarkers in order to monitor industrial exposures of the corresponding amine.DMEA exposure to a constant air level of 40-50 mg/m3 during eight hours caused epithelial corneal oedema with visual disturbances and respiratory irritalion. A 15 min exposure at 80 mg/m 3 caused eye irritation but no visual disturbances and 8 h exposure at 20 mg/m3 did not cause visual disturbances or eye irritation.Low air concentrations (20-120 )Jg/m3 ) of DMBA increased the number of metachromatic cells and eosinophils in a dose-response related manner in the nasal mucosa in healthy vountecrs, without causing significant clinical symptoms.Industrial exposure levels of DMEA in mould core manufacturing workers were determined. The mean TWA of DMEA was 3.7 mg/m3 (range 0.5-14). The determination of DMBA in epoxy workers showed a mean TW A air concentration of 18 pg/m3 (range 3-48), with a 2 h peak exposure of 91 µ/m3.This thesis will facilitate the evaluation and assessment of risk and threshold limit values of DMEA, DMBA, and other related compounds.
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| 29. |
- Sydsjö, Adam, 1940-
(författare)
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Sickness absence during pregnancy
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present study represents a series of surveys concerning the variation in rate and average duration of sickness absence during pregnancy from 1978 to 1997 in two Swedish communities, Linköping and Värnamo. The variation observed was related to the obstetrical course and outcome of the pregnancies, the reproductive histories of the women investigated, the occcupations held, the degree of employment, the prevalence of "back-pain during pregnancy" as a cause of sick-listing and the use before delivery of the special social benefits associated with childbearing, i.e. the Parental benefit and the Pregnancy benefit. The attitudes towards the subjective consequences of the state of pregnancy and the concept of being off-work for different reasons while pregnant, were examined by means of a questionnaire. A direct comparison was made between all pregnant women delivered during 1986 in the Värnamo community and the Hamar community in Norway, with special regard to the amounts of sickness absence registered during pregnancy in the two communities. Finally, with the help of two independent data bases, one computerized and based on routine reports and one manually extracted, we estimated the proportion of pregnant women among all sicklisted women, aged 16-44 years, during 1986 in Linköping, and their contribution to the total amount of sickness absence registered within these age strata. In total, 6 628 Swedish and 645 Norwegian pregnant women were included in the surveys.As a main result we found that the mean number of days of sickness absence per pregnant woman, aged 16-44 years, rose by more than 100 per cent, from 1978 to 1986. The corresponding increase for all women aged 16-44, was 20 per cent. Concurrently, there was no evidence of an "obstetric" explanation for these findings. "Back-pain during pregnancy" was the most frequent "complaint "to legitimate the sick-leave spells, increasing to about 30 per cent among employed pregnant women 1986. In 1997 it had decreased to 17 per cent. It was most often found in the younger pregnant women (< 25 years).No relation was observed between the occupation held by the pregnant women and the variation in sickness rate or the average duration of the sickness absence observed between 1978 and 1997. Nor was there any simple relation observed between the degree of unemployment among pregnant women and the amount of sickness absence registered.The variations in the social benefits offered to pregnant women was not found, either, to be related in a simple way to the rate and duration of sickness absence during pregnancy. Thus, when the social benefits, i.e. the Parental and the Pregnancy benefits, were substantially ameliorated in Sweden between 1978 and 1986, the sickness absence among pregnant women rose dramatically. In 1992 and 1997, when a modest reduction in the pregnancy associated social benefits had taken place, a decline in the amount of sickness absence was registered, i.e. down to 0.60 and 0.53. In 1986, 48 per cent of the employed pregnant women in Hamar were sicklisted during pregnancy as compared with 75 per cent in Vlimamo. This was in spite of the fact that the social benefits available to pregnant and employed women were much more favourable in Sweden than in Norway.In the questionnaire study about personal attitudes in 1995 we found, that 74 per cent of the women who had been sick-listed during pregnancy stated that they had enjoyed a "good" or "excellent" health during the whole of their pregnancy. Only 4.2 per cent of the women stated that they had suffered from a clearly pregnancy-related disorder. The present findings may indicate that a change in attitude towards pregnancy and its subjective consequences, together with a sensible adaptation to the prevailing conditions within the social security insurance system, may well be the most plausible explanation to the observed variations in sick-listing during the study period. When data from the two independent data bases were compared, it was found that 5.4 per cent of all sicklisted women aged 16-44, were pregnant. These women contributed as much as 22 per cent of all sickness absence registered. Only 46 per cent of the actually pregnant women could be identified in the computerized data base with the help of "pregnancy-related" diagnoses noted in the sick-leave certificates. To preclude misinterpretations, based on public health statistics, one must be properly informed on the reproductive state of thewomen sick-listed.
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| 30. |
- Söderhamn, Olle
(författare)
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Potential for self-care : Assessing and describing self-care ability among elderly people
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the nature of elderly people's potential for selfcare from a nursing perspective. The research was performed within an empirical frame of reference as well as within a phenomenological frame at a descriptive and hermeneutical level.In order to implement a relation-searching study, one instrument was translated and a new instrument constructed. Both tools were tested for reliability and validity. A relation-searching study and a phenomenological study were then performed. The participating elderly were 65+ years of age and Jiving in a health district in western Sweden. The study groups consisted of 1) a convenience sample comprising inpatients (n=52) and their caregivers (n=53) in three nursing homes and one geriatric rehabilitation department, 2) a consecutive sample of in-patients (n=57) in a geriatric rehabilitation department, 3) an age stratified random sample, from which 125 persons agreed to participate in the study, and 4) for the phenomenological study, nine persons from the original age stratified random sample participated together with two conveniently chosen persons lrom a pilot study.The in-patients were interviewed, and the home dwelling persons completed a mailed questionnaire and wrote self-reports, respectively. Bivariate and multivariate statistical methods were used in the quantitative studies. The Empirical Phenomenalogical Psychological (EPP) method and a phenomenological-hermeneutical method were used in the analyses of the self-reported narratives.The results showed that the constructed instrument, the Self-care Ability Scale for the Elderly (SASE), is a reliable and valid tool for the appraisal of elderly people's perceived ability for self-care. The Swedish version of the Appraisal of Self-care Agency (ASA) scale is a reliable and valid tool for the appraisal of elderly people's perceived activation of self-care ability. The proposed theoretical relationship between self-care ability and self-care activity was empirically supported. Self-care ability and self-care agency declined for the studied home dwelling elderly 75+ years of age. One hypothesis was generated, saying that self-care ability among elderly people may be reinforced by physical activity and by the development of self-awareness.In the phcnomenological study, the structure of self-care ability among the home dwelling elderly persons was found to be twofold; it entailed, I) being present to the opportunity to act on certain perceived influences on the body and 2) alone or with support from somebody else, to be able to bring about a change in attitude towards ones personal lifestyle or life situation. The meaning of actualising the self-care ability into self-care activity was interpreted as self-realisation and self-transcendence.
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