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  • Abdillahi, Hamda A, et al. (författare)
  • A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland
  • 2017
  • Ingår i: International Journal of Gynecology & Obstetrics. - John Wiley & Sons. - 0020-7292. ; 138:1, s. 119-124
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.
  • Aberg, Anna Cristina, et al. (författare)
  • On loss of activity and independence, adaptation improves life satisfaction in old age : a qualitative study of patients' perceptions
  • 2005
  • Ingår i: Quality of Life Research. - Springer. - 0962-9343 .- 1573-2649. ; 14:4, s. 1111-1125
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose was to improve the understanding of factors are perceived by elderly people as important for their life satisfaction, during and after rehabilitation. Fifteen persons aged 80-94 years were interviewed while in hospital and on two follow-up occasions after discharge. Assessment of motor function using the General Motor Function assessment scale was used for descriptive purposes. Three themes emerged as important for life satisfaction: activity, independence and adaptation. Activity and independence were considered significant for life satisfaction. Basic activity preferences were related to care of one's own body and to social contacts. Control and influence over help and services were regarded as important. Different strategies for adaptation to the consequences of disease were used: reorganisation, interaction with caregivers, mental adaptation and mental activities (used as pastime and escape). Those with declined motor functions limited their activity preferences. A key finding was that pleasant past memories were actively recalled in an effort to achieve current life satisfaction. This adaptation strategy created a sense of life satisfaction, however with a potential risk for concealing dissatisfaction with conditions that might otherwise be correctable. Strategies for improving life satisfaction among old people in rehabilitation are suggested.
  • Abramsson-Zetterberg, Lilianne, et al. (författare)
  • The impact of folate status and folic acid supplementation on the micronucleus frequency in human erythrocytes
  • 2006
  • Ingår i: Mutation Research. - 1383-5742 .- 1388-2139. ; 603:1, s. 33-40
  • Tidskriftsartikel (refereegranskat)abstract
    • Folic acid has a well-documented stabilising effect on chromosomes. A correlation between folate status and chromosome stability in humans has been reported in studies that were restricted to certain subpopulations, e.g., folate-deficient persons. The goal of the present investigation was to clarify if there also is a correlation between folate status and chromosome stability among individuals without any folate deficiency.The method used here is the recently developed flow cytometry-based micronucleus assay in human transferrin-positive reticulocytes (MN-Trf-Ret). In a blood sample, separation of the very young reticulocytes from the mature erythrocytes makes this micronucleus assay possible.This investigation comprises three studies (cross-sectional, giving baseline data), two of which are connected to an intervention study. In the three cross-sectional studies (total number of subjects, 99) the frequency of MN-Trf-Ret (fMN-Trf-Ret) was measured and compared with the serum folate status. In two of the studies also serum homocysteine and Vitamin B12 were measured and compared with the baseline fMN-Trf-Ret. Combining the results from the three cross-sectional studies, a negative correlation between folate status and fMN-Trf-Ret was obtained (p < 0.05).The goal of the intervention studies was to clarify if different nutritional supplementations had any effect on the fMN-Trf-Ret and the cell proliferation (percentage polychromatic erythrocytes, PCE). Each of the two studies involved two groups, one placebo and one supplemented group. In one of the studies the supplementation was folic acid, 1000 μg/day during 1 week (n = 30, both sexes); in the other intervention study, folic acid (800 μg/day), B12 (20 μg/day) and B6 (4 mg/day) were taken during 1 week (n = 29, both sexes). No significant difference in %PCE or fMN-Trf-Ret between the two groups was found in either of the two intervention studies.
  • af Winklerfelt Hammarberg, Sandra, et al. (författare)
  • Care managers can be useful for patients with depression but their role must be clear a qualitative study of GPs' experiences
  • 2019
  • Ingår i: Scandinavian Journal of Primary Health Care. - TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 37:3, s. 273-282
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Explore general practitioners' (GPs') views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases. Design: Qualitative content analysis of five focus-group discussions. Setting: Primary health care centers in the Region of Vastra Gotaland and Dalarna County, Sweden. Subjects: 29 GPs. Main outcome measures: GPs' views and experiences of care managers for patients with depression. Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases. Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members' roles must be clear.
  • Aghanavesi, Somayeh, et al. (författare)
  • Verification of a method for measuring Parkinson's disease related temporal irregularity in spiral drawings
  • 2017
  • Ingår i: Sensors. - 1424-8220. ; 17:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Parkinson's disease (PD) is a progressive movement disorder caused by the death of dopamine-producing cells in the midbrain. There is a need for frequent symptom assessment, since the treatment needs to be individualized as the disease progresses. The aim of this paper was to verify and further investigate the clinimetric properties of an entropy-based method for measuring PD-related upper limb temporal irregularities during spiral drawing tasks. More specifically, properties of a temporal irregularity score (TIS) for patients at different stages of PD, and medication time points were investigated. Nineteen PD patients and 22 healthy controls performed repeated spiral drawing tasks on a smartphone. Patients performed the tests before a single levodopa dose and at specific time intervals after the dose was given. Three movement disorder specialists rated videos of the patients based on the unified PD rating scale (UPDRS) and the Dyskinesia scale. Differences in mean TIS between the groups of patients and healthy subjects were assessed. Test-retest reliability of the TIS was measured. The ability of TIS to detect changes from baseline (before medication) to later time points was investigated. Correlations between TIS and clinical rating scores were assessed. The mean TIS was significantly different between healthy subjects and patients in advanced groups (p-value = 0.02). Test-retest reliability of TIS was good with Intra-class Correlation Coefficient of 0.81. When assessing changes in relation to treatment, TIS contained some information to capture changes from Off to On and wearing off effects. However, the correlations between TIS and clinical scores (UPDRS and Dyskinesia) were weak. TIS was able to differentiate spiral drawings drawn by patients in an advanced stage from those drawn by healthy subjects, and TIS had good test-retest reliability. TIS was somewhat responsive to single-dose levodopa treatment. Since TIS is an upper limb high-frequency-based measure, it cannot be detected during clinical assessment.
  • Ahrne, Malin, et al. (författare)
  • Antenatal care for Somali-born women in Sweden Perspectives from mothers, fathers and midwives
  • 2019
  • Ingår i: Midwifery. - 0266-6138 .- 1532-3099. ; 74, s. 107-115
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.Design: Eight focus group discussions with 2-8 participants in each were conducted, three with Somaliborn mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".Setting:Two towns in mid-Sweden and a suburb of the capital city of Sweden. Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.Findings:Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.Key conclusions:ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. (c) 2019 The Authors. Published by Elsevier Ltd.
  • Alexanderson, Karin, 1952-, et al. (författare)
  • Stuprör, hängrännor och rännkrokar Utvärdering av projektet Samordnat stöd till barn och föräldrar i familjer med missbruk 2013-2014
  • 2015
  • Rapport (övrigt vetenskapligt)abstract
    • Rapporten handlar om:Det är en utvärdering av ett pilotprojekt med fem kommuner som drivits av Socialstyrelsen 2012-2014. Socialtjänsten i de fem kommunerna har i projektet beskrivit och prövat olika former samordning mellan enheter för med vuxna och barn för att upptäcka och ge adekvat stöd ur ett familjeperspektiv. I rapporten beskrivs hinder och framgångsfaktorer i var och en av de medverkande kommunerna men också sammantaget.De viktigaste resultaten:Alla fem kommuner har fullföljt projektet och har en fortsatt ambition att fortsätta utvecklingsarbetet. De har kommit olika långt i sina ambitioner. De i implementeringsteori beskrivna hindren förekommer även i detta projekt. Det har gällt exempelvis brister i kommuniceringen av projektet nedåt och uppåt i organisationen, hög arbetsbelastning, personalomsättning och brister i ledningsstöd. Att enheterna är lokaliserade på olika ställen eller organiserade i olika förvaltningar är andra hinder. Tre förhållanden som identifierats som hindrande eller försvårande av ett samordnat arbetssätt kan sammankopplats med lagstiftning och organisationsformer. Utredning och insats går inte alltid i fas med varandra tidsmässigt på vuxenheten och enheten för barn och unga. Enligt socialtjänstlagen ska en barnutredning vara slutförd inom fyra månader och en förhandbedömning ska vara gjord inom 14 dagar (SOL 11:2). Sådana tidsgränser formuleras inte för vuxenärenden. Barnutredningen kan avslutas utan insats med hänvisning till att det finns en fungerande förälder. Vuxenutredningen likaså om den vuxne saknar motivation att göra något åt sitt missbruk. Någon uppföljning av vad detta innebär för barnen sker inte om barnutredningen avslutats. Slutligen diskuteras resultatet utifrån en vedertagen metafor. De flesta kommuner i Sverige har en specialiserad organisation. I en sådan organisation flyter barnärendena i ett stuprör och vuxenärenden i ett annat. Utöver metaforen stuprör införs här metaforerna hängrännor och rännkrokar. Hängrännor behövs för att möjliggöra ett helhetsperspektiv på familjen, i hängrännorna blandas ärendena. Rännkrokar slutligen ses som strukturerna i organisationen som underlättar de blandade ärendeflödena. De samordningsmodeller som kommunerna prövat kan liknas vid försök att montera upp hängrännor. Kommunerna kan använda utvärderingen som inspiration för att själva implementera familjeorienterat arbetssätt och samordnade insatser till familjer med missbruksproblematik. Socialstyrelsen planerar utge ett kunskapsstöd för ett sådant arbete bl.a. med stöd av resultaten av rapporten.
  • Amcoff, Jan, et al. (författare)
  • The (un)importance of the closure of village shops to rural migration patterns
  • 2011
  • Ingår i: International Review of Retail Distribution & Consumer Research. - London : Taylor & Francis. - 0959-3969. ; 21:2, s. 129-143
  • Tidskriftsartikel (refereegranskat)abstract
    • This study investigates the importance of local service provision for the survival of rural areas. EU Rural Development Policy includes support to village shops as a means to sustain population. Shop closing is assumed to negatively affect migration to and from the area served. We analyse quantitative data on all Swedish village shops and the migration patterns in their market areas before and after shop closure. No significant effect of shop closure on either in- or out-migration can be established, regardless of whether larger or smaller market areas are employed or whether migrants with more urban shopping habits (i.e. commuters and families with children) are excluded. Complementary interviews in three villages where the last shop has closed verify the results.
  • Amcoff, Jan, 1966-, et al. (författare)
  • Understanding rural change—demography as a key to the future
  • 2007
  • Ingår i: Futures : The journal of policy, planning and futures studies. - 0016-3287 .- 1873-6378. ; 39:4, s. 363-379
  • Tidskriftsartikel (refereegranskat)abstract
    • The last decades have seen a rapidly growing interest in foresight methodology. Methods have been developed in corporate and governmental communication exercises often labelled technology foresight. In reality, these foresights have often drifted into processes of social change, since technological change is hard to foresee beyond what is already in the pipe-line. Forecasting of social change, however, must be based on solid knowledge about the mechanisms of continuity and change. Virtually nothing can be said about the future without relating to the past; foresights and futures studies are about revealing the hidden pulse of history. Hence, the answer to forecasting the future is empirical research within the social sciences. Demographic change has been recognised as a key determinant for explaining social change. Population changes are fairly predictable and the age transition can explain a wide range of socio-economic changes. For rural futures, demographic change is a key issue, since age structure in rural areas is often uneven and also unstable due to migration patterns. A number of policy related questions as well as research challenges are raised as a consequence.
  • Andersen, Kasper, et al. (författare)
  • Skeletal muscle morphology and risk of cardiovascular disease in elderly men
  • 2015
  • Ingår i: European Journal of Preventive Cardiology. - 2047-4873 .- 2047-4881. ; 22:2, s. 231-239
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:While it is well known that physical inactivity is a major risk factor for cardiovascular disease, there is still a search for the mechanisms by which exercise exerts its positive effect. Skeletal muscle fibre type can be affected to some extent by exercise, and different fibre types possess different anti-inflammatory and glucometabolic properties that may influence cardiovascular disease risk.DESIGN:Population-based cohort study.METHODS:We investigated relations of skeletal muscle morphology to risk of cardiovascular events in a sample of 466 71-year-old men without cardiovascular disease, of which 295 were physically active (strenuous physical activity at least 3 h/week).RESULTS:During a median of 13.1 years of follow up, 173 major cardiovascular events occurred. Among physically active men, 10% higher proportion of type-I (slow-twitch oxidative) fibres was associated with a hazard ratio (HR) of 0.84 (95% confidence interval 0.74-0.95) for cardiovascular events, and 10% higher proportion of type-IIx (fast-twitch glycolytic) fibres was associated with a HR of 1.24 (1.06-1.45), adjusting for age. Similar results were observed in several sets of multivariable-adjusted models. No association of muscle fibre type with risk of cardiovascular events was observed among physically inactive men.CONCLUSIONS:Higher skeletal muscle proportion of type-I fibres was associated with lower risk of cardiovascular events and a higher proportion of type-IIx fibres was associated with higher risk of cardiovascular events. These relations were only observed in physically active men. Skeletal muscle fibre composition may be a mediator of the protective effects of exercise against cardiovascular disease.
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