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  • Arefalk, Gabriel, et al. (författare)
  • Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort Studies
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • BackgroundSnus, a Swedish type of smokeless tobacco, has potent acute hemodynamic effects, which could provoke stress on the cardiovascular system, including the myocardium. Snus has, however, not been linked to risk of ischemic heart disease. Therefore, we hypothesized that snus use increases the risk for heart failure of non-ischemic origin.MethodsWe conducted a pooled analysis of eight Swedish prospective cohort studies involving individual participant data from 350,711 men. Shared frailty models with random effects at the cohort level, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) of heart failure in relation to snus use. We investigated dose-response associations, and association with ischemic and non-ischemic heart failure in separate. For positive control purposes, we also investigated associations between smoking and risk of heart failure.ResultsDuring a median follow-up time of 16 years, 5,404 men were hospitalized for heart failure. In models adjusting for age, smoking, previous myocardial infarction and educational level, current snus use was associated with a higher risk of heart failure (HR 1.27, 95 % CI 1.07-1.50), relative to non-current snus use. A dose-response pattern was observed, with higher risk with more snus cans used per week. We observed an association of snus use with non-ischemic heart failure, HR 1.34 (95 % CI 1.11-1.63), but not with ischemic heart failure, HR 1.01 (95 % CI 0.72-1.42). Smoking was more strongly associated with heart failure, particularly of ischemic origin, than snus use.ConclusionsSnus use was associated with a modestly increased risk for heart failure of non-ischemic origin in a dose-response manner. This finding has public health implications for the risk assessment of snus use, and potentially other modes of smokeless use of nicotine.
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  • Blomberg, Karin, 1970-, et al. (författare)
  • Physical touch in nursing and nursing education – an integrative review
  • 2020
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Physical touch is a basic need of all people, regardless of age or life situation. It can provide security, well-being and belonging. But negative perceived physical touch can generate emotions such as fear, vulnerability and perceived as violations. As a consequent of the #metoo movement in the fall of 2017, it’s a risk that physical contact and especially physical touch are avoided by professions where it’s central. For example, in the context of education, studies show that sports teachers in many countries have become more cautious and avoid having physical contact with students due not to being misinterpreted as negative touch (Fletcher, 2013; Öhman, 2016; Piper, Garratt & Taylor, 2013). In healthcare, caregivers who use physical touch in their work with disabled and elderly people have also become insecure and worried that they may be misunderstood (Bergstrand, 2018). A review shows that healthcare professionals see physical touch as part of the work but want to be the initiator of the contact, not that it should be initiated by the patients (Kelly et al. 2018).The use of physical touch in healthcare is also affected by the need to avoid contamination and widespread of infections agents, a question with extra relevance in the light of the Covid-19 pandemic.There is currently a lack of knowledge about how physical touch is experienced and used. As a first step is to increase the knowledge and understanding of how physical touch is experienced and used in healthcare by mapping studies explored physical touch both in daily care but also from the perspective of nursing students. With increased knowledge, a basis for developing interventions/teaching modules can be generated.
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