| 1. |
- Andersson, Sofia, 1972-
(författare)
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Vård i livets slutskede på särskilt boende för äldre personer : närstående och vårdpersonals skattade och berättade erfarenheter
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund I Europa, blir det allt vanligare att äldre personer dör på särskilt boende i stället för på sjukhus. Särskilda boenden spelar därför en viktig roll när det gäller vård i livets slutskede. Målet med palliativ vård för personer med livshotande sjukdom och deras närstående är att öka livskvaliteten och lindra lidande. Strukturerade vårdplaner såsom Liverpool Care Pathway for care of the dying (LCP) kan vara ett sätt att öka vårdkvaliteten. Det saknas dock forskning om vård i livets slutskede på särskilda boenden när en strukturerad vårdplan har använts.Syfte Det övergripande syftet med avhandlingen var att beskriva vård i livets slutskede på särskilt boende för äldre personer utifrån närstående och vårdpersonals skattade och berättade erfarenheter.Metod Avhandlingen baseras på två kvantitativa (I, II) och två kvalitativa (III, IV) studier. Studie I baseras på frågeformuläret Views of Informal Carers – Evaluation of Services (VOICES) som har besvarats av närstående (n = 189) efter att en anhörig har dött. Data har därefter analyserats med beskrivande och jämförande statistik. Studie II baseras på data om alla förväntade dödsfall (n = 22 855) som registrerats i Svenska palliativregistret (SPR). Dödsfallsenkäten har besvarats av vårdpersonal och svaren har sedan analyserats med beskrivande statistik och univariat och multipel logistisk regressionsanalys. Studie III baseras på fokusgruppsintervjuer och enskilda intervjuer med vårdpersonal. Studie IV baseras på enskilda intervjuer med närstående. Data från studie III och IV har analyserats med hjälp av kvalitativ innehållsanalys.Resultat Resultatet i studie I visar att majoriteten av de närstående skattade att den äldre personen fick tillräcklig hjälp såväl med personlig vård (78,5 %) som med sjukvård (93,0 %) de sista tre dagarna i livet. De närstående (86,2 %) rapporterade att de var informerade om att det var sannolikt att den äldre personen skulle avlida och majoriteten (94,1 %) av de äldre hade avlidit på önskad plats. Resultatet visade dock på hög förekomst av smärta (46,5 %) och andnöd (55,9 %). Det var ingen skillnad mellan åldersgrupperna när det gällde smärta men de äldre < 85 år hade signifikant högre förekomst av andnöd (70,6 %) jämfört med de äldre äldre, ≥ 85 år, (47,5 %). De äldre, < 85 år, hade signifikant oftare symtomlindring för andnöd (53,1 %) jämfört med äldre äldre, ≥ 85 år, (31,8 %).Resultatet i studie II visar hög förekomst av smärta (68,8 %) och ångest (44,0 %). Faktorer associerade med symtomlindring av smärta, illamående, ångest och andnöd var dels att validerat smärtskattningsinstrument hade använts, dels att munhälsan var bedömd. Starkast samband var det mellan symtomlindring av tre symtom (smärta, andnöd och ångest) och att injektioner var förskrivna vid behov.Resultatet i studie III visar att vårdpersonalen upplevde sig tryggare efter implementeringen av LCP genom att de hade fått ett gemensamt förhållningssätt, kände stöd att skräddarsy vården utifrån den döende personens individuella behov, kände stöd att involvera närstående i beslut och i vården samt hade blivit mer medvetna om vårdmiljön.Resultatet i studie IV visar att närstående upplevde sig tryggare i en välbekant och varm atmosfär, att vara kontra inte vara involverad i vård i livets slutskede och att bli tröstade genom att bevittna vårdpersonalens strävan att lindra lidande.Konklusion Resultatet från studierna i den här avhandlingen pekar på hög vårdkvalitet i livets slutskede på särskilt boende genom god omvårdnad, men resultatet pekar också mot förekomst av inadekvat symtomlindring och hög förekomst av smärta, andnöd och ångest de sista dagarna i livet. Det framkom ett tydligt samband mellan ordinerade injektioner vid behov och symtomlindring av smärta, illamående och ångest. Resultatet indikerar även vikten av att använda smärtskattningsinstrument och göra munhälsobedömningar för symtomlindring vid vård i livets slutskede. Således kan ett sätt att öka vårdkvaliteten för döende personer vara att det finns ordinerade injektionsläkemedel vid behov mot vanliga symtom, att använda validerade smärtskattningsinstrument och att göra munhälsobedömningar. Det framkom också att användandet av en standardiserad vårdplan såsom LCP kan vara ett sätt att förbättra vården för de äldre personerna i livets slutskede. Såväl vårdpersonalen som de närstående upplevde stöd av den struktur för bedömningar och vårdaktiviteter som LCP ger. Vårdpersonalen upplevde också stöd i att involvera närstående i vården och i vårdrelaterade beslut.
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| 2. |
- Forsberg, Hanna
(författare)
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Active school transportation : Understanding the parental decision-making process
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Few children and adolescents reach the recommended levels of daily physical activity. This trend is evident in the countries examined in this thesis: Sweden and Spain. In efforts to reverse the current trend, active school transportation (AST) and independent mobility (IM) have been suggested as opportunities to increase levels of physical activity. Unfortunately, AST and IM have decreased during recent decades; consequently, initiatives promoting such behaviors have been called for. Parents are the main decision-makers on a child’s use of AST and IM, and thus, understanding their decisions is important in efforts to promote such behaviors. The overarching aim of this thesis was to increase the understanding of the parental decision-making process concerning their children’s active transport to school.This thesis applied an exploratory sequential design, with both interview (qualitative) and cross-sectional (quantitative) designs used to attain the overall aim. Data was collected through interviews with 20 parents (I) and two surveys: the PILCAST (Parents intentions to let their child use AST) questionnaire (II-III) and the PACO (Pedalea y Anda COlegio [Cycle and walk to school]) family questionnaire (IV). In total, 1024 responses from parents were collected with the PILCAST questionnaire (II). In paper III, a sub-sample of 610 was extracted from the 1024, based on parents responding “yes” or “no” to participation in an AST intervention. In paper IV, a total of 573 parents were included in the study. Data was analyzed with content analysis (I), descriptive statistics (II-IV), confirmatory factor analysis (II), linear regression analysis (II-IV), and logistic regression analysis (IV).The main findings showed that parents’ decisions regarding AST and IM were influenced by social norms, which was reflected in appearing to be a good parent and by what significant others do in their vicinity and neighborhood (I, II, IV). The importance of social norms applied to both Swedish and Spanish parents when it comes to AST. Some, gender differences were found, showing that they might play a more important role for parents of girls when it comes to AST and IM. Further, the findings showed that attitudes influence decisions, which was reflected in how parents master everyday life by sometimes choosing what is most convenient, even though they are aware of the benefits of AST (I-II). Parents identified factors both impeding and facilitating the use of AST, while safety and trusting the child were found to be important (I-II). The findings also indicate that the intervention within the Sustainable Innovation for Children Transporting Actively (SICTA) project might positively influence parents’ beliefs about AST (III). In addition, there seems to be a habitual factor involved in the parental decision-making process (II). Differences were found between parents’ decisions to let their child cycle to school compared to letting their child walk to school (II). Finally, the parental decision-making process seems to be influenced by the child’s age and the distance between home and school (I, II, IV). The PILCAST questionnaire showed acceptable validity and reliability.In conclusion, the findings show that when aiming to promote AST and IM, social acceptance is important. This concerns both other people’s judgments of parenting and what other important referent groups are doing, encompassing the visibility of AST and IM in the parents’ vicinity and neighborhoods. Attention given to gender differences could be beneficial as well. Further, it is also important to understand the prerequisites of modern family life. It is likely that strengthening positive attitudes in parents could promote AST, but the practice also needs to be in line with their everyday life tasks. Efforts should also be made to strengthen the factors that facilitate AST. From a parental perspective, this includes safety and being supported in gaining trust in their children and their children’s capabilities with respect to the age of the children. Habit seems to play an important role, and to encourage parents to form new habits, it might be beneficial to launch AST interventions along with contextual changes, as these might open a window for change, which could occur in the transition between preschool and primary school. It could be beneficial to consider cycling and walking as different behaviors because walking seems to be more dependent on the distance to school than cycling. Further, the PILCAST questionnaire was valid and reliable, providing an increased understanding of these behaviors from a parental perspective. Finally, to make children’s use of active transport to school the more favorable choice, it seems worthwhile not only to give children the opportunity to participate but also to involve parents and address their beliefs when designing interventions.
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| 3. |
- Lindqvist, Anna-Karin B.
(författare)
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The genetics of systemic lupus erythematosus : Mapping of susceptibility loci for human SLE
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting organs such as skin, jointsand kidneys. Characteristic for the disease is increased production of autoantibodies, in particular against dsDNA. Previous studies of SLE in mouse models and in humans indicate polygenic inheritance and genetic heterogeneity.For the purpose of genome scanning, we designed a set of chromosome specific panels of microsatellite markers for efficient genotyping. The 391 microsatellite markers, available from the Weber set 6.0 (CHLC), were organized according to chromosome and size of amplification products and were assigned fluorescent color for detection by ABI automated sequencers. The efficiency of the markers was evaluated regarding amplification of genomic DNA extracted from peripheral blood, formalin-fixed biopsy and pieces of hair. We conducted a genome wide search for SLE susceptibility loci in multi-case families from Iceland and Sweden using two-point linkage analysis. Prior to the analysis, the family material was stratified based on the presence of the deficiency of complement component C4A, a potential risk factor for susceptibility to SLE. Eighteen chromosomal regions with LOD scores > 1.0 were identified, some of which were shared between the two population groups. The most pronounced linkage was found on chromosome 2q37, with a LOD score of 4.24 in the combined family material. The locus was denoted hSLE1.To further evaluate the 2q37 region we analyzed additional microsatellite markers in families from Iceland; Sweden and Norway. The highest two-point lod score was obtained for the marker D2S125 and the multipoint analysis indicated the position of the locus between D2S125 and D2S2986 with a peak lod score of 5.29 at D2S125. No evidence of linkage was found in a set of families from Mexico. We also investigated the gene encoding interleukin 10 (IL-10) on chromosome 1, previously suggested to be a candidate gene for susceptibility to SLE. A microsatellite marker in the IL-10 promotor region was studied in 330 Mexican SLE patients and 368 ethnically matched controls for association to the disease. In addition, linkage to the same marker was evaluated in multi-case families from Iceland, Sweden and Mexico. No association or linkage was found.
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| 4. |
- Lindqvist, Anna-Karin
(författare)
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Promoting adolescents' physical activity @ school
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore the development of a health-promoting intervention that uses empowerment and information and communication technology, to examine the impact of the intervention and to describe adolescents' and parents' experiences of the intervention. This thesis includes four studies, three of which used a qualitative approach (I, III and IV) and one of which used a mixed method approach (II). Three of the studies involved adolescents (I-III), and one study involved parents (IV).Data were generated using focus groups and analyzed using latent content analysis (study I). Physical activity, self-efficacy, social support, and attitude data were collected before and after the intervention and analyzed using descriptive and analytical statistics (study II). Adolescents were interviewed and the data were analyzed using latent content analysis (study III). The parents were interviewed and the data were analyzed using latent content analysis (study IV). The findings formed three themes: A, Acknowledging empowerment andphysical activity; B, Bonded forces overcame barriers; and C, Competence andmotivation enable change. The first theme concerns behavior regarding health promotion, specifically physical activity. That theme includes the act of creating the intervention using an empowerment approach and the physical activity behavior after the intervention. The second theme concerns barriers to being physically active and social support from parents and peers regarding physical activity promotion. The third theme concerns motivation and associated personal factors, such as knowledge and self-efficacy.The main conclusion of this thesis is that it is possible to develop anempowerment-inspired health-promoting intervention with a positive impact.Furthermore, interventions that aim to promote physical activity among adolescents should preferably include information and communication technology from the adolescents’ reality, involve actions that stimulate the participation of both parents and peers and be school-based.
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