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  • Sandberg, Jonas, et al. (författare)
  • The hard thing is the changes : The importence of continuity for older men caring for thir wifes
  • 2007
  • Ingår i: Quality in Ageing: Policy, Practice and research. - 1471-7794. ; 8:2, s. 5-15
  • Tidskriftsartikel (refereegranskat)abstract
    • Few studies have been conducted into the contextual and relational aspects of male caregiving that include analysis by gender and family relationships. The aim was to gain understanding of the experience of older men as caregivers for an ill spouse. A narrative approach was adopted for this study. Interviews were conducted with three older men between 65 and 78 years, who had been caring for their wives for between one and 12 years. Two main categories emerged: taking on a new and unfamiliar role, and learning to live with the new role. The results also show how the men seek to maintain continuity in their relationships with the wives they are caring for. The findings can be understood in the light of a major life transition of how older men providing care for a spouse create new roles and how they cope with the changes in the marital relationship. A sense of continuity in the process of caring is important for men to help them find the strength to continue as caregivers.
  • Adolfsson, J, et al. (författare)
  • Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005 : Data from the national prostate cancer register in Sweden
  • 2007
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - Stockholm : Taylor & Francis. - 0036-5599. ; 41:6, s. 456-477
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. Material and methods. Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. Results. In total, 72 028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of >100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score ≤6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged ≥75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. Conclusions. All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer
  • Holmer, Helene, et al. (författare)
  • Non-fatal stroke, cardiac disease, and diabetes mellitus in hypopituitary patients on hormone replacement including growth hormone.
  • 2007
  • Ingår i: J Clin Endocrinol Metab. - 0021-972X. ; 92:9, s. 3560-3567
  • Tidskriftsartikel (refereegranskat)abstract
    • Context: The impact of long-term GH replacement on cerebrovascular and cardiovascular diseases and diabetes mellitus in hypopituitary patients is unknown. Objective: The incidence of nonfatal stroke and cardiac events, and prevalence of type 2 diabetes mellitus (T2D) and cardioprotective medication were compared between cohorts of GH-deficient (GHD) patients and population controls. Design and Participants: The incidence of nonfatal stroke and cardiac events was estimated retrospectively from questionnaires in 750 GHD patients and 2314 matched population controls. A prevalence of T2D and cardioprotective medication was recorded at the distribution of questionnaires. Time since first pituitary deficiency to start of GH therapy was 4 and 2 yr, and time on GH therapy was 6 yr for GHD women and men, respectively. Results: Lifelong incidence of nonfatal stroke was tripled in GHD women and doubled in GHD men, but a decline was seen in both genders during periods after first pituitary hormone deficiency and GHD, during which most patients had GH therapy. The lifelong incidence of nonfatal cardiac events declined in GHD men during first pituitary hormone deficiency and GHD periods. GHD women had a higher prevalence of T2D and lipid-lowering medication, whereas GHD men had a higher prevalence of antihypertensive medication. Conclusions: The declined risks of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men during periods on GH replacement may be caused by prescription of cardioprotective drugs and 6-yr GH replacement. GHD women had an increased prevalence of T2D, partly attributed to higher body mass index and lower physical activity.
  • Berglund, Karin, et al. (författare)
  • Entrepreneurship and Conscientization in Processes of Regional Development
  • 2007
  • Ingår i: Entrepreneurship and Regional Development. - 0898-5626. ; 19:6, s. 499-525
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper is based upon a regional development project in a 'vulnerable' Swedish region consisting of three municipalities. At a first glance, this is a region in decline that is lacking in entrepreneurial initiatives. During a crucial time period the project 'Diversity in Entrepreneurship' ( DiE) was launched to help the region to become more entrepreneurial and inclusive. An underlying logic was built into the project, which is associated with the critical pedagogy of Paolo Freire. From a Freirean perspective regions lacking in entrepreneurship could be reconsidered emphasizing that the entrepreneurial initiatives are always there - latent - however restrained by certain discourses; in this case a dominant enterprise discourse. Above all the enterprise discourse suppresses the ability for particular groups in society to view themselves as entrepreneurs. The purpose of this paper is to introduce Freire's critical pedagogical perspective to entrepreneurship and regional development. An episode illustrating how the enterprise discourse suppresses an equality discourse, introduced by way of the DiE-project, makes the point of departure for discussing the process of 'conscientization', which refers to a type of learning that is focused on perceiving and exposing contradictions and to take action against the oppressive elements of reality ( Freire 1970). Some key Freirean ideas or concepts are explained, first as they were expressed by Freire and then applied to entrepreneurship and regional development. It is then discussed how these concepts found their expressions in the project. The critical pedagogic perspective not only emphasizes an entrepreneurial potential in every individual, but it also gives an idea of what kind of processes could release entrepreneurial initiatives among those who do not view themselves as entrepreneurs.
  • Ehnfors, Margareta, et al. (författare)
  • Kvalitetsindikatorer för prevention av undernäring
  • 2007
  • Ingår i: Kvalitetsindikatorer inom omvårdnad. - Stockholm : Gothia. - 9789172055193 - 978-91-7205-519-3 ; s. 155-165
  • Bokkapitel (populärvet., debatt m.m.)abstract
    • En självklar del i sjuksköterskans ansvar är att ständigt utveckla omvårdnadsarbetet i syfte att förbättra vården för patienter och vårdtagare. Med hjälp av en indikator, eller ett kvalitetsmått, kan vårdens resultat och genomförande följas och mätas. I boken presenteras förslag på kvalitetsindikatorer inom olika omvårdnasområden. Syftet är att ge verktyg för registrering, utvärdering och förbättring av omvårdnadskvaliteten. Förhoppningen är att boken ska motivera sjuksköterskor att använda kvalitetsindikatorer så att omvårdnaden kan beskrivas och utvärderas. Denna femte upplaga är utökad med en kvalitetsindikator för fall och fallskadeprevention.
  • Johansson, Björn, et al. (författare)
  • Visual and optical performance of the akreos adapt advanced optics and tecnis Z9000 intraocular lenses - Swedish multicenter study
  • 2007
  • Ingår i: JOURNAL OF CATARACT AND REFRACTIVE SURGERY. - 0886-3350. ; 33:9, s. 1565-1572
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeTo compare the subjective visual and objective optical performance of 2 aspherical intraocular lenses (IOLs), the Akreos Adapt Advanced Optics (AO) (Bausch & Lomb, Inc.) and the Tecnis Z9000 (Advanced Medical Optics, Inc.).SettingFour university hospitals in Sweden.MethodsThis study comprised 80 patients, 20 each from 4 university hospital centers in Sweden. All patients had bilateral clear corneal phacoemulsification with implantation of an Akreos Adapt AO IOL in 1 eye and Tecnis Z9000 IOL in the other eye according to a randomization protocol. Preoperatively, 90% contrast Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity was measured and the mesopic pupil sizes were determined. Ten to 12 weeks postoperatively, 12.5% and 90% contrast ETDRS visual acuities and photopic and mesopic Functional Acuity Contrast Test chart contrast sensitivities were determined. Wavefront analysis was performed with the Zywave II aberrometer (Bausch & Lomb, Inc.), and a questionnaire on the subjective quality of vision was completed by each patient.ResultsThe Akreos AO IOL and Tecnis Z9000 IOL produced similar high- and low-contrast visual acuities as well as photopic and mesopic contrast sensitivities. The Tecnis Z9000 IOL resulted in lower spherical aberrations of the eye (mean 0.05 ± 0.13 μm versus 0.35 ± 0.13 μm root mean square, 6.0 mm pupil) (P<.001); however, the Akreos AO IOL provided a larger depth of field (mean 1.22 diopter [D] ± 0.48 [SD] versus 0.86 ± 0.50 D, 6.0 mm pupil) (P<.001). Patient satisfaction was generally high, although 68.8% of the patients reported some type of visual disturbance postoperatively. Twenty-eight percent of patients reported better subjective visual quality in the Akreos AO eye and 14%, in the Tecnis Z9000 eye (P<.0001). Accordingly, 33% perceived more visual disturbances in the Tecnis Z9000 eye and 11%, in the Akreos AO eye (P<.0001).ConclusionsMaximum reduction of spherical aberration did not maximize subjective visual quality. The higher perceived quality of vision with the Akreos AO IOL could be because of differences in depth of field, IOL material, or IOL design.
  • Mamhidir, Anna-Greta, et al. (författare)
  • Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care
  • 2007
  • Ingår i: JOURNAL OF CLINICAL NURSING. - 0962-1067. ; 16:5, s. 987-996
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To follow weight changes in patients with moderate and severe dementia and analyse how these changes related to biological and psychological parameters after staff education and support in integrity promoting care. A further aim was to describe meal environment and routines relative to the intervention. BACKGROUND: Weight loss in patients with dementia and in particular Alzheimer's disease is common. The aetiology appears multifactorial with the meal environment and a decreased independence while eating among the factors. METHOD: Over a three-month intervention period, an integrity-promoting care training programme was conducted with the staff of a long-term ward. Alzheimer's disease patients, 18 from an intervention ward and 15 from a control ward were included and possible effects were evaluated. Weighing was conducted at the start and after completion of the intervention. Weight changes were analysed in relation to psychological and biochemical parameters. In addition, the staff wrote diaries about, for example changes made in the environment and in their work. RESULTS: The most prominent difference observed was weight increases in 13 of 18 patients compared with two of 15 patients in the control ward. No weight changes were related to the type of dementia. The individual weight changes correlated significantly to changes in the intellectual functions. Relationships between weight change, increased motor function and increased appetite were non-significant. There was no significant relationship between weight changes and changes in biochemical parameters. According to the staff, increased contact with the patients and a more pleasant atmosphere resulted when the meal environment and routines were changed. RELEVANCE TO CLINICAL PRACTICE: Weight gain in patients with moderate and severe dementia was achieved by adjusting the meal environment to the individual's needs. Staff education was profitable, as increased competence seemed to promote individually adapted feeding situations. Ensuring good meal situations need to be given high priority.
  • Olsson, I., et al. (författare)
  • Medical problems in adolescents with myelomeningocele (MMC): an inventory of the Swedish MMC population born during 1986-1989
  • 2007
  • Ingår i: Acta Paediatr. - 0803-5253. ; 96:3, s. 446-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To describe the prevalence of myelomeningocele (MMC) and the medical needs of adolescents, 15–18 years, with MMC in Sweden, at a time when they are on the threshold of adulthood, leaving paediatrics.Methods: In a retrospective study, we identified all adolescents with MMC, born during 1986–1989 and living in Sweden on July 1, 2004. An inventory was agreed upon with questions concerning their medical problems and need for medical care.Results: There were 175 persons 15–18 years of age, born with MMC or lipoMMC (prevalence 3.8 per 10 000). Hydrocephalus was seen in 86%, 31% had been operated because of tethered cord syndrome, and 6% for Chiari malformation symptoms. The majority had motor impairments. Clean intermittent catheterisation for bladder emptying was used by 85%, and 59% used enemas on a regular basis because of the neurogenic bowel dysfunction. Renal dysfunction was seen in 1.7% of the adolescents.Conclusion: Lifelong follow-up by many specialists, among others neurologists and neurosurgeons, urotherapists and urologists, orthopaedic surgeons and orthotists, is necessary for individuals with MMC. The complex medical situation, often in combination with cognitive difficulties, makes it necessary to coordinate medical services for this increasing group of adults with multiple impairments.
  • Pahlman, L., et al. (författare)
  • The Swedish rectal cancer registry.
  • 2007
  • Ingår i: The British journal of surgery. - 1365-2168. ; 94:10, s. 1285-92
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: An audit of all patients with rectal cancer in Sweden was launched in 1995. This is the first report from the Swedish Rectal Cancer Registry (SRCR). Methods: Between 1995 and 2003, 13 434 patients treated for adenocarcinoma of the rectum were registered with the SRCR, there were approximately 1500 new patients annually. Results: Approximately half had an anterior resection, a quarter an abdominoperineal resection and 15 per cent a Hartmann's procedure. The median 30-day postoperative mortality rate was 2.4 per cent and the overall postoperative morbidity rate was 35.0 per cent. The 5-year cancer-specific survival rate was 62.3 percent. The 5-year relative survival rate was 70.1 percent after anterior resection, 59.8 per cent after abdominoperineal resection and 39.8 per cent after a Hartmann's procedure. The crude 5-year local recurrence rate was 9.5 per cent overall, 6.1 per cent after preoperative radiotherapy and 11.4 per cent after surgery alone. For 3868 patients who had a locally curative procedure the local recurrence rate was 7-4 per cent overall, 5.9 per cent for those who had radiotherapy and 10.2 per cent for those who did not. The local recurrence rate was 2.9 per cent (28 of 968) for stage I disease, 7.9 per cent (112 of 1418) for stage II, 13.9 per cent (188 of 1357) for stage III and 8.5 per cent (45 of 532) for stage IV. Conclusion: These good population-based results are due, in part, to the nationwide prospective quality assurance registration. Copyright © 2007 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd.
  • Sedimbi, S. K., et al. (författare)
  • SUMO4 M55V polymorphism affects susceptibility to type I diabetes in HLA DR3- and DR4-positive Swedish patients
  • 2007
  • Ingår i: Genes Immun. - 1466-4879. ; 8:6, s. 518
  • Tidskriftsartikel (refereegranskat)abstract
    • SUMO4 M55V, located in IDDM5, has been a focus for debate because of its association to type I diabetes (TIDM) in Asians but not in Caucasians. The current study aims to test the significance of M55V association to TIDM in a large cohort of Swedish Caucasians, and to test whether M55V is associated in those carrying human leukocyte antigen (HLA) class II molecules. A total of 673 TIDM patients and 535 age- and sex-matched healthy controls were included in the study. PCR–RFLP was performed to identify the genotype and allele variations. Our data suggest that SUMO4 M55V is not associated with susceptibility to TIDM by itself. When we stratified our patients and controls based on heterozygosity for HLA-DR3/DR4 and SUMO4 genotypes, we found that presence of SUMO4 GG increased further the relative risk conferred by HLA-DR3/DR4 to TIDM, whereas SUMO4 AA decreased the risk. From the current study, we conclude that SUMO4 M55V is associated with TIDM in association with high-risk HLA-DR3 and DR4, but not by itself.
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