| 1. |
- Ahlström, Gerd, et al.
(författare)
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Similarities and differences between China and Sweden regarding the core features of palliative care for people aged 60 or older : a systematic scoping review
- 2022
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite the increasing longevity of the world's population, with an unprecedented rise in the number of people who need palliative care (PC), there has been sparse research regarding palliative care for older people, especially when it comes to comparison of PC between healthcare systems and cultures. The aim of this systematic scoping review was to identify the characteristics of the body of literature and to examine the knowledge gaps concerning PC research for older people (> 60 years) in two healthcare systems and cultures, mainland China and Sweden.METHODS: The guidelines PRISMA (Preferred Reporting Items for Systematic Reviews), and PICOS (Patient/population, Intervention, Comparison/control, and Outcome) were used. Empirical studies on patients 60 years or older, next of kin or staff participating in a palliative care intervention or setting were included. They were conducted in mainland China or in Sweden during 2007-2019, were published in English and were extracted from seven databases: Embase, PubMed, Scopus, Cinahl, PsycInfo, Academic Search Complete and Cochrane Library. Two independent researchers conducted the selection of studies, data extraction and methodological evaluation. Any disagreements were resolved in consultation with a third researcher. The analysis was manifest directed content analysis based on PICOS domains.RESULTS: Of the 15 studies, four were from mainland China and 11 from Sweden. Both countries included older patients with cancer but also other end-stage diseases such as heart failure and dementia. The studies differed in design, method and the content of the interventions. The study in China based on traditional Chinese medicine concerns traditional Chinese folk music. The six qualitative studies from Sweden were evaluations of five interventions.CONCLUSIONS: Despite the high age of the participating patients, there was no focus on an ageing perspective concerning palliative care. To adapt to the changes taking place in most societies, future research should have increased focus on older persons' need for palliative care and should take account of issues concerning research ethics, ethnicity and culture.REGISTERED IN PROSPERO: CRD42020078685 , available from.
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| 2. |
- Borné, Yan, et al.
(författare)
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Cadmium, Carotid Atherosclerosis, and Incidence of Ischemic Stroke.
- 2017
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 6:12
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Tidskriftsartikel (refereegranskat)abstract
- Exposure to cadmium has been associated with carotid plaques, inflammation in carotid plaques, and increased risk of ischemic stroke. This study examined the separate and interacting effects of blood cadmium levels and carotid plaques on the risk of incident ischemic stroke.Cadmium levels were measured in 4156 subjects (39.2% men; mean±SD age 57.3±5.9years) without history of stroke, from the Malmö Diet and Cancer cohort. The right carotid artery was examined using B-mode ultrasound examination at baseline. Incidence of ischemic stroke was monitored over a mean follow-up of 16.7years. Carotid plaque was present in 34.5% of participants. Cadmium was significantly higher in subjects with plaque (mean±SD: 0.53±0.58μg/L versus 0.42±0.49μg/L; P<0.001). A total of 221 subjects had ischemic stroke during the follow-up. Incidence of ischemic stroke was associated both with carotid plaque (hazard ratio 1.44, 95% confidence interval, 1.09-1.90, P=0.009) and cadmium (hazard ratio for quartile [Q] 4 versus Q1-3: 1.95, confidence interval, 1.33-2.85, P=0.001), after adjustment for risk factors. There was a significant interaction between cadmium and plaque with respect to risk of ischemic stroke (P=0.011). Adjusted for risk factors, subjects with plaque and cadmium in Q4 had a hazard ratio of 2.88 (confidence interval, 1.79-4.63) for ischemic stroke, compared with those without plaque and cadmium in Q1 to Q3.Cadmium was associated with incidence of ischemic stroke, both independently and in synergistic interaction with carotid plaques. This supports the hypothesis that cadmium promotes vulnerability of carotid plaques, thereby increasing the risk of rupture and ischemic stroke.
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| 3. |
- Fagerberg, Björn, 1943, et al.
(författare)
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Cadmium exposure and atherosclerotic carotid plaques -Results from the Malmo diet and Cancer study
- 2015
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Ingår i: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 136, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiological studies indicate that cadmium exposure through diet and smoking is associated with increased risk of cardiovascular disease. There are few data on the relationship between cadmium and plaques, the hallmark of underlying atherosclerotic disease. Objectives: To examine the association between exposure to cadmium and the prevalence and size of atherosclerotic plaques in the carotid artery. Methods: A population sample of 4639 Swedish middle-aged women and men was examined in 1991-1994. Carotid plaque was determined by B-mode ultrasound. Cadmium in blood was analyzed by inductively coupled plasma mass spectrometry. Results: Comparing quartile 4 with quartile 1 of blood cadmium, the odds ratio (OR) for prevalence of any plaque was 1.9 (95% confidence interval 1.6-2.2) after adjustment for sex and, age; 1.4 (1.1-1.8) after additional adjustment for smoking status; 1.4 (1.1-1.7) after the addition of education level and life style factors; 1.3 (1.03-1.8) after additional adjustment for risk factors and predictors of cardiovascular disease. No effect modification by sex was found in the cadmium-related prevalence of plaques. Similarly, ORs for the prevalence of small and large plaques were after full adjustment 1.4 (1.0-2.1) and 1.4 (0.9-2.0), respectively. The subgroup of never smokers showed no association between cadmium and atherosclerotic plaques. Conclusions: These results extend previous studies on cadmium exposure and clinical cardiovascular events by adding data on the association between cadmium and underlying atherosclerosis in humans. The role of smoking remains unclear. It may both cause residual confounding and be a source of proatherogenic cadmium exposure. (C) 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
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| 4. |
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| 5. |
- Johansson, Gerd, et al.
(författare)
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Hemtjänstpersonalens arbetsmiljö och hälsa i fyra skånska kommuner
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I denna rapport presentas resultaten från en arbetsmiljöenkät som genomförts ihemtjänsten i fyra skånska kommuner (2 landsortskommuner, 1 medelstor stad, 1 storstad). Enkäten syftade till att brett kartlägga hemtjänstpersonalens arbetsmiljö, hälsa och välmående och är en del av det fyraåriga forskningsprojektet ”Att skapa en bättre arbetsmiljö i hemtjänsten - participativt förändringsarbete i praktiken”. Projektet har finansierats av Forskningsrådet för hälsa, arbetsliv och välfärd (FORTE).Totalt svarade 114 personer varav 99 var kvinnor, 14 män och en person som inte angivit kön på enkäten. Andelen av hemtjänstpersonalen som svarade på enkäten var 73%. Personerna svarade på frågor om övergripande arbetssituation inklusive ergonomiska förhållanden och psykosocial arbetsmiljö och om hälsa.De allra flesta (mer än 90%) uppgav att de trivs med sitt arbete och sin arbetsplats. De angav också att stämningen var god, att de kände en gemenskap på arbetsplatsen och upplevde ett stort stöd från sina arbetskamrater, vilket medför att de har möjlighet att få råd och att lära av andra. En majoritet uppgav att de också hade ett gott stöd från närmaste chef. Däremot upplevde de att de ganska sällan fick uppskattning eller belöning för sitt arbete. Det kan också noteras att två tredjedelar av deltagarna kände att de ville arbeta kvar på nuvarande arbetsplats om fem år.Hemtjänstpersonalen lyfter i sina enkätsvar främst fram tre problem i arbetet;bristen på vikarier, att tiden att ägna sig åt varje omsorgstagare är för kort samt att antalet omsorgstagare som varje person ska besöka under en vecka är för stort.Bristen på tid hos omsorgstagarna medför bl.a. att de inte hinner sköta andrakringuppgifter, att tiden att förflytta sig mellan olika omsorgstagare äts upp ochnågon tid för att kunna varva ner finns inte. Möjligen kan denna brist på mikropauser i vardagen bidra till både ökad stress och fysisk belastning.Av samtliga undersökningsdeltagare angav mer än hälften i sina enkätsvar attnuvarande arbete hade gjort deras hälsa något eller mycket sämre. Förekomsten av besvär från muskler och leder var anmärkningsvärt hög jämfört med andra yrkesgrupper och även jämfört med tidigare studier av personal inom hemtjänst. Det var särskilt vanligt med besvär från rygg och armbågar/händer.För bedömning av indikation för utmattning har tre olika instrument använts.Dessa visar att en fjärdedel till en tredjedel av de hemstjänstanställda rapporterarstress och/eller utmattningsreaktioner på en nivå som indikerar risk för utmattningssyndrom eller annan relaterad psykisk ohälsa om deras situation blir långvarig.Sammanfattningsvis anser vi att de positiva sociala aspekterna av arbetsmiljön iform av trivsel på arbetsplatsen, god gemenskap med stöd från både ledning ochkollegor betyder att bilden av hemtjänsten som en oattraktiv arbetsplats inte är entydig. Det finns resurser i organisationen och bland personalen som det går attbygga vidare på.Vad gäller individens fysiska och psykologiska arbetsmiljö ser vi dock ett antalutmaningar i form av hög fysisk belastning och risk för stress och utmattning. Allt detta måste åtgärdas för att öka attraktionen för yrket och minska riskerna för arbetsskador och sjukskrivning. Även om organisatoriska förändringar och användning av tekniska hjälpmedel i vissa fall kan minska problemen så måste det anställas fler personer för att personalen ska kunna ge omsorgstagarna den vård- och omsorg de behöver. För att fler personer ska välja att arbeta inom hemtjänst krävs också förbättrade anställningsförhållanden som tillsvidareanställning, förbättrade löneförmåner, möjlighet till fortbildning, en arbetsmiljö som inte påverkar hälsan negativt och möjlighet att påverka hur arbetet utförs.
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| 6. |
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| 7. |
- Persson, Johanna, et al.
(författare)
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A framework for participatory work environment interventions in home care - success factors and some challenges
- 2022
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Ingår i: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations. Methods The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design. Results Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful. Conclusions The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.
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| 8. |
- Rydenfält, Christofer, et al.
(författare)
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Exploring Local Initiatives to Improve the Work Environment : A Qualitative Survey in Swedish Home Care Practice
- 2021
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Ingår i: Home Health Care Management & Practice. - : SAGE Publications. - 1084-8223 .- 1552-6739. ; 33:3, s. 154-161
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Tidskriftsartikel (refereegranskat)abstract
- Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.
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| 9. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Carotid intima-media thickness is associated with incidence of hospitalized atrial fibrillation.
- 2014
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 233:2, s. 673-678
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Tidskriftsartikel (refereegranskat)abstract
- Carotid intima-media thickness (IMT) is a measure of arterial thickening and a risk predictor for myocardial infarction and stroke. It is unclear whether IMT also predicts atrial fibrillation (AF). We explored the association between IMT and incidence of first AF hospitalization in a population-based cohort.
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