| 1. |
- Christensson, Eva, et al.
(författare)
-
Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?
- 2018
-
Ingår i: Anesthesia and Analgesia. - : Lippincott Williams & Wilkins. - 0003-2999 .- 1526-7598. ; 127:3, s. 736-743
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.METHODS: In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m2, Age >50 years, Neck circumference >40 cm, and male Gender.RESULTS: The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55–0.70) and 69% (95% CI, 0.64–0.75), respectively. A STOP-Bang score of <2 had a probability of 95% (95% CI, 0.92–0.98) to exclude an AHI >15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87–0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43–0.58) and 0.96 (95% CI, 0.94–0.97), respectively.CONCLUSIONS: STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2–5 when there is a need for screening for sleep apnea (ie, before surgery).
|
|
| 2. |
- Ayala, Ana, et al.
(författare)
-
Newborn infants who received skin-to-skin contact with fathers after Caesarean sections showed stable physiological patterns.
- 2021
-
Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 110:5, s. 1461-1467
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: Separating infants and their parents after a Caesarean section is still the routine care worldwide. This study investigated three caregiving models on the wakefulness and physiological parameters of full-term infants after an elective Caesarean section.METHODS: Newborn infants born in a Chilean public hospital in 2009-12 were randomised to three groups: cot, fathers' arms or skin-to-skin contact with their father. They were assessed at 15-minute intervals, from 45 to 120 minutes after the Caesarean section. Their physiological parameters were measured, and their wakefulness was assessed using the Neonatal Behavioural Assessment Scale.RESULTS: We studied 95 infant (53% girls) born at a mean gestational age of 38.9 ± 0.9 weeks. Heart rates were significantly higher in the skin-to-skin than cot or fathers' arms groups and showed greater stability over time. Wakefulness was initially higher in the skin-to-skin group, but there were no significant differences by the end of the observation. There were no differences between the groups in peripheral oxygen saturation. Skin-to-skin contact had no negative impact on the infants.CONCLUSION: The skin-to-skin group showed some advantages over the cot and fathers' arms groups when it came to establishing stable physiological parameters and wakefulness. This approach should be supported during mother-infant separation.
|
|
| 3. |
|
|
| 4. |
- Christensson, Eva
(författare)
-
Perioperative management and molecular patterns in patients with obstructive sleep apnea
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obstructive sleep apnea (OSA) is a common disorder, both in the general and surgical population. While there is a steadily increased awareness of the disorder both in the society as a whole and within health care, unfortunately, most individuals with OSA still go undiagnosed. The repeated upper airway obstructions causing hypoxias, microarousals and increased sympathetic activation do not only contribute to the classical symptoms of excessive daytime tiredness and nightly snoring but also to increased cardiovascular and metabolic comorbidity. Patients with OSA are found to have an increased risk for perioperative pulmonary and cardiovascular complications, but also increased risk for intensive unit care and prolonged hospital stay after surgery. The aim of this thesis was to investigate the effect of partial neuromuscular blockade on the hypoxic ventilatory regulation in patients with OSA, to evaluate the STOP-Bang questionnaire in a sleep clinic population and to explore whole blood transcriptome and circulating inflammatory biomarkers in patients with OSA compared to matched controls and after three and twelve months of continuous positive airway pressure (CPAP) treatment. It has previously been shown that the hypoxic ventilatory response (HVR) is reduced by a third during partial neuromuscular blockade in healthy volunteers and that sleep apnea patients have an increased HVR compared to healthy controls. We found that the HVR is reduced by 36% in untreated sleep apnea patients at a train-of-four ratio of 0.7, whilst the hypercapnic ventilatory response was unaffected. The STOP-Bang questionnaire is designed as a simple screening tool to identify OSA in the surgical population. It consists of eight dichotomous (yes/no) questions, each yes giving one score. In the sleep clinic population, we found that the optimal cut-off for identifying OSA is a score of 5 and to identify at least moderate OSA is a score of 6. In addition, we also showed that a score of ³6 has a sensitivity of 91% to detect moderate-to-severe OSA and that a score <2 can exclude moderate-to-severe OSA by 95%. There was a good correlation between the apnea-hypopnea index and the oxygen desaturation index. Obstructive sleep apnea is considered a chronic low-grade inflammatory disease and together with increased sympathetic activation and oxidative stress may cause many of the associated comorbidities. To better understand the pathophysiology of the disease, there has been an intense search for biomarkers. We showed that untreated patients with OSA have a downregulation of immune-related genes, including light and heavy chain immunoglobulins and interferon-inducible genes compared to matched controls. However, after three months of CPAP treatment, the gene expression resembled that of the matched controls and finally, after twelve months of treatment, the gene expression returned to the initial untreated state. When exploring circulating inflammatory biomarkers we found that capase 8 and glia cell-line derived neurotrophic factor were downregulated and that monocyte chemoattractant protein 1, fibroblast growth factor 21, neutrophils and neutrophil-to-lymphocyte ratio was upregulated by 3 and/or 12 months CPAP treatment. No inflammatory biomarker was changed in untreated patients with OSA compared to matched controls. However, interleukin 1 alpha, c-reactive protein and erythrocyte sedimentation rate were increased in untreated sleep apnea patients compared to normal body mass index controls. In conclusion, untreated patients with OSA are as vulnerable to acute hypoxia during partial neuromuscular block as healthy volunteers with a reduced HVR by one-third. They are not protected by their typically increased HVR. The STOP-Bang questionnaire can be an effective screening tool in the sleep population, where nearly all patients with a score of ³6 have at least moderate OSA and a score <2 almost excludes at least moderate OSA. For intermediate scoring (2-5) nightly pulse oximetry can add extra information. There is a difference in the genetic and protein molecular pattern in patients with OSA before and after CPAP treatment in the sense that changes in the transcriptome were found in the untreated state compared to matched controls but not in circulating inflammatory biomarkers. Howevere there was a normalisation of the genetic expression after three months of treatment and a return to the untreated state after twelve months whereas the changes of inflammatory biomarkers mainly appeared after 12 months of CPAP treatment.
|
|
| 5. |
- Christensson, Eva, et al.
(författare)
-
Whole blood gene expression signature in patients with obstructive sleep apnea and effect of continuous positive airway pressure treatment
- 2021
-
Ingår i: Respiratory Physiology & Neurobiology. - : Elsevier. - 1569-9048 .- 1878-1519. ; 294
-
Tidskriftsartikel (refereegranskat)abstract
- The molecular mechanisms of obstructive sleep apnea (OSA), in particular the gene expression patterns in whole blood of patients with OSA, can shed more light on the underlying pathophysiology of OSA and suggest potential biomarkers. In the current study, we have enrolled thirty patients with untreated moderate-severe OSA together with 20 BMI, age, and sex-matched controls and 15 normal-weight controls. RNA-sequencing of whole blood and home sleep apnea testing were performed in the untreated state and after three and twelve months of continuous positive airway pressure (CPAP) treatment. Analysis of the whole blood transcriptome of the patients with OSA revealed a unique pattern of differential expression with a significant number of downregulated immune-related genes including many heavy and light chain immunoglobulins and interferon-inducible genes. This was confirmed by the gene ontology analysis demonstrating enrichment with the biological processes associated with various immune functions. Expression of these genes was recovered after three months of CPAP treatment. After 12 months of CPAP treatment, the overall gene expression profile returns to the initial, untreated level. In addition, we have confirmed the importance of choosing BMI-matched controls as a reference group as opposed to normal-weight healthy individuals based on the significantly different gene expression signatures between these two groups.
|
|
| 6. |
- Christensson, Kyllike, et al.
(författare)
-
The Challenge of Improving Perinatal Care in settings with Limited Resources : Observations of Midwifery Practices in Mozambique
- 2006
-
Ingår i: African Journal of Reproductive Health. - Benin City, Edo State, Nigeria : Women's Health and Action Research Centre. - 1118-4841. ; 10:1, s. 47-61
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to observe and analyze midwifery care routine related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre-and post intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery –attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer to partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.
|
|
| 7. |
- Ehinger, Mats, et al.
(författare)
-
A Subset of CD5- Diffuse Large B-Cell Lymphomas Expresses Nuclear Cyclin D1 With Aberrations at the CCND1 Locus.
- 2008
-
Ingår i: American Journal of Clinical Pathology. - 1943-7722 .- 0002-9173. ; 129:4, s. 630-638
-
Tidskriftsartikel (refereegranskat)abstract
- In 231 diffuse large B-cell lymphomas, the expression of cyclin D1 and CD5 was evaluated. All cases were CD5-. Ten (4.3%) were positive for cyclin D1 and were subjected to fluorescence in situ hybridization at the CCND1 locus. One case showed the t(11;14). In another case, the telomeric probe signal for cyclin D1 was lost in most tumor cells, and in a small proportion of the cells, there were fluorescence signals indicative of the t(11;14). Two other cases displayed additional cyclin D1 signals in the absence of the t(11;14). All cases but 1 were positive for bcl-6 or MUM1, disfavoring the possibility of misdiagnosed blastoid variants of CD5- mantle cell lymphomas. Thus, contrary to the current view, there seems to exist a certain number of cyclin D1+ and CD5- diffuse large B-cell lymphomas, some of which have structural aberrations at the CCND1 locus, including the t(11;14).
|
|
| 8. |
- Flygare Wallén, Eva, 1956-, et al.
(författare)
-
A school-based intervention associated with improvements in cardiometabolic risk profiles in young people with intellectual disabilities
- 2013
-
Ingår i: Journal of Intellectual Disabilities. - : SAGE Publications. - 1744-6295 .- 1744-6309. ; 17:1, s. 38-50
-
Tidskriftsartikel (refereegranskat)abstract
- This study evaluates a multifactorial school-based intervention with the aim of decreasing cardiometabolic risk factors by means of a healthy lifestyle, primarily with daily physical activity and healthy food during school hours, at an upper secondary school for students with intellectual disabilities. The outcome is measured in terms of cardiometabolic risk factors and cardiovascular fitness, both known to increase the risk of future cardiovascular disease, type 2 diabetes and cancer. Two years of intervention resulted in a positive trend in several measured cardiometabolic risk factors, with no increase in fat mass. Cardiovascular fitness levels were unchanged. We conclude that a healthy school environment can contribute to a deceleration of both fat mass gain and loss of cardiovascular fitness.
|
|
| 9. |
|
|
| 10. |
- Haettner Aurelius, Eva, et al.
(författare)
-
Självbiografier och dagböcker
- 2007
-
Ingår i: Signums svenska kulturhistoria. Gustavianska tiden. - 9789187896842 ; 5, s. 279-304
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- En översikt över dagboksskrivandets och det självbiografiska skrivandets roll,typer och funktio under svenskt 1700-tal. Särskilt intresse ägnas den kristna traditionens betydelse för introspektion och subjektsuppfattning.
|
|
| 11. |
- Jha, Paridhi, et al.
(författare)
-
Cashless childbirth, but at a cost : A grounded theory study on quality of intrapartum care in public health facilities in India
- 2016
-
Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 39, s. 78-86
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. Design: qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. Participants: thirteen women who had given vaginal birth to a healthy newborn infant. Setting: participants were interviewed in their homes in one district of Chhattisgarh, India. Data collection: the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? Findings: 'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. Conclusions: increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.
|
|
| 12. |
|
|
| 13. |
- Kilbo Edlund, Karl, et al.
(författare)
-
Occupational particle exposure and chronic kidney disease: a cohort study in Swedish construction workers.
- 2024
-
Ingår i: Journal of Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 81:5, s. 238-243
-
Tidskriftsartikel (refereegranskat)abstract
- Increasing epidemiological and experimental evidence suggests that particle exposure is an environmental risk factor for chronic kidney disease (CKD). However, only a few case-control studies have investigated this association in an occupational setting. Hence, our objective was to investigate associations between particle exposure and CKD in a large cohort of Swedish construction workers.We performed a retrospective cohort study in the Swedish Construction Workers' Cohort, recruited 1971-1993 (n=286089). A job-exposure matrix was used to identify workers exposed to nine different particulate exposures, which were combined into three main categories (inorganic dust and fumes, wood dust and fibres). Incident CKD and start of renal replacement therapy (RRT) were obtained from validated national registries until 2021 and analysed using adjusted Cox proportional hazards models.Exposure to inorganic dust and fumes was associated with an increased risk of CKD and RRT during working age (adjusted HR for CKD at age <65 years 1.15, 95%CI 1.05 to 1.26). The elevated risk did not persist after retirement age. Exposure to cement dust, concrete dust and diesel exhaust was associated with CKD. Elevated HRs were also found for quartz dust and welding fumes.Workers exposed to inorganic particles seem to be at elevated risk of CKD and RRT. Our results are in line with previous evidence of renal effects of ambient air pollution and warrant further efforts to reduce occupational and ambient particle exposure.
|
|
| 14. |
|
|
| 15. |
- Nyström Godfrey, Inger, et al.
(författare)
-
The RAAR Project — Heritage Management Aspects on Reburial After Ten Years of Work
- 2012
-
Ingår i: Conservation and Management of Archeological Sites. - 1350-5033. ; 14:1-4, s. 360-371
-
Tidskriftsartikel (refereegranskat)abstract
- The general purpose of the international reburial project, Reburial and Analyses of Archaeological Remains (RAAR), is to evaluate reburial as a method for the long-term storage and preservation of waterlogged archaeological remains. Since 2001 material samples have been buried, retrieved, analysed systematically, and the results reported. RAAR has mainly focused on the degradation of materials commonly encountered on archaeological sites, and on environmental monitoring techniques in order to determine what type of material can be reburied and for how long. The project has concluded that a heritage institution could provide short- or long-term curation for its archaeological archive by using reburial depots provided they are set up according to guidelines and restrictions stipulated by the RAAR project. However, there are management and legal aspects that need to be discussed and resolved before each reburial project. Actual reburials that have been carried out so far are often a solution to emergency situations and lack collection and management policies. The questions ‘what’, ‘why’, and ‘for how long’ have been forgotten and need to be addressed. The legal protection of a reburial site is also important. This paper discusses these aspects and their consequences and highlights possible differences in approaches between the countries involved in the RAAR project.
|
|
| 16. |
- Odberg Pettersson, Karen, 1951-, et al.
(författare)
-
Adaptation of health care seeking behavior during childbirth : Focus group discussions with women living in the suburban areas of Luanda, Angola
- 2004
-
Ingår i: Health Care for Women International. - New York, NY : Taylor & Francis Group. - 0739-9332 .- 1096-4665. ; 25:3, s. 255-280
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore how various factors influenced women's decisions regarding place of confinement in Luanda, Angola. Ten focus group discussions were conducted with pregnant and nonpregnant women residing in suburban areas of Luanda and the data were analyzed using the grounded theory technique. Four patterns of action of the main theme, "the molding of women'scare-seeking behavior during childbirth," were identified: (I) the "labor process 'on-course' avoiding pattern"; (II) the "labor process 'off-course' avoiding pattern"; (III) the "labor process 'on-course' approaching pattern"; and (IV) the "labor process 'off-course' approaching pattern." Our findings indicate that personal "courage" and social support empowered women and impacted on their preference for home birth, whereas demand for informal user fees and perceived low quality of care influenced women to avoid institutional care during childbirth, sometimes even in spite ofcomplications. Ability to meet demands for informal user fees and knowledge of childbirth influenced women to seek institutional care. The study highlights the need to improve the quality of available maternal health care addressing the implicit educational, attitudinal, and ethical issues.
|
|
| 17. |
- Odberg Pettersson, Karen, 1951-, et al.
(författare)
-
Mozambican midwives' views on barriers to quality perinatal care
- 2006
-
Ingår i: Health Care for Women International. - Philadelphia, USA : Taylor & Francis. - 0739-9332 .- 1096-4665. ; 27:2, s. 145-68
-
Tidskriftsartikel (refereegranskat)abstract
- Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.
|
|
| 18. |
- Odberg Pettersson, Karen, et al.
(författare)
-
Strategies Applied by Women in Coping With ad-hoc Demands for Unauthorized User Fees During Pregnancy and Childbirth. A Focus Group Study From Angola.
- 2007
-
Ingår i: Health Care for Women International. - : Informa UK Limited. - 1096-4665 .- 0739-9332. ; 28:3, s. 46-224
-
Tidskriftsartikel (refereegranskat)abstract
- Our aim in this study was to explore women's responses to reported ad-hoc demands for unauthorized user fees during pregnancy and childbirth in Luanda, Angola. Ten focus group discussions were conducted and data were analysed using grounded theory. Women were found to apply six strategies as they "endeavored to cope with demands for unauthorized user fees" (core category): (i) blowing the whistle, (ii) searching for comprehension, (iii) manipulating the system, (iv) bargaining, (v) extending the limits, and (vi) balancing. The system of unauthorized user fees appears to be a symptom of a deeper structural problem, which requires multifaceted and long-term interventions such as insti-tutional reforms and clear policies on accountability and transparency. Better resource availability for the MHC sector is required in order to secure adequate salaries to maternal health care providers. The fact that unethical behavior is unveiled implies that interventions also need to target the national midwifery training.
|
|
| 19. |
|
|
| 20. |
- Pellagatti, Andrea, et al.
(författare)
-
Lenalidomide inhibits the malignant clone and up-regulates the SPARC gene mapping to the commonly deleted region in 5q-syndrome patients
- 2007
-
Ingår i: Proceedings of the National Academy of Sciences. - : Proceedings of the National Academy of Sciences. - 1091-6490 .- 0027-8424. ; 104:27, s. 11406-11411
-
Tidskriftsartikel (refereegranskat)abstract
- Myelodysplastic syndromes (MDSs) are a group of hematopoietic stem cell disorders characterized by ineffective hernatopoiesis and peripheral blood cytopenias. Lenalidomide has dramatic therapeutic effects in patients with low-risk MDS and a chromosome 5q31 deletion, resulting in complete cytogenetic remission in >60% of patients. The molecular basis of this remarkable drug response is unknown. To gain insight into the molecular targets of lenaliclomide we investigated its in vitro effects on growth, maturation, and global gene expression in isolated erythroblast cultures from MDS patients with clel(5)(q3l). Lenalidomide inhibited growth of differentiating del(5q) erythroblasts but did not affect cytogenetically normal cells. Moreover, lenalidomide significantly influenced the pattern of gene expression in del(5q) intermediate erythroblasts, with the V51G4, PPIC, TPBG, activin A, and SPARC genes up-regulated by >2-fold in all samples and many genes involved in erythropoiesis, including HBA2, GYPA, and KLF1, down-regulated in most samples. Activin A, one of the most significant differentially expressed genes between lenalidomide-treated cells from MDS patients and healthy controls, has pleiotropic functions, including apoptosis of hematopoietic cells. Up-regulation and increased protein expression of the tumor suppressor gene SPARC is of particular interest because it is anti proliferative, antiadhesive, and antiangiogenic and is located at 5q3l-q32, within the commonly deleted region in MDS 5q- syndrome. We conclude that lenalidomide inhibits growth of del(5q) erythroid progenitors and that the up-regulation of SPARC and activin A may underlie the potent effects of lenalidomide in MDS with clel(5)(q3l). SPARCmay play a role in the pathogenesis of the 5q- syndrome.
|
|
| 21. |
- Sharma, Bharati, et al.
(författare)
-
Do the pre-service education programmes for midwives in India prepare confident 'registered midwives'? : A survey from India
- 2015
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 8
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM). Design: A cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains - antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain. Results: Overall, 25-40% of students scored above the 75th percentile and 38-50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council. Conclusions: The pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed.
|
|
| 22. |
- Sharma, Bharati, et al.
(författare)
-
Self-assessed confidence of students on selected midwifery skills : Comparing diploma and bachelors programmes in one province of India
- 2018
-
Ingår i: Midwifery. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 67, s. 12-17
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: There are two integrated pre-service education programmes for nurses and midwives in India; a diploma in General Nursing and Midwifery (GNM) and bachelor's in nursing (B.Sc. nursing). This study assessed and compared confidence of final-year students from these two programmes for selected midwifery skills from the list of midwifery competencies given by the International Confederation of Midwives (ICM).Design: A cross-sectional survey.Participants: 633 final-year students, from 25 educational institutions randomly selected, stratified by the type of programme (diploma/bachelor), and ownership (private/government) from the Gujarat province.Data collection and analysis: Students assessed their confidence on a 4-point scale, in four midwifery competency domains-antepartum, intrapartum, postpartum, and newborn care. Skill statements were reduced to subscales for each competency domain separately through Principle Component Analysis. Crude and adjusted odds ratios with 95% CI were calculated for students with high confidence (>= 75th percentile on each subscale) and not high (all others) between diploma and bachelor students.Findings: The diploma students were 2-4 times more likely to have high confidence on all subscales under antepartum, intrapartum, postpartum and newborn care compared to the bachelor students. Though both groups had less hands-on clinical practice during their education, more diploma students could fulfil the requirements of attending recommended number of births compared to the bachelor students.Conclusion: Overall the students of the general nursing and midwifery (GNM) programme have higher confidence in skills for antepartum, intrapartum, newborn and postpartum care. One important reason is more hands-on clinical practice for the diploma compared to the bachelor students.
|
|
| 23. |
- Söderström, Lisa, 1982-
(författare)
-
Nutritional status among older people : Risk factors and consequences of malnutrition
- 2013
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite the high frequency and serious consequences of protein–energy malnutrition, prevention and treatment of malnutrition do not currently receive appropriate attention. Increased awareness of the importance of nutritional screening among older people is needed. The overall aim of this thesis was to extend our current knowledge about malnutrition and the consequences of a poor nutritional status in relation to preterm death, and to identify possible risk factors for developing malnutrition among older people. The aim of Paper I was to estimate the prevalence of malnutrition and to examine the associations between mealtime habits, meal provision, and malnutrition among older people admitted to a Swedish hospital. The aim of Paper II was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in older people.The baseline survey was a cross-sectional study of 1771 patients aged ³65 years who were admitted to hospital. Nutritional status was assessed using the MNA instrument, and possible risk factors associated with malnutrition were recorded during the hospital stay (Paper I). Overall survival was followed up after 35–50 months in a cohort study of 1767 participants (Paper II).Of the 1771 participants, 35.5% were well-nourished, 55.1% were at risk of malnutrition, and 9.4% were malnourished at baseline. An overnight fast >11 hours was associated with risk of malnutrition (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.14–1.87) and being malnourished (OR 1.67; 95% CI 1.04–2.69). Fewer than four eating episodes a day was associated with both risk of malnutrition (OR 1.88, 95% CI 1.52–2.32) and being malnourished (OR 3.10; 95% CI 2.14–4.49). Not cooking independently was also associated with both risk of malnutrition (OR 1.9; 95% CI 1.30–2.93) and being malnourished (OR 5.04; 95% CI 2.95–8.61). At the 50-month follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants. After adjusting for confounders, the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18–2.07) in the group at risk of malnutrition and 3.71 (2.28–6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicted preterm death in people aged 65 years and older.This thesis provides additional knowledge of the current nutritional situation among older people admitted to hospital. The high prevalence and serious consequences of malnutrition demonstrated in this thesis underline the importance of screening and taking actions to counteract malnutrition among older people. The data showing that the length of overnight fasting and number of eating episodes per day are possible risk factors for malnutrition are consistent with the current nutritional recommendations. This knowledge may stimulate care providers to decrease the length of overnight fasting and increase the number of eating episodes per day among older people at risk of malnutrition.
|
|
| 24. |
- Wahlin, Bjorn E., et al.
(författare)
-
Clinical significance of the WHO grades of follicular lymphoma in a population-based cohort of 505 patients with long follow-up times
- 2012
-
Ingår i: British Journal of Haematology. - : Wiley. - 0007-1048 .- 1365-2141. ; 156:2, s. 225-233
-
Tidskriftsartikel (refereegranskat)abstract
- The prognostic value of grading follicular lymphoma has been debated since the 1980s. There is consensus that World Health Organization (WHO) grades 1 and 2 are indolent, but not whether grades 3A or 3B are aggressive. We retrospectively reviewed the follicular lymphoma diagnoses according to the 2008 WHO classification in all diagnostic specimens from a population-based cohort of 505 patients with a median follow-up time of 10.0 years (range, 4.616.0). After excluding 43 patients with concomitant diffuse large B-cell lymphoma, 345 remained with grade 12, 94 with grade 3A, and 23 with grade 3B follicular lymphoma. Grades 12 and 3A seemed equally indolent, with indistinguishable clinical courses, even in patients receiving anthracyclines. Compared with grades 13A and independently of clinical factors, grade 3B correlated with higher mortality (P = 0.008), but outcome was improved after upfront anthracycline-containing therapy (P = 0.015). In contrast to grade 13A patients, grade 3B patients experienced no relapses or deaths beyond 5 years of follow-up. Furthermore, patients with grade 3B were predominantly male and seldom presented with bone-marrow involvement. We conclude that follicular lymphoma grade 13A is indolent and incurable with conventional therapy. Grade 3B appears to be an aggressive but curable disease.
|
|
| 25. |
- Wahlin, Bjorn Engelbrekt, et al.
(författare)
-
Higher World Health Organization grades of follicular lymphoma correlate with better outcome in two Nordic Lymphoma Group trials of rituximab without chemotherapy
- 2014
-
Ingår i: Leukemia and Lymphoma. - : Informa UK Limited. - 1042-8194 .- 1029-2403. ; 55:2, s. 288-295
-
Tidskriftsartikel (refereegranskat)abstract
- A common treatment for follicular lymphoma is rituximab monotherapy. To identify patients for whom this regimen is adequate as first-line therapy, we applied the World Health Organization (WHO) classification for grading follicular lymphoma in a prospective central pathology review of the biopsies of previously untreated patients in two randomized trials of rituximab without chemotherapy. In the first trial (n(1) = 53), higher WHO grades correlated with longer time to next treatment, independently of clinical prognostic factors (p = 0.030); the finding was replicated in the second trial (n(2) = 221; p = 0.019). Higher grades were associated with better treatment responses (p = 0.018). Furthermore, also grades externally confirmed by independent local pathologists correlated with time to next treatment (p = 0.048). Flow cytometry in a separate patient series showed that the intensity of CD20 increased with the malignant cell size (p < 0.00005). In conclusion, WHO grade 1 follicular lymphoma correlates with inferior outcome after rituximab monotherapy. WHO grading might provide a clinically useful tool for personalized therapy.
|
|
