| 1. |
- Cavallin, Lena, et al.
(författare)
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Comparison between visual assessment of MTA and hippocampal volumes in an elderly, non-demented population
- 2012
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 53:5, s. 573-579
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Tidskriftsartikel (refereegranskat)abstract
- Background It is important to have a replicable easy method for monitoring atrophy progression in Alzheimer's disease. Volumetric methods for calculating hippocampal volume are time-consuming and commonly used in research. Visual assessments of medial temporal lobe atrophy (vaMTA) is a rapid method for clinical use. This method has not been tested in a large non-demented population in comparison with volumetry mesurements. Since hippocampal volume decreases with time even in normal aging there is also a need to study the normal age differences of medial temporal lobe atrophy. Purpose To compare visual assessment of medial temporal lobe atrophy (vaMTA) with hippocampal volume in a healthy, non-demented elderly population. To describe normal ageing using vaMTA. Material and Methods Non-demented individuals aged 60, 66, 72, 78, 81, 84, and ≥87 years old were recruited from the Swedish National study on Ageing and Care in Kungsholmen (SNAC-K), Sweden. Standard magnetic resonance imaging (MRI) scans, vaMTA, and calculations of hippocampal volumes were performed in 544 subjects. Results Significant correlation (rs = −0.32, P < 0.001, sin; and rs = −0.26, P < 0.001, dx) was found between hippocampal volume measurements and vaMTA. In normal ageing, almost 95% of ≤66-year-olds had a medial temporal lobe atrophy (MTA) score ≤1, with possible scores ranging from 0 to 4. Subjects aged 72, 78, and 81 years scored ≤2, while the two oldest age groups had scores ≤3. Conclusion There was a highly significant correlation between volumetric measurements of the hippocampus and MTA scoring. In normal ageing, there is increasing MTA score. For non-demented elderly individuals ≤70 years, an MTA score of 0–1 may be considered normal, compared with MTA ≤2 for 70–80-years and MTA 3 for >80-year-old individuals.
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| 2. |
- Hedwall, Per-Ola, et al.
(författare)
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Half a century of multiple anthropogenic stressors has altered northern forest understory plant communities
- 2019
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Ingår i: Ecological Applications. - : Wiley. - 1051-0761 .- 1939-5582. ; 29
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Tidskriftsartikel (refereegranskat)abstract
- Boreal forests form the largest and least disturbed forest biome in the northern hemisphere. However, anthropogenic pressure from intensified forest management, eutrophication, and climate change may alter the ecosystem functions of understory vegetation and services boreal forests provide. Swedish forests span long gradients of climate, nitrogen deposition, and management intensity. This makes them ideal to study how the species composition and functions of other, more pristine, boreal forests might change under increased anthropogenic pressure. Moreover, the National Forest Inventory (NFI) has collected systematic data on Swedish forest vegetation since the mid-20th century. We use this data to quantify changes in vegetation types between two periods, 1953-1962 and 2003-2012. The results show changes in forest understory vegetation since the 1950s at scales not previously documented in the boreal biome. The spatial extent of most vegetation types changed significantly. Shade-adapted and nutrient-demanding species (those with high specific leaf area) have become more common at the expense of light-demanding and nutrient-conservative (low specific leaf area) species. The cover of ericaceous dwarf shrubs decreased dramatically. These effects were strongest where anthropogenic impacts were greatest, suggesting links to drivers such as nitrogen deposition and land-use change. These changes may impact ecosystem functions and services via effects on higher trophic levels and faster plant litter decomposition in the expanding vegetation types. This, in turn, may influence nutrient dynamics, and consequently ecosystem productivity and carbon sequestration.
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| 3. |
- Hedwall, Per-Ola, et al.
(författare)
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Interactions between local and global drivers determine long-term trends in boreal forest understorey vegetation
- 2021
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Ingår i: Global Ecology and Biogeography. - : Wiley. - 1466-822X .- 1466-8238. ; 30, s. 1765-1780
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Tidskriftsartikel (refereegranskat)abstract
- Aim Global change effects on forest ecosystems are increasingly claimed to be context dependent, indicated by interactions between global and local environmental drivers. Most examples of such context dependencies originate from temperate systems, while limited research comes from the boreal biome. Here we set out to test if interactions between climate warming, nitrogen deposition, land-use change resulting in increasing forest density, and soil pH drive long-term changes in understorey vegetation in boreal forests. Location Sweden. Time period 1953-2012. Major taxa studied Vascular plants. Methods We used long-term (50 years) National Forest Inventory data on forest understorey vegetation in Sweden to model the combined effects of climate warming, nitrogen deposition, increase in forest density (tree basal area), and soil pH. Results Our results identify increasing temperature, nitrogen deposition and denser, shadier forest conditions as the main drivers of understorey vegetation changes during this time period. More importantly, we found that these effects varied with local conditions, that is, that the change towards a more nitrophilic understorey vegetation was more pronounced at low than high soil pH. Forest density was an important modulator of nitrogen deposition and temperature increase, with effects generally decreasing with density. Decreased cover of ericaceous dwarf shrubs was driven by both forest density and nitrogen deposition, with a stronger effect at low than at high pH. Main conclusions Our results highlight that to understand forest ecosystems' response to global change, and to make adequate management decisions to mitigate the effects of global change, we need to understand how changes in local environmental factors (forest density and soil pH) interact with global-scale drivers (nitrogen deposition and climate warming). Neglecting such interactions will lead to incorrect estimations of effects. In our case, we would for example, have underestimated the eutrophication effects on acid soils, which constitute a considerable part of the boreal biome.
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| 4. |
- Nääv, Åsa, et al.
(författare)
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A1M Ameliorates Preeclampsia-Like Symptoms in Placenta and Kidney Induced by Cell-Free Fetal Hemoglobin in Rabbit.
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Preeclampsia is one of the most serious pregnancy-related diseases and clinically manifests as hypertension and proteinuria after 20 gestational weeks. The worldwide prevalence is 3-8% of pregnancies, making it the most common cause of maternal and fetal morbidity and mortality. Preeclampsia lacks an effective therapy, and the only "cure" is delivery. We have previously shown that increased synthesis and accumulation of cell-free fetal hemoglobin (HbF) in the placenta is important in the pathophysiology of preeclampsia. Extracellular hemoglobin (Hb) and its metabolites induce oxidative stress, which may lead to acute renal failure and vascular dysfunction seen in preeclampsia. The human endogenous protein, α1-microglobulin (A1M), removes cell-free heme-groups and induces natural tissue repair mechanisms. Exogenously administered A1M has been shown to alleviate the effects of Hb-induced oxidative stress in rat kidneys. Here we attempted to establish an animal model mimicking the human symptoms at stage two of preeclampsia by administering species-specific cell-free HbF starting mid-gestation until term, and evaluated the therapeutic effect of A1M on the induced symptoms. Female pregnant rabbits received HbF infusions i.v. with or without A1M every second day from gestational day 20. The HbF-infused animals developed proteinuria and a significantly increased glomerular sieving coefficient in kidney that was ameliorated by co-administration of A1M. Transmission electron microscopy analysis of kidney and placenta showed both intracellular and extracellular tissue damages after HbF-treatment, while A1M co-administration resulted in a significant reduction of the structural and cellular changes. Neither of the HbF-treated animals displayed any changes in blood pressure during pregnancy. In conclusion, infusion of cell-free HbF in the pregnant rabbits induced tissue damage and organ failure similar to those seen in preeclampsia, and was restored by co-administration of A1M. This study provides preclinical evidence supporting further examination of A1M as a potential new therapy for preeclampsia.
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| 5. |
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| 6. |
- Abe, O, et al.
(författare)
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Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials
- 2005
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Ingår i: The Lancet. - 1474-547X. ; 365:9472, s. 1687-1717
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Tidskriftsartikel (refereegranskat)abstract
- Background Quinquennial overviews (1985-2000) of the randomised trials in early breast cancer have assessed the 5-year and 10-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival. Here, we report the 10-year and 15-year effects. Methods Collaborative meta-analyses were undertaken of 194 unconfounded randomised trials of adjuvant chemotherapy or hormonal therapy that began by 1995. Many trials involved CMF (cyclophosphamide, methotrexate, fluorouracil), anthracycline-based combinations such as FAC (fluorouracil, doxombicin, cyclophosphamide) or FEC (fluorouracil, epirubicin, cyclophosphamide), tamoxifen, or ovarian suppression: none involved taxanes, trastuzumab, raloxifene, or modem aromatase inhibitors. Findings Allocation to about 6 months of anthracycline-based polychemotherapy (eg, with FAC or FEC) reduces the annual breast cancer death rate by about 38% (SE 5) for women younger than 50 years of age when diagnosed and by about 20% (SE 4) for those of age 50-69 years when diagnosed, largely irrespective of the use of tamoxifen and of oestrogen receptor (ER) status, nodal status, or other tumour characteristics. Such regimens are significantly (2p=0 . 0001 for recurrence, 2p<0 . 00001 for breast cancer mortality) more effective than CMF chemotherapy. Few women of age 70 years or older entered these chemotherapy trials. For ER-positive disease only, allocation to about 5 years of adjuvant tamoxifen reduces the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age (<50, 50-69, &GE; 70 years), progesterone receptor status, or other tumour characteristics. 5 years is significantly (2p<0 . 00001 for recurrence, 2p=0 . 01 for breast cancer mortality) more effective than just 1-2 years of tamoxifen. For ER-positive tumours, the annual breast cancer mortality rates are similar during years 0-4 and 5-14, as are the proportional reductions in them by 5 years of tamoxifen, so the cumulative reduction in mortality is more than twice as big at 15 years as at 5 years after diagnosis. These results combine six meta-analyses: anthracycline-based versus no chemotherapy (8000 women); CMF-based versus no chemotherapy (14 000); anthracycline-based versus CMF-based chemotherapy (14 000); about 5 years of tamoxifen versus none (15 000); about 1-2 years of tamoxifen versus none (33 000); and about 5 years versus 1-2 years of tamoxifen (18 000). Finally, allocation to ovarian ablation or suppression (8000 women) also significantly reduces breast cancer mortality, but appears to do so only in the absence of other systemic treatments. For middle-aged women with ER-positive disease (the commonest type of breast cancer), the breast cancer mortality rate throughout the next 15 years would be approximately halved by 6 months of anthracycline-based chemotherapy (with a combination such as FAC or FEC) followed by 5 years of adjuvant tamoxifen. For, if mortality reductions of 38% (age <50 years) and 20% (age 50-69 years) from such chemotherapy were followed by a further reduction of 31% from tamoxifen in the risks that remain, the final mortality reductions would be 57% and 45%, respectively (and, the trial results could well have been somewhat stronger if there had been full compliance with the allocated treatments). Overall survival would be comparably improved, since these treatments have relatively small effects on mortality from the aggregate of all other causes. Interpretation Some of the widely practicable adjuvant drug treatments that were being tested in the 1980s, which substantially reduced 5-year recurrence rates (but had somewhat less effect on 5-year mortality rates), also substantially reduce 15-year mortality rates. Further improvements in long-term survival could well be available from newer drugs, or better use of older drugs.
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| 7. |
- Allard, Christina, et al.
(författare)
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Rasbiologiskt språkbruk i statens rättsprocess mot sameby
- 2015
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Ingår i: Dagens Nyheter. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Statens hantering av forskningsresultat i rättsprocessen med Girjas sameby utgör ett hot mot Sverige som rättsstat och kunskapsnation. Åratal av svensk och internationell forskning underkänns och man använder ett språkbruk som skulle kunna vara hämtat från rasbiologins tid. Nu måste staten ta sitt ansvar och börja agera som en demokratisk rättsstat, skriver 59 forskare.
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| 8. |
- Andersson Hagiwara, Magnus, et al.
(författare)
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Patient safety and patient assessment in pre-hospital care: a study protocol
- 2016
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 24:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is tosurvey patient safety problems in pre-hospital care in Sweden.Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screeningcriteria. Two instruments for structured medical record review are used: a trigger tool instrument designed forpre-hospital care and a newly development instrument designed to compare the pre-hospital assessment withthe final hospital assessment. Three different ambulance organisations are participating in the study. Every month,one rater in each organisation randomly collects 30 medical records for review. With guidance from the reviewinstrument, he/she independently reviews the record. Every month, the review team meet for a discussion ofproblematic reviews. The results will be analysed with descriptive statistics and logistic regression.Discussion: The findings will make an important contribution to knowledge about patient safety issues in prehospitalcare.
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| 9. |
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| 10. |
- Antonsson, Ann-Beth, et al.
(författare)
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Miljö- och arbetsmiljötillsyn i små företag. En inledande studie
- 2005
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Studiens övergripande mål är att ta fram ett underlag för fortsatt diskussion om lagar, föreskrifter och tillsyn på miljö- och arbetsmiljöområdet i småföretag. Detta inkluderar att identifiera förslag som dels kan underlätta lagefterlevnaden på miljö- och arbetsmiljöområdet och dels kan undanröja konkurrens-hinder till följd av lagstiftning. Ett annat viktigt mål är att identifiera förbättringsområden inom vilka tillsyn och lagefterlevnad kan förenklas utan försämrad arbetsmiljö/större miljöpåverkan. Studien är kvalitativ med syftet att öka förståelsen för hur lagefterlevnad och tillsyn i små företag funge-rar inom områdena miljö och arbetsmiljö. Olika aktörers perspektiv lyfts fram i studien och statistik över omfattningen av tillsyn redovisas. Djupintervjuer har gjorts med 13 företag och 14 tillsynspersoner från länsstyrelser, kommuner och Arbetsmiljöverket. Studiens företag är positivt inställda till tillsynsbesök. Tillsynspersonernas polisiära roll har tonats ned över tid och balanseras av insatser för att motivera företagen. Företagen upplever ett stöd från tillsyns-personerna att leva upp till lagkraven. Företagen uppfattar tillsynen som en slags besiktning som 'godkänner' att deras arbetsmiljö- respek-tive miljöarbete uppfyller alla gällande lagkrav. I själva verket gör tillsynspersonerna ett urval av vad de ska inspektera vilket inte fråntar företagen något ansvar för att själva kontrollera lagefterlevnad. Lag-stiftningen går mer och mer mot egen kontroll av lagefterlevnad, både inom arbetsmiljö och miljö. Denna typ av regler är inget som uppskattas av studiens små företag. Tillfrågade företag förutsätter att tillsynen är konkurrensneutral men det finns exempel på motsatsen.
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| 11. |
- Antonsson, Malin, 1986, et al.
(författare)
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Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson’s disease or multiple sclerosis
- 2023
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Ingår i: International Journal of Speech-Language Pathology. - 1754-9507 .- 1754-9515.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson’s disease (PD) or multiple sclerosis (MS). Method: Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. Result: The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. Conclusion: The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures.
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| 12. |
- Arvidsson Lindvall, Mialinn, 1977-, et al.
(författare)
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START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD : protocol for a randomized controlled trial
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.Objective: To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants' experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.Methods: This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18-65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.Discussion: Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.Trial registration: ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).
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| 13. |
- Axelsson, Anna-Lena, et al.
(författare)
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Att jämföra skogens då med nu
- 2011
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Ingår i: Miljötrender från SLU. - 1403-4743. ; , s. 3-5
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 14. |
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| 15. |
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| 16. |
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| 17. |
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| 18. |
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| 19. |
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| 20. |
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| 21. |
- Axelsson, Cecilia, 1973-
(författare)
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En Meningsfull Historia? : Didaktiska perspektiv på historieförmedlande museiutställningar om migration och kulturmöten
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis concerns the mediation of history in a public arena in society, namely in historical exhibitions in museums. The foci of the thesis are exhibitions on migration history, cultural encounters, “Us” and “the Others”, and in particular how relations based on the principles of class, gender and ethnicity are mediated. The research concerns two exhibitions – "Afrikafararna" (The Travellers to Africa) and "Kongospår" (Traces of Congo).In this thesis museums are viewed as arenas for public education and meaning-making. It explores how the historical contents as well as the forms of mediation in the exhibitions correspond to the task of promoting democracy that has been assigned to Swedish museums. This task is expressed in the intentions of the respective museums, in the general policies on culture and also in the policy documents for schools. Therefore the thesis also explores how pupils and teachers understand the mediation of history and use the museum as a source for learning.Exhibitions are regarded in this thesis as mediation processes of history. Three distinct phases can be seen in this process – the phase of production, the phase of mediation and the phase of reception. People connected to the different phases, such as curators, producers, museum educators, and pupils, have been interviewed. These interviews show how conditions, convictions and scope for action influence how the stories of migration and cultural encounters are told and understood. The contents of the exhibitions are analysed from a perspective of class, gender and ethnicity. Furthermore, the limitations and possibilities for the visitors to intensify their historical consciousness are discussed.The study shows how economic conditions and access to historical source material influence the way history is mediated, but also, and to a very large extent, convictions on pedagogy and concepts of history among museum staff. The latter two are determining factors when it is made clear that the way the historical source material is used results in the fact that history is mediated in a way that does not correspond to the intentions and goals to promote democratic values, such as equality, and active democratic readiness for action.The study shows that the exhibitions in question mediate patterns of subordination and asymmetrical relations between women and men and between Swedes/Scandinavians and Africans in their mediation of history. There are sometimes very distinct lines between “Us” and “the Others”. One of the exhibitions offers more space for individual meaning-making and reflection than the other, however, because of its problematization of the occurrence of African artefacts in Scandinavia and because there are more stories and more voices in the exhibition.The interviews with teachers and pupils show that the visits to the exhibitions are often isolated events that are rarely incorporated into the students’ education in a prolonged theme or perspective. Several students uncritically accepted the mediation in the exhibition, others were provoked and challenged, but the students had little opportunity to discuss these experiences in either the museum or in school. In summing up, several of the results of the analysis show that the mediation of history in the exhibitions cannot be described as corresponding to the demands of a democratic conception of education.
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| 22. |
- Axelsson, Clara, et al.
(författare)
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Mina vårdkontakter : Utvärdering av ett pilotprojekt i Landstinget i Kalmar län
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Som ett led i utvecklingen av ”Vården på webben” har en applikation, ”Mina vårdkontakter”, testats i ett pilotprojekt av Landstinget i Kalmar län. Inför breddinförandet av Mina vårdkontakter uppdrog Landstinget i Kalmar län eHälsoinstitutet att genomföra föreliggande utvärdering med målet att samla in och ta tillvara erfarenheter från pilotprojektet och de verksamheter som däri deltagit.Utvärderingen är en kvalitativ studie där totalt 17 intervjuer genomförts, 15 med vårdpersonal och 2 med pilotprojektets ledning. Representanter från respektive av de 11, i pilotprojektet deltagande enheterna, har intervjuats. I samband med de 15 intervjuerna med vårdpersonal har en enkät fyllts i. I gruppen vårdpersonal har sjuksköterskor, läkarsekreterare och chefer inkluderats. En läkare fanns med i urvalet dock avbokades denna intervju pga. sjukdom.Sammantaget är de flesta nöjda med sitt deltagande i pilotprojektet samt användningen av Mina vårdkontakter. Man upplever att den information och utbildning som givits innan införandet varit tillfredsställande och bra. Den generella attityden hos personalen har varit övervägande positiv med få undantag. Den yrkesgrupp som uppfattas av andra yrkesgrupper som minst positiv till Mina vårdkontakter är läkare.Mina vårdkontakter upplevs av samtliga som en enkel applikation att lära och använda. Användarna tyckte generellt att applikationen fyllde en viktig funktion. Men systemet upplevs vid tiden för utvärderingens genomförande dock som långsamt.
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| 23. |
- Axelsson, Helene, et al.
(författare)
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Behaviour in female mink housed in enriched standard cages during winter
- 2009
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Ingår i: Applied Animal Behaviour Science. - : Elsevier BV. - 0168-1591 .- 1872-9045. ; 121, s. 222-229
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated whether adding environmental enrichments to a standard housing system during winter could decrease stereotypic behaviours in female mink. The study was conducted on two private farms (F1 and F2) in southern Sweden. In total, 75 farmed mink oil each farm were housed in standard cages, with either a wire net shelf, a plastic ball, a plastic cylinder or all three enrichments together. Standard cages without enrichments were used as a control. All animals in the study were born and raised in a standard cage system without enrichments. The animals were housed in the enriched cages from early December, at approximately 7 months of age, until the beginning of March. Behavioural observations were made in January-March during three observation periods (10 consecutive days each) on each farm. The behaviours were recorded using one-zero sampling during 2 h prior to feeding and 2 h afterwards. There were no significant differences in stereotypic behaviours between treatments at F1, but stereotypic behaviours decreased significantly (P < 0.05) in mink with access to wire net shelves at F2. Stereotypic behaviours were most often performed before feeding and differed in occurrence between periods (P < 0.001). The total number of interactions with the enrichments differed between treatments (P < 0.001), and was highest for the wire net shelf enrichment on both farms. In conclusion, our results indicate that a wire net shelf, plastic cylinder, ball or all these three enrichments together were not sufficient to decrease or interrupt stereotypic behaviours that had already developed in standard housing during winter. (C) 2009 Elsevier B.V. All rights reserved.
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| 24. |
- Axelsson, Helene, et al.
(författare)
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Effects of group size on behaviour, growth and occurrence of bite marks in farmed mink
- 2017
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Ingår i: Applied Animal Behaviour Science. - : Elsevier BV. - 0168-1591 .- 1872-9045. ; 194, s. 112-119
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to investigate the occurrence of stereotypic behaviours and the activity level in farmed mink when group housed in climbing cages and if group housing increase aggression by assessing the prevalence of bite marks. This was studied in juvenile mink of the colour types "demibuff" (n = 165) and "half sapphire" (n = 165). The animals were housed in standard cages (S2: one male, one female), or in climbing cages (C2: one male, one female; C3: one male, two females; C4: two males, two females). Behaviours were recorded for two hours beginning at sunrise and two hours before sunset during six periods of five days each from August-October. After pelting, the leather side of the undried skins were visually inspected for bite marks. Stereotypic behaviours were infrequent (0.1% of observations). Pair housed mink in climbing cages were more "inactive out in cage" than pair housed mink in standard cages (p < 0.0001), but cage type had no effect on the behaviours "being in nest box", "active out in cage", "interactions with enrichments" or "social interactions" (n.s.). Group sizes of three or four mink increased the behaviours "active out in cage" (P < 0.0001) and decreased "being in nest box" (P < 0.001) but had no effect on "interactions with enrichments", "inactive out in cage" or "social interactions" (n.s.). Males had lower growth when kept in groups of four compared to groups of three or pairs (P < 0.001), and shorter skin lengths when kept in groups of four compared to pairs (P < 0.001), but females did not differ in growth or skin lengths between group sizes (n.s.). Number of bite marks on the leather side of the skins did not differ between cage types (n.s.) or group sizes (n.s.). In conclusion, neither the cage design nor the group size affected the occurrence of stereotypies or the occurrence of bite marks, but activity levels increased and the use of a nest box and male growth decreased in larger groups.
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| 25. |
- Axelsson, Lena, et al.
(författare)
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Clustering of β2-integrins on human neutrophils activates dual signaling pathways to Ptdlns 3-kinase
- 2000
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Ingår i: Experimental Cell Research. - : Elsevier BV. - 0014-4827. ; 256:1, s. 257-263
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Tidskriftsartikel (refereegranskat)abstract
- The β2-integrins on leukocytes can serve as a signaling unit during cell adhesion and locomotion, and to further clarify this important property we investigated the possible mechanisms of β2-integrin-induced activation of PtdIns 3-kinase. It has previously been demonstrated that clustering of β2-integrins activates p21(ras) by a tyrosine kinase-dependent pathway, and here we show that active p21(ras) interacts with its downstream target, PtdIns 3-kinase. Engagement of β2-integrins also activates the tyrosine kinases p58(c-fgr) and p59/61(hck) and causes them to associate with the p85 subunit of PtdIns 3-kinase. These findings suggest a mechanism whereby p58(c- fgr) and p59/61(hck) are directly involved in the activation of PtdIns 3- kinase. No coupling between p58(c-fgr) and p59/61(hck) could be detected; hence these kinases probably trigger independent but parallel signals to PtdIns 3-kinase. The effect of β2-integrin clustering on PtdIns 3-kinase activity was monitored as the activation of protein kinase B (PKB). Stimulation of PKB by β2-integrins was abolished by genistein and wortmannin but not by using methyl transferase inhibitors to abrogate the influence of p21(ras)-related proteins. Thus, even if PtdIns 3-kinase is not activated by p21(ras), it can maintain full enzyme activity due to the mentioned interaction with p58(c-fgr) or p59/61(hck). These tyrosine kinases apparently activate similar pathways that operate in parallel and therefore have the potential to substitute for each other in mediating adhesion and regulating cell locomotion. (C) 2000 Academic Press.
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| 26. |
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| 27. |
- Axelsson, Lena, et al.
(författare)
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End-of-life and palliative care of patients on maintenance hemodialysis treatment : a focus group study
- 2019
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Ingår i: BMC Palliative Care. - : BioMed Central. - 1472-684X. ; 18:1, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite complex illness trajectories and a high symptom burden, palliative care has been sub-optimal for patients with end-stage kidney disease and hemodialysis treatment who have a high rate of hospitalization and intensive care towards end of life. There is a growing awareness that further development of palliative care is required to meet the needs of these patients and their family members. In this process, it is important to explore healthcare professionals' views on provision of care. The aim of this study was therefore to describe nurses' and physicians' perspectives on end-of-life and palliative care of patients treated with maintenance hemodialysis. Methods: Four focus group interviews were conducted with renal nurses (17) and physicians (5) in Sweden. Qualitative content analysis was used to analyze data. Results: Participants were committed to giving the best possible care to their patients, but there were challenges and barriers to providing quality palliative care in nephrology settings. Professionals described palliative care as end-of-life care associated with hemodialysis withdrawal or palliative dialysis, but also identified care needs and possibilities that are in line with an earlier integrated palliative approach. This was perceived as complex from an organizational point of view. Participants identified challenges related to coordination of care and different perspectives on care responsibilities that impacted symptom management and patients' quality of life. Communication issues relating to the provision of palliative care were revealed where the hemodialysis setting was regarded as an impediment, and personal and professional experiences, beliefs and knowledge were considered of major importance. Conclusions: Nurses and physicians identified a need for the improvement of both late and earlier palliative care approaches. The results highlighted a requirement for and possibilities of training, counselling and support of health care professionals in the dialysis context. Further, multi-professional palliative care collaborations should be developed to improve the coordination and organization of end-of-life and palliative care of patients and their family members. A climate allowing conversations about advance care planning throughout the illness trajectory may facilitate the gradual integration of palliative care alongside life-prolonging treatment for improved support of patients and families.
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| 28. |
- Axelsson, Lena, et al.
(författare)
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End of life of patients treated with haemodialysis as narrated by their close relatives
- 2015
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:4, s. 776-784
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.DESIGN: Qualitative and descriptive.METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.
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| 29. |
- Axelsson, Lars, et al.
(författare)
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Inequalities of quality of life in unemployed young adults : a population-based questionnaire study
- 2007
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Ingår i: International Journal for Equity in Health. - 1475-9276 .- 1475-9276. ; 6, s. 1-
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is well known that unemployment is a great problem both to the exposed individual and to the whole society. Unemployment is reported as more common among young people compared to the general level of unemployment. Inequity in health status and lifesatisfaction is related to unemployment. The purpose of this population-based study was to describe QOL among unemployed young people compared to those who are not unemployed, and to analyse variables related to QOL for the respective groups.Methods: The sample consisted of 264 young unemployed individuals and 528 working or studying individuals as a reference group. They all received a questionnaire about civil status, educational level, immigration, employment status, self-reported health, self-esteem, social support, social network, spare time, dwelling, economy and personal characteristics. The response rate was 72%. The significance of differences between proportions was tested by Fisher's exact test or by χ2 test. Multivariate analysis was carried out by means of a logistic regression model.Results: Our results balance the predominant picture of youth unemployment as a principally negative experience. Although the unemployed reported lower levels of QOL than the reference group, a majority of unemployed young adults reported good QOL, and 24% even experienced higher QOL after being unemployed. Positive QOL related not only to good health, but also to high self-esteem, satisfaction with spare time and broad latitude for decision-making.Conclusion: Even if QOL is good among a majority of unemployed young adults, inequalities in QOL were demonstrated. To create more equity in health, individuals who report reduced subjective health, especially anxiety need extra attention and support. Efforts should aim at empowering unemployed young adults by identifying their concerns and resources, and by creating individual programmes in relation not only to education and work, but also to personal development.
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| 30. |
- Axelsson, Lars, et al.
(författare)
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Inequalities of quality of life in unemployed young adults : a population-based questionnaire study
- 2007
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Ingår i: International Journal for Equity in Health. - : BioMed Central Ltd.. - 1475-9276. ; 6
-
Tidskriftsartikel (refereegranskat)abstract
- Background: It is well known that unemployment is a great problem both to the exposed individual and to the whole society. Unemployment is reported as more common among young people compared to the general level of unemployment. Inequity in health status and lifesatisfaction is related to unemployment. The purpose of this population-based study was to describe QOL among unemployed young people compared to those who are not unemployed, and to analyse variables related to QOL for the respective groups. Methods: The sample consisted of 264 young unemployed individuals and 528 working or studying individuals as a reference group. They all received a questionnaire about civil status, educational level, immigration, employment status, self-reported health, self-esteem, social support, social network, spare time, dwelling, economy and personal characteristics. The response rate was 72%. The significance of differences between proportions was tested by Fisher's exact test or by χ2 test. Multivariate analysis was carried out by means of a logistic regression model. Results: Our results balance the predominant picture of youth unemployment as a principally negative experience. Although the unemployed reported lower levels of QOL than the reference group, a majority of unemployed young adults reported good QOL, and 24% even experienced higher QOL after being unemployed. Positive QOL related not only to good health, but also to high self-esteem, satisfaction with spare time and broad latitude for decision-making. Conclusion: Even if QOL is good among a majority of unemployed young adults, inequalities in QOL were demonstrated. To create more equity in health, individuals who report reduced subjective health, especially anxiety need extra attention and support. Efforts should aim at empowering unemployed young adults by identifying their concerns and resources, and by creating individual programmes in relation not only to education and work, but also to personal development.
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| 31. |
- Axelsson, Lena, et al.
(författare)
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Intensity of Predeath Grief and Postdeath Grief of Family Caregivers in Palliative Care in Relation to Preparedness for Caregiving, Caregiver Burden, and Social Support
- 2020
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Ingår i: Palliative Medicine Reports. - : Mary Ann Liebert. - 2689-2820. ; 1:1, s. 191-200
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Tidskriftsartikel (refereegranskat)abstract
- Background: The intensity of predeath grief is associated with postdeath grief in family caregivers of patients in palliative care. Different factors during caregiving may influence this association.Objective: To examine (1) the intensity of grief in relation to preparedness for caregiving, caregiver burden, and social support, and (2) if these variables moderate associations between predeath and postdeath grief.Methods: This prospective correlational study used unpaired t-test to compare grief in relation to preparedness for caregiving, caregiver burden, and social support. Hierarchical multiple linear regression analysis investigated moderation effects. Family caregivers were recruited from 10 palliative homecare facilities. The Anticipatory Grief Scale, Texas Revised Inventory of Grief, Preparedness for Caregiving Scale, Caregiver Burden Scale, and Multidimensional Scale of Perceived Social Support were used. Ethical approval for the study was granted by the Regional Ethical Review Board in Stockholm, Sweden.Results: In total, 128 family caregivers participated. Those with high caregiver burden scored significantly higher intensity of predeath but not postdeath grief. Caregiver burden and social support moderated the association between intensity of predeath grief and postdeath grief. There was a stronger association between predeath and postdeath grief among caregivers with low caregiver burden or low social support. Preparedness for caregiving had no moderating effect.Discussion: Attention should be directed to caregiver burden and social support during family caregiving, as these variables seem to be significant for the intensity of grief before and after the patient's death. Acknowledging predeath grief during caregiving and recognizing pre- and postdeath grief as parts of the same process are of importance in clinical practice and when designing supportive interventions.
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| 32. |
- Axelsson, Lena, et al.
(författare)
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Kroppskännedomsgrupp i psykiatrisk öppenvård : en kvalitativ studie av patienters upplevelser
- 2004
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet var att undersöka hur patienter i psykiatrisk öppenvård upplevde det att delta i kroppskännedomsgrupp och vilka faktorer som hade betydelse för upplevelsen, samt att undersöka patienternas uppfattningar om kroppskännedomsgruppens betydelse för resultatet av den sjukgymnastiska behandlingen. En kvalitativ etnografisk ansats användes. Data samlades in med halvstrukturerad kvalitativ intervju med intervjuguide innehållande teman. Sju patienter från en psykiatrisk sjukgymnastisk enhet intervjuades, varav fyra i en fokusgrupp och tre i individuella intervjuer. I intervjuerna tog informanterna upp ett brett spektrum av upplevelser. Resultaten tyder på att det fanns många fördelar med att arbeta i grupp med kroppskännedom. Fem teman speglade hur informanterna upplevde gruppbehandlingen. Dessa relaterade till det egna självet, den egna kroppen, gruppledaren, andra personer och olika aspekter av rummet. Varje tema delades, utifrån informanternas berättelser, in i underteman och tillhörande förhållningssätt. Sammanfattningsvis tyder resultaten på att sjukgymnastens insatser på kroppslig nivå kan påverka förhållningssätt till jagets olika relationer, vilket beskrivs i en nyskapad modell.
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| 33. |
- Axelsson, Lena
(författare)
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Living with haemodialysis close to death - patients' and close relatives' experiences
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to generate understanding and knowledge a bout the experiences of patients living with haemodialysis, and their close relati ves, near the end of life. In studies I and II we conducted a series of 31 qualitative interviews over a period of 12 months with 8 severely ill patients (aged 66–87) treated with haemodialysis. For study I the text of the interviews was analysed using phenomenological hermeneutics to describe and to el ucidate the meanings of being severely ill living with haemodialysis when nearing end of life. For study II the text was analysed using qualitative content analysis to describe inner thoughts and feelings relating to death and dying of these patients. For studies III and IV, we conducted 14 retrospective qualitative interviews with close relatives of deceased patients treated with haemodialysis about th eir experiences during end of the patient’s life. For paper III the interview text was analysed usi ng phenomenological hermeneu tics to describe and elucidate the meanings of being a close relative at the end of life of a severely ill family member treated with maintenance haemodialysis. For paper IV the text was analysed using qualitative content analysis to describe end of life for the patients from the perspective of their close relatives. The findings of study I suggest that being severely i ll and living with haemodialysis near the end of life means living with suffering from a deteriorating body, a high symptom burden, and dependence on advanced medical technology, simultaneously with r econciliation and well-being. The meanings of living with illness and dialysis are intertwined with the meanings of being old. Study II shows that thoughts and feelings about deat h and dying are significant and complex for those living with haemodialysis as they approach the end of life. Patients experience a multifaceted presence of death. Their awareness of approaching death may include their repressing of thoughts of death, not as denial, but to allow them to focus on living as fully as possible the time they have left. Study III shows that close relatives strive to maintain balance and well-being for themselves and for the patient, which we interpreted as their striving to regain balance, and inner equilibrium in their changed and challenged rhythm of life. Study IV shows that after gradual deterioration and increasing care needs, older patients in haemodialysis care with co-morbidities follow three different main paths at the end of life: uncertain anticipation of death; awaiting death after dialysis withdrawal; and sudden but not unexpected death. The ends of their lives are marked by complex symptoms and existential issues related to haemodialysis treatment and withdrawal, and their uncertainty of what to expect at the end of life suggests the need for increased continuity and coordination of whole person care. Both patients and their close relatives are often alone with their existential thoughts. In their complex lifeworlds, intertwined meanings of living with illness and maintenance of life with haemodialysis treatment near the end of life show that patients live in a borderland of living-dying that is shared by the close relative. Patients and close relatives focus on living when death is close but uncertain, with severe illness and the maintenance of life through advanced technology. Integrating the philosophy of palliative care (with a focus on symptom relief, team work, communication, relationships, and support of family members) into dialysis care, may support health care professionals in haemodialysis units and other re nal contexts, to improve the care of severely ill patients, both earlier in their illness and as they approach the end of their lives.
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| 34. |
- Axelsson, Lena, et al.
(författare)
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Living with haemodialysis when nearing end of life
- 2012
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 45-52
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim of this study was to describe and to elucidate the meanings of being severely ill living with haemodialysis when nearing end of life.INTRODUCTION: To have end stage renal disease and to be treated with maintenance haemodialysis implies being dependent on lifelong treatment. Several studies have reported that these patients suffer a high symptom burden and an impaired quality of life due to both disease and treatment. In the dialysis unit, where the focus is on handling technology and maintaining life, end of life care may be neglected or overlooked. Nevertheless, mortality rates show that about one-fourth of patients in haemodialysis care are in their last year of life.DESIGN: A qualitative interpretative design was used.METHODS: Serial qualitative interviews over a period of 12 months were conducted with eight patients (aged 66-87). Altogether text of 31 interviews was interpreted using a phenomenological hermeneutical method in three phases. The study is ethically approved.FINDINGS: The structural analysis resulted in 11 subthemes and thereafter the following three themes were formulated; being subordinate to the deteriorating body, changing outlook on life and striving for upheld dignity. The comprehensive interpretation revealed that being severely ill living with haemodialysis near the end of life means living with suffering simultaneously with reconciliation and well-being. Further, the meanings are understood as intertwined with being old.CONCLUSIONS: Findings contribute to an increased awareness of the complexities of these patients' life worlds and their meanings, and thus of the importance to listen to their experiences and their understandings. Findings suggest that to integrate the philosophy of palliative care in haemodialysis units may improve care for patients who are living with haemodialysis and approaching the end of their lives.
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| 35. |
- Axelsson, Lena, et al.
(författare)
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Livskvalitet hos Närstående till personer i livets slut : Validering av The Quality of Life in Life-Threatening Illness - Family carer version
- 2022
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Självskattningsinstrumentet Quality of Life in Life Threatening Illness - Family carer version (QOLLTI-F) är utvecklat för att mäta livskvalitet hos närstående till personer i livets slut. Instrumentet är översatt till svenska och har uppvisat tillfredsställande innehållsvaliditet. Vidare validering behövs.Syfte: Att utvärdera mätegenskaper för QOLLTI-F, med fokus på begreppsvaliditet och reliabilitet, bland närstående till personer i livets slut.Metod: Studien har en tvärsnittsdesign och data samlades in vid två specialiserade hemsjukvårdsenheter i två städer i Sverige. Totalt 114 närstående (61% kvinnor, medelålder 67,5 år) besvarade en enkät bestående av bakgrundsfrågor och självskattningsinstrumenten QOLLTI-F, Caregiver Burden Scale (CBS), Preparedness for Caregiving Scale (PCS) samt Reward of Caregiving Scale (RCS). Konvergerande validitet utvärderades genom att korrelera QOLLTI-F med CBS, PCS och RCS. För att utvärdera den relativa betydelsen av QOLLTI-Fs dimensioner för närståendes övergripande livskvalitet användes multipel linjär regressionsanalys. Intern konsistens utvärderades med Cronbach’s alfa.Resultat: De allra flesta närstående hade svarat på alla frågor och hela svarsskalan från 0–10 användes för nästan alla frågor. Samtliga QOLLTI-F dimensioner förutom patientens tillstånd korrelerade som förväntat med upplevelse av påfrestning, förberedelse för att vårda och/eller egen behållning vilket stöder konvergerande validitet. Dimensionerna i QOLLTI-F förklarade tillsammans 70,5% av variationen i övergripande livskvalitet; närståendes eget tillstånd och närståendes perspektiv hade högst förklaringsvärde. Cronbach’s alfa varierade mellan 0,58–0,86.Betydelse: Självskattningsinstrumentet QOLLTI-F uppvisade goda mätegenskaper för att skatta närståendes livskvalitet i den aktuella studien. Resultaten indikerar att den övergripande frågan kan användas enskilt, speciellt när intresset är att fånga livskvalitet utifrån närståendes eget tillstånd och perspektiv.
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| 36. |
- Axelsson, Lena, et al.
(författare)
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Meanings of being a close relative of a family member treated with haemodialysis
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:3/4, s. 447-456
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES:To describe and elucidate the meanings of being a close relative of a severely ill family member treated with maintenance haemodialysis approaching the end of life.BACKGROUND:End-stage renal disease together with comorbidities, haemodialysis treatment and high mortality rates also affects the lives of close relatives, who report burdens and impaired quality of life. To improve care, more understanding is needed of close relatives' experiences during these patients' end of life.DESIGN:This study has a qualitative interpretative design.METHODS:Fourteen retrospective qualitative interviews were conducted with close relatives (aged 48-93 years) of deceased patients who had been treated with haemodialysis. The interview text was interpreted using a phenomenological hermeneutical method in three phases.RESULTS:The findings of the structural analysis were formulated as six themes: Striving to be supportive and helpful without doing harm to the ill person's self; Needing increasing strength and support; Balancing the will to help with one's own ongoing life; Increasing responsibility involving dilemmas; Striving for a good life together in the present and Living with awareness of death.CONCLUSIONS:Close relatives strive for balance and well-being accompanying their ill family member through the end of life. They are facing moral dilemmas and growing demands as their responsibility increases with the deterioration of their family member. Support from and interaction with the healthcare professionals is then of significance.RELEVANCE TO CLINICAL PRACTICE:Findings challenge healthcare professionals in haemodialysis settings to identify close relatives' individual resources and needs towards the patients' end of life. Healthcare professionals in haemodialysis settings need to offer close relatives opportunities to talk about the future and what may be expected at end of life, with or without haemodialysis. They should also contact the closest relative after the death as they may need confirmation and closure.
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| 37. |
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| 38. |
- Axelsson, Lena, et al.
(författare)
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Measuring quality of life in life-threatening illness - content validity and response processes of MQOL-E and QOLLTI-F in Swedish patients and family carers
- 2020
-
Ingår i: Bmc Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background The McGill Quality of Life Questionnaire - Expanded (MQOL-E) and the Quality of Life in Life-Threatening Illness-Family Carer/Caregiver version (QOLLTI-F) are developed for use with patients facing the end of life and their family carers, respectively. They are also developed for possible use as companion instruments. Contemporary measurement validity theory places emphasis on response processes, i.e. what people feel and think when responding to items. Response processes may be affected when measurement instruments are translated and adapted for use in different cultures. The aim of this study was to translate and examine content validity and response processes during completion of MQOL-E and QOLLTI-F version 2 (v2) among Swedish patients with life-threatening illness and their family carers. Methods The study was conducted in two stages (I) translation and adaptation (II) examination of content validity and response processes using cognitive interviews with 15 patients and 9 family carers. Participants were recruited from the hemodialysis unit, heart clinic, lung clinic and specialized palliative care of a Swedish county hospital. Patients had life-threatening illness such as advanced heart failure, advanced chronic obstructive pulmonary disease, end-stage kidney disease or advanced cancer. Patients were outpatients, inpatients or receiving home care. Results Patients and family carers respectively believed that the items of the MQOL-E and QOLLTI-F v2 reflect relevant and important areas of their quality of life. Although some items needed more time for reflection, both instruments were considered easy to understand. Some changes were made to resolve issues of translation. Participants expressed that reflecting on their situation while answering questions was valuable and meaningful to them, and that responding was an opportunity to express feelings. Conclusions The results of response processes pertaining to the Swedish translations of both MQOL-E and QOLLTI-F v2 contribute evidence regarding content validity, linguistic equivalence and cultural appropriateness of the translated instruments. In addition, results show that the instruments may support conversations on matters of importance for quality of life between patients and/or family carers and health care professionals. Further research is needed to study the psychometric properties of Swedish translations.
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| 39. |
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| 40. |
- Axelsson, Lena, et al.
(författare)
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Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives
- 2020
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:2, s. 419-432
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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| 41. |
- Axelsson, Lena, et al.
(författare)
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Swedish Registered Nurses' incentives to use nursing diagnoses in clinical practice
- 2006
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:8, s. 936-45
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. BACKGROUND: The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. DESIGN: A qualitative descriptive design. METHODS: A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. RESULTS: Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. CONCLUSIONS: The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses.
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| 42. |
- Axelsson, Lena, et al.
(författare)
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Thoughts on death and dying when living with haemodialysis approaching end of life
- 2012
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 21:15-16, s. 2149-59
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life.BACKGROUND: Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit.DESIGN: A qualitative descriptive design was used. Methods. A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data.RESULTS: The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option.CONCLUSIONS: Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts.RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.
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| 43. |
- Axelsson, Lena, et al.
(författare)
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Unmet Palliative Care Needs Among Patients With End-Stage Kidney Disease : A National Registry Study About the Last Week of Life
- 2018
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Ingår i: Journal of Pain and Symptom Management. - : Elsevier. - 0885-3924 .- 1873-6513. ; 55:2, s. 236-244
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Tidskriftsartikel (refereegranskat)abstract
- Context. End-stage kidney disease (ESKD) is characterized by high physical and psychological burden, and therefore, more knowledge about the palliative care provided close to death is needed. Objectives. To describe symptom prevalence, relief, and management during the last week of life, as well as end-of-life communication, in patients with ESKD. Methods. This study was based on data from the Swedish Register of Palliative Care. Patients aged 18 or older who died from a chronic kidney disease, with or without dialysis treatment (International Classification of Diseases, Tenth Revision, Sweden; N18.5 or N18.9), during 2011 and 2012 were selected. Results. About 472 patients were included. Of six predefined symptoms, pain was the most prevalent (69%), followed by respiratory secretion (46%), anxiety (41%), confusion (30%), shortness of breath (22%), and nausea (17%). Of patients with pain and/or anxiety, 32% and 44%, respectively, were only partly relieved or not relieved at all. Of patients with the other symptoms, a majority (55%-84%) were partly relieved or not relieved at all. End-of-life discussions were reported in 41% of patients and 71% of families. A minority died in specialized palliative care: 8% in hospice/inpatient palliative care and 5% in palliative home care. Of all patients, 19% died alone. Bereavement support was offered to 38% of families. Conclusion. Even if death is expected, most patients dying with ESKD had unmet palliative care needs regarding symptom management, advance care planning, and bereavement support. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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- Axelsson, Malin, et al.
(författare)
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Living in the Wake of Chronic Obstructive Pulmonary Disease and Long-Term Oxygen Therapy
- 2016
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 6, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.
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- Axelsson, Per, et al.
(författare)
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Indigenous infant mortality in Sweden : the key to the health transition
- 2009
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Konferensbidrag (refereegranskat)abstract
- The Sami of northern Scandinavia have experienced a positive health development that has brought them from a high-mortality situation two hundred years ago to their present-day low-mortality profile. Their experience is not shared by other indigenous peoples around the world. This study is concerned with infant mortality, a key issue in the health transition process. Long-term infant mortality trends are analyzed in order to compare Sami and non-Sami groups in the area. Data is obtained from the world-unique Northern Population Data Base at Umeå university, and consist of digitized 18th and 19th-century parish records. These complete life biographies include ethnic markers and enable longitudinal studies of causes of death, differences in sex, age-distribution, stillbirths and legitimacy status. The results are discussed from the perspective of the source quality, methodological considerations, the health transition generally in Sweden, and the overall Sami health transition
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- Axelsson Svedell, Lena, 1978-, et al.
(författare)
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Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder : a randomized pilot study
- 2023
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Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs).OBJECTIVE: The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up.MATERIALS AND METHODS: Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation.RESULTS: Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning.CONCLUSION: Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.
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