| 1. |
- Göransson, Carina, 1967-
(författare)
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Developing and evaluating an interactive app to support self-care among older persons receiving home care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The proportion of older persons worldwide is growing. With older age, complex health problems may occur and the need for home care increases. To support older persons to maintain health and self-care, innovative ways need to be developed. The aim of the project was to develop and evaluate an interactive app among older persons receiving home care. The project had several phases: i) to define and understand the problem ii) develop the intervention iii) develop and optimise evaluation. Qualitative and quantitative methods were employed. Data were collected through a scoping review, interviews with healthcare experts, older persons and nursing assistants (study I); interviews with older persons (studies II, III); focus groups with homecare nurses (study II). Questionnaires at baseline, end of intervention and 6-month follow-up; with instruments to assess aspects of health, health literacy, self-care, and a study specific question regarding sense of security were used (studies III-IV). Logged data from reported health concerns, alerts, and notes were collected (study IV). Data were analysed using qualitative content analysis (study I), thematic analysis (study II), qualitative content analysis with directed approach (study III) and descriptive and inferential statistics (studies III, IV). Results: Important aspects for health and self-care from the older persons’ perspectives were described as: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care (I). These results were included in the app as questions with self-care advice, graphs and alerts to homecare nurses. The app use was described as an enabler for learning (II). The older persons showed improved communicative and critical health literacy at the 6- month follow-up (IV). They described an increased sense of security (II and III), which decreased at the 6-month follow-up (III). They expressed increased self-confidence (II) and support in self-care, but reported a decrease in self-care ability at the 6-month follow-up (III). App usage was high, with the health concern pain triggering the most alerts (IV). Their aspects of health were unchanged at the three assessments points (IV). In this context using an app may increase older persons’ participation in their care. The results show that for some older persons, an app can be implemented as a tool for support in conventional home care.
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| 2. |
- Valgeirsdóttir, Heiddis, 1982-
(författare)
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Polycystic Ovary Syndrome and Pregnancy : Prenatal Exposures and Pregnancy Complications
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of fertile age. The aetiology of PCOS is not fully understood and might be affected by foetal exposures. Women with PCOS have an increased risk of pregnancy complications, but information on rare severe complications is scarce.The overall aim of this thesis was to gain further knowledge of the association between the intrauterine environment and development of PCOS in offspring, and the association between maternal PCOS and adverse pregnancy outcomes, with a focus on preterm birth and stillbirth.This thesis includes three nationwide register-based cohort studies and one matched cohort study including early second-trimester blood samples. Associations were estimated with multivariate Cox, logistic and linear regression models, with adjustment for confounders including body mass index. Correlations were estimated with Spearman’s rank correlation coefficient.It was found that maternal overweight and obesity, and smoking during pregnancy, were associated with increased risk for female offspring to develop PCOS later in life compared with offspring of normal weight and non-smoking mothers, respectively. Size at birth was not associated with the risk of PCOS development. During pregnancy, women with PCOS had higher second-trimester levels of anti-Müllerian hormone (AMH) and testosterone than non-PCOS women, and AMH levels were positively correlated with total testosterone levels. High AMH levels were not associated with an increased risk of pregnancy complications. Women with PCOS seemed at increased risk of extremely, very, and moderately preterm birth compared with non-PCOS women. The association was strongest for extremely preterm birth of spontaneous onset. Women with PCOS also seemed at increased risk of stillbirth compared with non-PCOS women, and the rate of stillbirth in PCOS women was particularly high in term pregnancy.In conclusion, increased maternal BMI and maternal smoking may increase the risk of PCOS in offspring. Even though second-trimester AMH levels are higher in pregnant women with PCOS than controls, AMH seems not to be a mediator of increased risk for pregnancy complications in PCOS women. PCOS should be considered a risk factor for severe pregnancy complications such as extremely preterm birth and stillbirth.
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| 3. |
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| 4. |
- Carlhäll, Sara, 1974-
(författare)
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Maternal obesity, duration of labor and the role of leptin
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process.Material and Methods: Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women.Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses.Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.
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| 5. |
- Probert, Noelle, 1994-
(författare)
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Patients with hip fracture : A decade of morbidity and surgery
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hip fracture is a devastating condition causing excess mortality in older people. Over recent time, incidence has declined while mortality remains unchanged, suggesting changes in morbidity. Swedish national guidelines recommend preoperative full-body disinfection (FBD) to prevent surgical site infection (SSI) despite little evidence, a method causing patients’ substantial pain. The aim of this thesis was to investigate differences in comorbidity, malnutrition, sarcopenia, mortality, surgical characteristics, and functional outcome in patients with hip fracture, ten years apart (I-II). Another aim was to compare preoperative FBD with local disinfection (LD) of the surgical site regarding SSI incidence (III) and experiences of nursing personnel (IV). Patients with hip fracture from 2008 and 2018 (I-II)respectively from 2018 to 2019 (III) and orthopedic nursing personnel (IV) were included. Anthropometric measurements were collected prospectively (I-II) and data from medical records (I-III) and the Swedish hip fracture register (II) were collected retrospectively. Focus group discussions were conducted and analyzed by content analysis (IV). Results suggest increasing levels of comorbidity over time while malnutrition and sarcopenia decreased, potentially explaining the unaltered mortality (I). Concurrently, choice of surgical method seems to have changed, potentially contributing to the seen improvements in functional outcome (II). Study III presented no significant difference in SSI incidence between 2018 (FBD) and 2019 (LD) in the adjusted regression analysis and in study IV nursing personnel testified to an increased wellbeing in patients after the switch to LD. In conclusion, patients who succumb to hip fracture today are not the same as they were yesterday, highlighting the importance of continuous adjustment of treatment and care.
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| 6. |
- Raepsaet, Charlotte, et al.
(författare)
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Promoting and Maintaining Skin Integrity in End-of-Life Care : A Systematic Review
- 2022
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Ingår i: Advances in Skin & Wound Care. - : Lippincott Williams & Wilkins. - 1527-7941 .- 1538-8654. ; 35:11, s. 617-631
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: To systematically review recommendations for promoting and maintaining skin integrity in end-of-life care and their level of evidence.DATA SOURCES: MEDLINE (PubMed interface), CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and The Cochrane Library were systematically searched using a combination of key terms including end-of-life care, skin care, skin hygiene, and skin cleansing.STUDY SELECTION: Articles were included if they (1) described skin care recommendations, including but not limited to the use of skin care products and interventions such as cleansing procedures; and (2) included adult patients who were expected to die within 12 months. There were no restrictions on study design, study setting, or language. Articles with a publication date before 2000 were excluded.DATA EXTRACTION: Two data extraction forms were developed. The first included information about the author, publication year, type of evidence, study topic, sample, sample size, setting, limitations of the study, level of evidence, and quality of the study. The second included recommendations for promoting and maintaining skin integrity in patients at the end of life.DATA SYNTHESIS: Because of methodological heterogeneity, results were synthesized narratively, and no meta-analysis was performed.CONCLUSIONS: The information contained in the recommendations will assist nurses in promoting and maintaining skin integrity in patients at the end of life. More research is needed on end-of-life skin care, with an emphasis on patient-centered, holistic strategies that improve patient well-being and quality of life. In most current research, recommendations are limited to literature reviews and level V evidence. Skin care must balance the promotion and maintenance of skin integrity, wound prevention, and management while promoting patient dignity and quality of life.
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| 7. |
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| 8. |
- Söderman, Annika, 1980-
(författare)
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Evaluating the Swedish Dignity Care Intervention within municipality healthcare : for older persons with palliative care needs
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Palliative care in Sweden is not equal in terms of age, disease, and place of care. An essential value within palliative care is dignity, therefore healthcare emphasizing this value must be prioritized. However, older persons are concerned their dignity would not be considered and dignity interventions are rare. The overall aim of the thesis was to evaluate the Swedish Dignity Care Intervention (DCI-SWE) and its implementation within municipal palliative healthcare in order to conserve older persons’ dignity and quality of life. Methods: Qualitative and mixed methods were used. Data were collected with an integrative review (study I), focus group and individual interviews with community nurses (CNs) (studies II, IV), healthcare professionals and managers (study IV), individual interviews with older persons and relatives (study III), reflective diaries and field notes (studies II, IV), and questionnaires measuring older persons’ dignity-related distress and quality of life (study III). Data were analysed using thematic synthesis (study I), inductive content analysis(study II), inductive thematic analysis and comparative statistical analysis (study III), directed content analysis and descriptive statistical analysis (study IV). Results: Within dignity-conserving care, broad outcomes like dignity-related distress and quality of life have been used. However, communication outcomes should also be considered (study I). The DCISWE has clear benefits if it is used with background of who the older person is and with respect of personal needs (studies II - IV). The feasibility of the DCI-SWE depends on the healthcare organization’s engagement and capacity (studies II, IV). The DCI-SWE can support CNs in communicating with older persons (studies II, IV). However, more communication training is needed, and managers leadership is an important component (studies II, IV). The implementation intervention needs further development, and the use of a behavior change model may be beneficial.
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| 9. |
- Warstedt, Kristina, 1962-
(författare)
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Polyunsaturated fatty acids, maternal and infant immune responses and allergic disease in infancy
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The incidence of allergic diseases in industrialized countries has increased, and a relation between allergy and dietary fatty acids has been proposed. Modulation of the maternal immune function during pregnancy may have an impact on future clinical outcome in the child.Aim: The aim of this thesis was to add knowledge on the relationship between long chain polyunsaturated fatty acids, sensitization and allergic disease and possible immunological events regulating this.Subjects: The thesis is based on results obtained from two cohorts. The first, including 300 cord blood samples collected from 1985-2005. The second, a double-blind placebo controlled multi-centre study comprising 145 families with allergic disease.Methods: Phospholipid fatty acids and total IgE antibodies were analyzed in cord blood samples with gas chromatography and Uni-CAP™, respectively.The families participating in the double-blind placebo controlled multi-centre study were recruited at antenatal units in Linköping and Jönköping and the mothers were supplemented with 2.6 g ω-3 long-chain polyunsaturated fatty acids (LCPUFA) or placebo daily from gestational week 25 until 3 months of breast feeding. Phospholipid fatty acids in maternal serum were analysed before and during the intervention to assess compliance. Prostaglandin E2, leukotrienes B4 and cytokines were analyzed with ELISA technique in supernatants from maternal LPS-stimulated whole blood cultures. Clinical outcome was allergic disease with positive skin prick test and/or specific circulating IgE to food allergens at one year of age. Cytokines, chemokines, SIgA antibodies and prostaglandin E2 were analyzed in breast milk with Luminex and ELISA techniques.Results: The proportions of cord serum linoleic acid (LA, C18:2 ω-6) and α-linolenic acid (LNA, C18:3 ω-3) decreased significantly from 1985 to 2005. However, the LA/LNA ratio did increase, revealing a relatively larger decrease in LNA than in LA. The proportions of both arachidonic acid (AA; C20:4 ω-6) and docosahexaenoic acid (DHA, C22:6 ω-3) as well as other ω-6 and ω-3 fatty acids increased significantly during the same time period. No correlations were found between ω-6 and ω-3 fatty acids and total IgE antibodies.Proportions of ω-3 LCPUFA increased in the ω-3 supplemented group of mothers.Lipopolysaccharide-induced prostaglandin E2 secretion in whole blood culture decreased in a majority of ω-3 PUFA supplemented mothers (18 of 28, p < 0.002).The decreased prostaglandin E2 production was more pronounced among non-atopic than atopic mothers. Lipopolysaccharide induced cytokine and chemokine secretion was not affected. The period prevalence of food allergy was lower in the ω-3 group (1⁄52, 2%) compared to the placebo group (10⁄65, 15%, p <0.05) as well as the incidence of IgE-associated eczema (ω-3 group: 4 ⁄ 52, 8%; placebo group: 15 ⁄ 63, 24%, p < 0.05) at one of year. There were no differences in breast milk cytokine, SIgA and PGE2 levels between the two intervention groups. However, the levels of several cytokines tended to be higher in colostrum from non-atopic ω-3 supplemented mothers as compared to non-atopic placebo supplemented mothers. Higher levels of TGFß2 and SIgA in 3 months milk were associated with allergic disease at one year of age both with and without detectable IgE.Conclusions: Cord blood LA proportions decreased and LA/LNA ratio increased over the 20 year period between 1985 and 2005 this was not related to total IgE. ω-3 fatty acid supplementation of pregnant and lactating mothers resulted in a lower period prevalence of IgE associated eczema and food allergy in the children at one year of age. This was most pronounced in children of non-allergic mothers. The underlying mechanism requires further clarification.
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| 10. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Fifty-year follow-up of childhood epilepsy : Social, psychometric, and occupational outcome
- 2019
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Ingår i: Epilepsy & Behavior. - : Elsevier. - 1525-5050 .- 1525-5069. ; 96, s. 224-228
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this study was to explore and describe the experience of a childhood diagnosis of epilepsy and its consequences for the experiences of daily life over a span of 50 years.METHODS: A descriptive mixed method design was chosen. Data were collected through a survey returned by 86 persons (59% response rate) who had received diagnoses of epilepsy as children. The survey contained questions about education, vocation, family status, and included the 14-item Hospital Anxiety and Depression Scale (HAD). Additionally, interviews (n = 11) were conducted and analyzed by interpretative description.RESULTS: Few persons reported that the childhood diagnosis of epilepsy had affected their choice of education, work, or leisure activities. However, 20% reported that the diagnosis had caused problems in school or at work and had restricted their activities of daily living. Sixty-six percent of the participants were married, and 68% had children; of those, 12 (20%) reported that one or more of the children had also had seizures. Almost all reported no anxiety (82%) and no depression (90%). The results of the interviews revealed a balancing act between 'Controlling and managing the situation' and 'Not being restricted by the condition'.SIGNIFICANCE: This long-term follow-up over a 50-year life-span of persons who received childhood diagnoses of epilepsy suggests that the consequences for education, work, and leisure activities were few. Most of the participants had developed strategies to manage their situation.
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| 11. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Physical touch in nursing and nursing education – an integrative review
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Physical touch is a basic need of all people, regardless of age or life situation. It can provide security, well-being and belonging. But negative perceived physical touch can generate emotions such as fear, vulnerability and perceived as violations. As a consequent of the #metoo movement in the fall of 2017, it’s a risk that physical contact and especially physical touch are avoided by professions where it’s central. For example, in the context of education, studies show that sports teachers in many countries have become more cautious and avoid having physical contact with students due not to being misinterpreted as negative touch (Fletcher, 2013; Öhman, 2016; Piper, Garratt & Taylor, 2013). In healthcare, caregivers who use physical touch in their work with disabled and elderly people have also become insecure and worried that they may be misunderstood (Bergstrand, 2018). A review shows that healthcare professionals see physical touch as part of the work but want to be the initiator of the contact, not that it should be initiated by the patients (Kelly et al. 2018).The use of physical touch in healthcare is also affected by the need to avoid contamination and widespread of infections agents, a question with extra relevance in the light of the Covid-19 pandemic.There is currently a lack of knowledge about how physical touch is experienced and used. As a first step is to increase the knowledge and understanding of how physical touch is experienced and used in healthcare by mapping studies explored physical touch both in daily care but also from the perspective of nursing students. With increased knowledge, a basis for developing interventions/teaching modules can be generated.
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| 12. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Using a Facebook Forum to Cope With Narcolepsy After Pandemrix Vaccination : Infodemiology Study
- 2019
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 21:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, newly diagnosed narcolepsy cases among children and adolescents were seen in several European countries as a consequence of comprehensive national vaccination campaigns with Pandemrix against H1N1 influenza. Since then, a large number of people have had to live with narcolepsy and its consequences in daily life, such as effects on school life, social relationships, and activities. Initially, the adverse effects were not well understood and there was uncertainty about whether there would be any financial compensation. The situation remained unresolved until 2016, and during these years affected people sought various ways to join forces to handle the many issues involved, including setting up a social media forum.Objective: Our aim was to examine how information was shared, and how opinions and beliefs about narcolepsy as a consequence of Pandemrix vaccination were formed through discussions on social media.Methods: We used quantitative and qualitative methods to investigate a series of messages posted in a social media forum for people affected by narcolepsy after vaccination.Results: Group activity was high throughout the years 2010 to 2016, with peaks corresponding to major narcolepsy-related events, such as the appearance of the first cases in 2010, the first payment of compensation in 2011, and passage of a law on compensation in July 2016. Unusually, most (462/774, 59.7%) of the group took part in discussions and only 312 of 774 (40.3%) were lurkers (compared with the usual 90% rule of thumb for participation in an online community). The conversation in the group was largely factual and had a civil tone, even though there was a long struggle for the link between the vaccine and narcolepsy to be acknowledged and regarding the compensation issue. Radical, nonscientific views, such as those expounded by the antivaccination movement, did not shape the discussions in the group but were being actively expressed elsewhere on the internet. At the outset of the pandemic, there were 18 active Swedish discussion groups on the topic, but most dissolved quickly and only one Facebook group remained active throughout the period.Conclusions: The group studied is a good example of social media use for self-help through a difficult situation among people affected by illness and disease. This shows that social media do not by themselves induce trench warfare but, given a good group composition, can provide a necessary forum for managing an emergency situation where health care and government have failed or are mistrusted, and patients have to organize themselves so as to cope.
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| 13. |
- Brorson, Lars-Olov, et al.
(författare)
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Fifty years' follow-up of childhood epilepsy : Medical outcome, morbidity, and medication
- 2019
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Ingår i: Epilepsia. - : Wiley-Blackwell. - 0013-9580 .- 1528-1167. ; 60:3, s. 381-392
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the long‐term prognosis of childhood epilepsy, with special emphasis on seizure remission, relapse, medication, associated neurologic impairment, mortality rate, and cause of death.Methods: A prospective longitudinal study on a population‐based total cohort of 195 children with epileptic seizures in 1962‐1964. Data were collected from medical records and a questionnaire.Results: Follow‐up data from 94% of the initial cohort showed the best long‐term prognosis for seizure freedom for children with no intellectual or neurologic impairment. These children had later seizure onset, shorter total duration of epilepsy, and were more often medication free. Only a few of them had isolated relapses. Generalized, rather than focal, epilepsy was associated with fewer relapses and less ongoing medication. The “true incidence” group, with onsets during the inclusion period of 1962‐1964, had the best long‐term prognosis for seizure freedom, with 90% seizure‐free after 50 years. Although only 10% of this group had ongoing seizures at follow‐up, 22% still used anticonvulsive medication, often with old drugs, that is, phenobarbital or phenytoin, as one of the anticonvulsive drugs. The standardized mortality ratio (SMR) was 2.61 for the whole group, with no difference between those with or without other neurodeficits. Those who died young either had neurologic impairment or died from epilepsy‐related conditions; later deaths often followed non–epilepsy‐related conditions. No one in the incidence group died of SUDEP (sudden unexpected death in epilepsy).Significance: This 50‐year, long‐term follow‐up of a cohort of persons with childhood epilepsy in general demonstrates a better outcome for seizure freedom compared to our follow‐up after 12 years and to previous reports. We also report a low incidence of seizure relapses. Remission of seizures does not automatically lead to termination of medication. The mortality rate associated with SUDEP was lower than previously reported.
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| 14. |
- Brorson, Lars-Olov, et al.
(författare)
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Fifty years’ follow up of childhood epilepsy - medical and psycho-social outcomes
- 2020
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Konferensbidrag (refereegranskat)abstract
- Purpose: To describe the long-term prognosis of childhood epilepsy in general, with special emphasis on seizure remission, relapse, medication, associated neurological impairment, mortality rate, cause of death, the experience of a childhood diagnosis of epilepsy and its consequences for the experiences of daily life.Methods: A prospective longitudinal study on a population-based total cohort of 195 children with epilepsy in 1962-1964. Data were collected from medical records, questionnaires and additional interviews were conducted. Results: Follow-up data from 94% of the initial cohort showed the best long-term prognosis for seizure freedom for children with no intellectual or neurological impairment. These children had later seizure onset, shorter total duration of epilepsy and, they were more often medication free. Generalized, rather than focal, epilepsy had a better outcome. Ninety per cent, with onset during the inclusion period 1962-1964, were seizure-free after 50 years. No one in this group died in SUDEP. The standardized mortality ratio (SMR) was 2. 61. Death at young age was due to neurological impairment or epilepsy-related conditions whereas later deaths often followed non–epilepsy-related conditions. Few persons reported that the childhood diagnosis of epilepsy had affected their choice of education, work or leisure activities. However, 20% reported that the diagnosis had caused problems in school or at work and had restricted their activities of daily living. Almost all reported no anxiety (82%) and no depression (90%). The interviews revealed a good balance between ‘Controlling and managing the situation’ and ‘Not being restricted by the condition’.Conclusion: This 50-year, long-term, follow-up of a cohort of persons with childhood epilepsy in general demonstrates a better outcome for seizure freedom, relapses and minor consequences for education, work and leisure activities than earlier reported. Most of the participants had developed strategies to manage their situation.
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| 15. |
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| 16. |
- Chaplin, John, et al.
(författare)
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Varför ska du använda PROMIS? : Nytt system för patientrapporterad utfallsmått
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PROMIS är ett itembanksystem för hälso- och sjukvården. Syftet är att erbjuda moderna, patientrapporterade mått som kan användas för flertalet patientgrupper till en mycket låg kostnad och med ett nationellt supportsystem.En itembankär en modern form av elektronisk enkät som kan innehålla ett stort antal enkätfrågor. Ett datorprogram väljer ut de mest lämpade frågorna till varje person utifrån dennes svar på föregående frågor, på så sätt enkäten individanpassas.
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| 17. |
- Eriksson, Mats, Professor, 1959-, et al.
(författare)
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Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? an international survey
- 2024
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Background: Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload.Objectives: This study aimed to investigate the association between primary care practices’ organization, and quality and safety changes during the COVID-19 pandemic.Design: Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as “Only GPs”, comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and “Multiprofessional,” comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936).Results: Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more “Multiprofessional” practices, whereas “Only GPs” were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic.Conclusions: Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.
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| 18. |
- Ewertsson, Mona, 1958-
(författare)
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Lärande av praktiska färdigheter inom sjuksköterskeprofessionen : studier av lärande i olika arenor
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A central part of the nursing profession is the performance of practical skills. In order to provide adequate care, maintain patient-safety, and feel comfortable in the profession, registered nurses (RNs) need to be equipped with requisite skills. Overall aim: To explore and describe how learning and development of practical skills occurs during the preparatory phases and within the nursing profession. Method: Qualitative (I, III, IV) and quantitative methods (II) were used. Data were collected through individual interviews (I, IV), questionnaires (II) and participant observations, including informal talks (III, IV). Results: Both students and new RNs expressed a need to learn and develop practical skills (I, II, III, IV). Less than half of the new RNs had access to a clinical skill laboratory (CSL), where they could learn and practice practical skills (II). The students described that learning at a CSL had been meaning for their clinical practice. They also expressed a great need for continuing learning in real patient situations (I, III, IV). During clinical practice, preceptors and students took different approaches which affected student’s learning processesö (I, III, IV). There was a tension between learning at a CSL and learning in clinical practice sites because students perceived differences in the performance of skills. Students described that they understood that performance of skills could be done in different ways without injuring patients. However, the data also showed deviations in performances that could jeopardize patientsafety. In these situations, student’s behavior differed (I, IV). One third of new RNs deviated from evidence based guidelines when they performed practical skills which they were unfamiliar with (II). Both students and new RNs reported that reflection in connection with the performance of practical skills was not common (I, II III, IV). Conclusions: Cooperation between university CSLs and clinical settings must be intensified in order to enhance the understanding of learning processes regarding practical skills. A consensus regarding academic approaches should be reached. Universities need to support preceptors in educational issues where the importance of reflection is clarified and exemplified. Increasing patient-safety requires that new RNs receive opportunities for training in artificial environments, and that a culture that reinforces the use of guidelines and a reflective stance is cultivated.
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| 19. |
- Larsson, Anna-Karin, 1975-
(författare)
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Early life cytokines, viral infections and IgE-mediated allergic disease
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The reasons why some individuals become IgE-sensitised and allergic are largely unknown, though genetic- and early life environmental factors seem to be of importance.Objective: The overall aim of this thesis was to investigate the relationship between IgE-sensitisation and allergic disease, viral infections, genetic markers and early life cytokines.Results: IgE-sensitised children were found to have reduced numbers of IL-12 producing cord blood mononuclear cells (CBMC), whereas children diagnosed with eczema were found to have reduced numbers of IFN-γ producing CBMC. When dividing the children into early onset of IgE-sensitisation and late onset of IgE-sensitisation we found that the children with an early onset had low numbers of PHA-induced IL-4, IL-12 and IFN-γ secreting CBMC. At the age of two there was a general exacerbation of cytokine responses in the IgE-sensitised children, and the results were similar for the children with early onset IgE-sensitisation. Children with a late onset IgE-sensitisation were more similar to the non-sensitised children, but with a specific increase in the response to cat allergen (IL-4 and IFN-γ). The mothers of IgE-sensitised children, were just as their children, found to have an exaggerated cytokine response as compared to mothers of non-sensitised children. Maternal responses correlated well to the responses seen in the child, though the samples were taken two years after delivery.Cytomegalovirus (CMV) infection in early life was associated to reduced numbers of IL-4, and increased numbers of IFN-γ producing cells at the age of two. No association between CMV seropositivity and IgE-sensitisation was seen. Epstein-Barr virus (EBV) infection, on the other hand, was inversely correlated with IgE –sensitisation, whereas no statistically significant association to cytokine production could be seen.We also showed that the IL12B 1188 C-allele was associated to having a positive skin prick test at the age of two. The rare alleles of the three SNPs investigated (IL12B 1188C, IL12RB1132C and IRF1 1688A) were all associated to low IL-12 production at birth.Conclusions: Our results indicate that allergic diseases are complex traits, and that both the genetic and the cytokine background differ between the different allergic diseases. We can also conclude that the time of onset seem to play a role when investigating IgE-sensitisation, and that perhaps early and late onset IgE-sensitisation have partly different causes. CMV and EBV infection early in life are associated to a protective cytokine profile and to protection from IgE-sensitisation, respectively, again indicating the heterogeneity and the complexity of allergic diseases.
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| 20. |
- Oldgren, Jonas, 1964-, et al.
(författare)
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Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study
- 2021
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 28:3, s. 250-259
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Tidskriftsartikel (refereegranskat)abstract
- Background It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. Design The design of this study was as a cross-sectional analysis from a population-based study cohort. Methods From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Results Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have >1 carotid plaques (1.67 (1.61-1.74)). Conclusion Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.
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| 21. |
- Pettersson, Miriam, 1977-, et al.
(författare)
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Home phototherapy for hyperbilirubinemia in neonates : an unblinded multicentre randomised controlled trial
- 2023
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Ingår i: Örebro University's Nobel Day Festivities. - 9789187789922
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: The aim of this study was to assess whether home phototherapy is a safe alternative to hospital treatment.Method: This was a randomised controlled, multicentre, trial in which term newborns with a total serum bilirubin of 300-400 μmol/ were randomized to either home phototherapy or conventional in-hospital phototherapy.The outcome measurements were parent-infant bonding, stress and measurements of safety and feasibility. A descriptive qualitative study based on interviews was performed as well as a health economic analysis.Result: 147 patients were recruited from 6 hospitals, Results showed no difference between groups in the safety and feasibility outcomes. Parents in the intervention group had better scores on bonding and lower levels of stress. The interviews showed that parents felt secure at home. The cost per patient was €337 for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 or 71% per patient.Conclusion: Home phototherapy can be considered a safe and feasible alternative to hospital care for well selected patients. It improves bonding and stress for parents and reduces health care costs. Since the first publication from this study was published home phototherapy is now recommended by the American Academy of Pediatrics as an alternative to hospital care for patients with uncomplicated hyperbilirubinemia.
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| 22. |
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| 23. |
- Pettersson, Miriam, 1977-, et al.
(författare)
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Parental experiences of home phototherapy for neonatal hyperbilirubinemia
- 2023
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Ingår i: Journal of Child Health Care. - : Sage Publications. - 1367-4935 .- 1741-2889. ; 27:4, s. 562-573
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Tidskriftsartikel (refereegranskat)abstract
- Newborns with hyperbilirubinemia have traditionally received phototherapy in hospital. Hospital stays for infants, however, may negatively affect parent–infant bonding and induce anxiety and feelings of powerlessness in mothers. This study examined parent’s experiences of providing phototherapy to their neonates at home instead. A descriptive qualitative study based on 15 interviews (8 mothers and 7 fathers) with parents of 8 children who had been randomised to home phototherapy was conducted during spring 2018 in Örebro county, Sweden. Inductive content analysis was used. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood and accessing information. The findings support the use of home phototherapy. Parents felt secure at home with their infants and emphasised the importance of clear information and round-the-clock access to hospital staff.
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| 24. |
- Pålsson, Ylva, 1971-
(författare)
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A pathway into the profession : The use, feasibility and outcomes of a peer learning intervention for nursing students and newly graduated nurses
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of present thesis was to study the use, feasibility and outcomes of a peer learning intervention for nursing students and new graduates, including studies using a quasi-experimental (Study I and III), descriptive (Study II) and mixed-methods (Study IV) design. Data were collected using questionnaires, observations, checklists for intervention fidelity, individual interviews and group interviews. When studying peer learning outcomes among nursing students, peer learning seems to have a significant interaction effect on self-efficacy, based on a comparison of changes over time between the intervention (n=42) and comparison (n=28) groups. Studying each group separately over time, significant improvements were found in the intervention group on thirteen of the twenty variables, whereas the comparison group improved on four (Study I). Observations of how nursing students (n=16) used peer learning revealed that the student pairs collaborated to different extents and in different ways. All students were observed practicing several competencies together (Study II). Testing the peer learning model in new graduates’ workplace introduction (n=10) revealed that new graduates’ descriptions of peer learning were consistent with the theoretical description (Study III). Feasibility was tested in relation to compliance and acceptability, and lessons were learned. In Study IV, fidelity to the intervention was generally good. When first-line managers (n=8) described their perception of using the peer learning intervention with new graduates, predominantly positive outcomes were expressed. When examining the effect of peer learning in workplace introduction for newly graduated nurses (n=35), it was difficult to draw any conclusions due to recruitment problems (Study IV). The conclusions is that peer learning is a useful model for nursing students’ that seems to improve self-efficacy more than traditional supervision does. The model gives nursing students opportunities to practice several competencies on each other, and these competencies, e.g., leadership and organizational skills are useful in their future profession. The students practice teaching and supervision skills on each other, which seems to be a natural part of the peer relationship. Peer learning in the context of new graduates’ workplace introduction describes in a way consistent with the theoretical description of peer learning outcomes thus, also here it seems as a useful model. When developing and testing new interventions such as peer learning, it is important to do so systematically to minimize problems when conducting an evaluation, where the MRC framework can be useful. First-line managers generally expressed a positive attitude toward the peer learning model.
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| 25. |
- Rask, Marie
(författare)
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Women receiving notification of an abnormal Pap smear result : experiences and impact on health-related quality of life
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of this thesis was to investigate experiences of receiving notification of an abnormal Pap smear result and its impact on women’s health-related quality of life as well as to investigate women’s awareness of human papillomavirus.Methods: In total, 176 women and 20 healthcare professionals participated. Data were collected through individual interviews (I, II) and a questionnaire (IV) including the instrument Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) and Hospital Anxiety and Depression Scale (HADS). For the translation and cross-cultural adaptation of the FACIT-CD, and for evaluation of its linguistic validity and reliability, cognitive debriefing interviews and a questionnaire consisting of the Swedish instrument FACIT-CD was used. Data were analysed by content analysis (I, II) and by using statistical analysis (III, IV), while one part (III) was analysed according to FACIT translation methodology. Results: Women receiving notification of an abnormal Pap smear result have good overall HRQoL; they become anxious but not depressed. Reasons for anxiety were mainly that women misinterpreted the result as cancer, which could lead to lower attendance for further investigation, treatment and follow-up. To cope with the anxiety, women sought emotional support and information. They primarily used the Internet for information but also turned to healthcare professionals for information needs. Moreover, women had low awareness of HPV, its sexually transmitted nature, and its relationship to abnormal Pap smear results and cervical cancer. An awareness of HPV as a sexually transmitted infection did not lead to higher level of anxiety or more depression symptoms or worse HRQoL, compared to not being aware. Finally, the Swedish FACIT-CD is equivalent to the English version and linguistically valid and exhibited good internal consistency reliability.Conclusion: Women have low awareness of HPV and abnormal Pap smear results, whereupon they misinterpret their test result as cancer. It is of importance that women understand their test result, in order to minimise anxiety as well as to maintain high attendance for investigation, treatment and follow-up of abnormalities.
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| 26. |
- Runngren, Eva, 1963-, et al.
(författare)
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Attitudes and knowledge about HPV vaccination of school children and their parents following a targeted information
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: This study aimed to investigate children’s’ and parents’attitudes and knowledge about HPV (human papilloma virus) following introductionof gender neutral HPV vaccination in the national immunization program (NIP) inSweden. An evaluation of a tailored information package for parents and childrenlaunched by the Public Health Agency (PHAS) alongside the introduction of genderneutral HPV vaccination was also performed.Method: In total, 276 parents and 206 children from 22 School Health Servicesresponded to a web-based survey, spring 2021 to January 2022.Result: Overall, parents (78%) perceived HPV vaccination to be of importance fortheir child’s health. About half of the participating children and two thirds of theparents had used the tailored information package for the HPV vaccination. The factsheet was mostly used by parents (55%) and children (20%) and also perceived as easyto understand (99% and 68% respectively). For both children and parents the schoolnurse (70% respectively) was the primary source for information. The teacher (59%)was also a common source of information of HPV vaccination for the children.Conclusion: The school health nurse is essential for informing about HPV vaccinationfor both children and parents. There is a need to strengthen the knowledge regardingHPV vaccination among teachers as they also are a key source of information for themajority of the children. Additional interventions are needed to support parents inmaking informed decisions for HPV vaccinations.POSTER 1Page 1
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| 27. |
- Runngren, Eva, 1963-, et al.
(författare)
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Attitudes and knowledge about HPV vaccination of school children and their parents following use of a targeted information
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: This study aimed to investigate children’s’ and parents’ attitudes and knowledge about HPV (human papillomavirus) following introduction of gender-neutral HPV vaccination in the national immunization program (NIP) in Sweden. An evaluation of a tailored information package for parents and children launched by the Public Health Agency (PHAS) alongside the introduction of gender-neutral HPV vaccination was also performed Method: In total, 276 parents and 206 children from 22 School Health Services responded to a web-based survey, spring 2021 to January 2022. Result: Overall, parents (78%) perceived HPV vaccination to be of importance for their child’s health. About half of the participating children and two thirds of the parents had used the tailored information package for the HPV vaccination. The fact sheet was mostly used by parents (55%) and children (20%) and also perceived as easy to understand (99% and 68% respectively). For both children and parents, the school nurse (70% respectively) was the primary source for information. The teacher (59%) was also a common source of information of HPV vaccination for the children. Conclusion: The school nurse is essential for informing about HPV vaccination for both children and parents. There is a need to strengthen the knowledge regarding HPV vaccination among teachers as they also are a key source of information for the majority of the children. Additional interventions are needed to support parents in making informed decisions for HPV vaccinations.
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| 28. |
- Runngren, Eva, 1963-, et al.
(författare)
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Balancing Between Being Proactive and Neutral : School Nurses’ Experiences of Offering Human Papilloma Virus Vaccination to Girls
- 2022
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Ingår i: Journal of School Nursing. - : Sage Publications. - 1059-8405 .- 1546-8364. ; 38:3, s. 270-278
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the experiences of Swedish school nurses when they offered the human papilloma virus (HPV) vaccination to girls aged 10–12 years. Four focus groups with a total of 17 school nurses were conducted and analyzed using inductive content analysis. The results showed that the school nurses were balancing between keeping a neutral role and the need to increase the uptake of the HPV vaccination. They described the consent forms and information that they gave the girls and their parents to help them make an informed decision about the vaccination. There were also ethical and moral dilemmas that arose with regard to the HPV vaccinations. Our findings demonstrate the need to provide school nurses with clear guidelines and support, so they can play an active role in interacting with the girls and their parents when they offer the HPV vaccination.
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| 29. |
- Runngren, Eva, 1963-, et al.
(författare)
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Parents’ reasoning about HPV vaccination in Sweden
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 36:4, s. 1113-1122
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this study was to describe parents’ reasoning in making decisions about vaccinating their daughters against human papilloma virus (HPV), a part of the Swedish vaccination programme.Method: Twenty parents whose daughter had been offered HPV vaccination participated. Semi-structured individual interviews were conducted and analysed using thematic analysis.Results: The findings reveal that the decision-making process is complex. The parents trusted the vaccination programme and saw it as beneficial to society. They also described using different resources to decide about HPV vaccination, but they did not include their daughters in making the decision.Discussion: Parents need better vaccine and health literacy to be able to decide, based on evidence and in consultation with their daughters, on HPV vaccination. School nurses can play an important role in evidence-based decision-making about HPV vaccination and introducing children to this health-promoting intervention.
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| 30. |
- Runngren, Eva, 1963-, et al.
(författare)
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School nurse’s experiences of offering HPV vaccination to young girls in a Swedish vaccination program
- 2019
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Konferensbidrag (refereegranskat)abstract
- Background: In the Swedish school health system, girls 10-12 years old are vaccinated for Human Papillomavirus (HPV) with a vaccination coverage of 80%, which is less than other vaccinations in the national child vaccination program according to The Public Health Agency of Sweden. The aim of this study was to describe school nurse’s experience of offering HPV vaccination to girls, age 10-12 years old.Methods: Focus group interviews (n=4) with school nurses (n=17) working in rural and urban areas. The analysis was based on Elo & Kyngäs content analysis.Results: The school nurses had different strategies, abilities and presumptions when offering HPV vaccination. There were various ways to inform parents and girls about HPV and HPV vaccination, but commonly they use information from the school health systems guidelines. It was found that school nurses experienced that there was a lack of knowledge about HPV among both school nurses, parents, girls. One of the problems that the school nurses had was to get the written consent from the parent. Without the written consent, the vaccination will not be performed.Conclusions: The school nurse's vaccination assignment is complex. There are several factors that are important before the vaccination itself can be carried out. How it is performed differs between the school nurses depending on strategy, ability and presumption. The results indicate that an increased knowledge and support in the daily work with HPV vaccination is needed in order to increase the HPV vaccination coverage in the long term.
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| 31. |
- Sezgin, Duygu, et al.
(författare)
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Defining palliative wound care : A scoping review by European Association for Palliative Care wound care taskforce
- 2023
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Ingår i: Journal of tissue viability. - : Elsevier. - 0965-206X. ; 32:4, s. 627-634
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management.OBJECTIVES: To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review.ELIGIBILITY CRITERIA: Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English.SOURCES OF EVIDENCE: The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar.CHARTING METHODS: A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS: A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care.CONCLUSIONS: Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION: A review protocol was developed but not registered.
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| 32. |
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| 33. |
- Wätterbjörk, Inger, 1955-
(författare)
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Couples' experiences of an extended information visit about prenatal screening : decision making and satisfaction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe pregnant women's and partners' views and experiences on early prenatal screening with the combined test, with special focus on the two-step information model.Interviews were performed with 15 couples who had taken part in the extended information visit about prenatal screening, describing their perceptions of the information model (I) and ten couples or women of those, for a follow-up interview exploring their decision-making process (II). Seven couples, who had not taken part in the extended information visit, were interviewed describing their views and experiences about prenatal screening (III). A questionnaire was answered by 295 women and by 223 partners about their satisfaction about the decision whether or not to participate in the combined test, and their assessment of whether or not this choice had been difficult (IV).The results showed that different opinions were expressed about the offer of the extended information visit. The separate visit was welcomed by most couples (I). The decision-making process regarding whether to take part in the test or not was described by most couples as a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration (II). An apprehension of the test, by some of those who had refrained the extended information visit, was that it was an expression of society's involvement in decisions that belong to the expectant parents (III). Ninety-three percent of both women and partners considered the decision about participating in the combined tests as uncomplicated, and well over 90%, of both women and partners were satisfied with their decision (IV).The conclusions in this thesis, are that the decision whether or not to participate in the combined test is multidimensional and influenced by different views. The two-step information model helped the pregnant woman and the partner to make a decision in a fairly straightforward process or a more complex process with mixed feelings.
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