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1.	Alakukku, Laura, et al. (författare) Maatalouden ympäristötuen vaikuttavuuden seurantatutkimus (MYTVAS 3) : loppuraportti 2014 Rapport (övrigt vetenskapligt/konstnärligt)abstract Since 1995, agri-environmental support partly funded by the EU has formed the core of Finland’s agri-environmental policy. This system has had a variety of impacts on the relationship between agriculture and the environment. Today’s agri-environmental support is one of the packages included in the Rural Development Programme for Mainland Finland (2007–2013/2014), which both in itself and through the underlying EU legislation requires monitoring of the impacts of the measures implemented. The study monitoring the impact of the 2nd Finnish agri-environmental scheme (MYTVAS 3), which ran from 2008 to 2013, forms part of this monitoring. The MYTVAS 3 monitoring study was also financed by the Ministry of the Environment. The monitoring study was carried out by a consortium coordinated by MTT Agrifood Research Finland and including the Finnish Environment Institute (SYKE), the University of Helsinki, the Finnish Game and Fisheries Research Institute and the University of Turku.The purpose of the MYTVAS 3 monitoring study was to find out how agri-environmental support and its various measures have affected the state of the environment in agricultural areas, how agri-environmental support has affected the potential for farming and how agri-environmental support should be developed to increase its impact. The monitoring focused on the impacts of agri-environmental support on the nutrient load from agriculture on the waterways and on biodiversity. When evaluating the findings presented, we should remember that while monitoring data shows that something happened, it does not necessarily explain what caused it. It is not always possible to show that particular developments were a specific outcome of the current agri-environmental support system and the implementation of its measures. The delay between a measure and its observed impact is often long, and the cause-and-effect relationships are complicated and partly unknown. Also, other agricultural policy and fluctuations on the market may affect the state of the agricultural environment directly or indirectly.The monitoring data show that agri-environmental support has not had a detrimental impact on the potential for farming. Despite a slight increase in the incidence of weeds, they do not cause problems of the kind that would require amendments to the content of agri-environmental measures. Carbon levels in the surface stratum of arable land seems to be continuing their slow decline, and there is still need for measures to preserve organic material in the soil.Compliance with the fertilisation limits in the agri-environmental support system would seem to have had very little impact on crop quality. Variations in the weight and protein content per hectolitre and per 1,000 seeds were of the same order between 2006 and 2012 as they were between 1995 and 2005. Crop quantities have also not been noticeably affected by compliance with the fertilisation limits. Average crop yields remained stable between 1986 and 2013, and no clearly different crop years were observed in the 2000s. It is possible, however, that the lower fertilisation levels could have lowered crop potential in the years with advantageous weather conditions in the 2000s and that protein contents have been lower in advantageous years.The monitoring data also show that the nutrient load potential of agriculture, measured by nutrient balances, has decreased continuously for nitrogen and particularly for phosphorus. The decrease in the nutrient load potential is due above all to a decrease in the use of synthetic fertilisers. The decline in nitrogen fertilisation has bottomed out in recent years, and low protein levels measured in high crop yield years show that there is no point in further reducing nitrogen fertilisation. Optimising nitrogen fertilisation according to how advantageous the growing season is and effectively using the soluble nitrogen in cattle manure are key measures in achieving reasonable nitrogen balances and good crop quality despite fluctuations in growing season conditions. New crop variants have been found to make more efficient use of nitrogen than old ones, and thus the introduction of new variants should be promoted. Despite the decrease in the nutrient balances, there are indications that nutrient loads in runoff water from domestic animal production sites are becoming an increasing problem. Indeed, the fundamental problem with the nutrient load from agriculture is the diversification of livestock farming and crop farming, which has made it more difficult to use nutrients appropriately. Therefore attention must be paid to measures that both boost the use of nutrients in manure and reduce the levels of nutrients that end up in manure. Based on nutrient load monitoring in the catchment areas of rivers, the phosphorus load per hectare of cropland has decreased in each programme period, being about 80% of the level of the first period (1995–1999) in the third period (2007–2013). Because of the increase in the area of cropland, the nitrogen load on waterways from agriculture continued to grow during the second programme period (2000–2006) but peaked in the third (2007–2013). A similar trend was found in the nitrogen load per hectare of cropland.The most important threat to biodiversity is caused by the development of landscape structure, typically involving a decrease in the number of open or half-open areas excluded from actual cultivation. The consequence of the clearing of margins and ecological islands located in crop fields, drainage measures aimed at increasing arable land and all rationalisation of cultivated areas is the diminishing of exactly those areas that are the most important from the perspective of the biodiversity of the agricultural environment. However, the measure-specific findings in the monitoring study show that biodiversity benefits have been locally achieved where measures have been implemented on a broad enough scale (biodynamic farming, traditional biotopes, wetlands, buffer zones, green fallow / nature management areas). Particular care should therefore be taken that all cultivated land continues to have a sufficient percentage of non-cultivated areas, whether they be natural meadows, nature management areas, biodiversity strips, buffer zones, filter strips, headlands, ecological islands, etc. Including the rather popular nature management areas as a new voluntary measure under basic measures was a significant contribution to biodiversity.Regarding the rural landscape, it may be noted that by visual inspection the area of cropland has remained largely unchanged, at the level of the landscape as a whole it is far more common for the landscape to become more closed than to become more open. This trend was also observed in the visual inspection of traditional biotopes, even if the openness of the meadows monitored largely remained unchanged.The only measures that directly address the reduction of gaseous emissions in the agri-environmental support system are the longterm grass cultivation on peat fields and special aid agreements for slurry injection in cropland. While other measures have indirectly affected gaseous emissions, the impact of agri-environmental support as a whole on reducing gaseous emissions from agriculture has been negligible. In general, we may conclude that the goals, content and support levels of agri-environmental support measures must be increasingly adapted and customised by region, by type of farming and by farm, because both the state of the agricultural environment and the needs of society differ greatly between different types of rural area.
2.	Aaltonen, Kirsimari, et al. (författare) Familial breast cancers without mutations in BRCA1 or BRCA2 have low cyclin E and high cyclin D1 in contrast to cancers in BRCA mutation carriers 2008 Ingår i: Clinical Cancer Research. - 1078-0432 .- 1557-3265. ; 14:7, s. 1976-83 Tidskriftsartikel (refereegranskat)abstract PURPOSE: We analyzed the expression of critical cell cycle regulators cyclin E and cyclin D1 in familial breast cancer, focusing on BRCA mutation-negative tumors. Cyclin E expression in tumors of BRCA1 or BRCA2 carriers is higher, and cyclin D1 expression lower, than in sporadic tumors. In familial non-BRCA1/2 tumors, cyclin E and cyclin D1 expression has not been studied. EXPERIMENTAL DESIGN: Cyclin E and cyclin D1 immunohistochemical expression was studied in tissue microarrays consisting of 53 BRCA1, 58 BRCA2, 798 familial non-BRCA1/2, and 439 sporadic breast tumors. RESULTS: In univariate analysis, BRCA1 tumors had significantly more frequently high cyclin E (88%) and low cyclin D1 (84%) expression than sporadic (54% and 49%, respectively) or familial non-BRCA1/2 (38% and 45%, respectively) tumors. BRCA2 tumors had significantly more frequently low cyclin D1 expression (68%) than sporadic or familial non-BRCA1/2 tumors and significantly more frequently high cyclin E expression than familial non-BRCA1/2 tumors. In a logistic regression model, cyclin expression, early age of onset, and estrogen receptor (ER) and human epidermal growth factor receptor-2 (HER2) status were the independent factors most clearly distinguishing tumors of BRCA1 mutation carriers from other familial breast cancers. High cyclin E and low cyclin D1 expression were also independent predictors of BRCA2 mutation when compared with familial non-BRCA1/2 tumors. Most interestingly, lower frequency of high cyclin E expression independently distinguished familial non-BRCA1/2 tumors also from sporadic ones. CONCLUSIONS: Cyclin E and cyclin D1 expression distinguishes non-BRCA1/2 tumors from both sporadic and BRCA1- and BRCA2-associated tumors and may reflect different predisposition and pathogenesis in these groups.
3.	Aaltonen, Kirsimari, et al. (författare) High cyclin B1 expression is associated with poor survival in breast cancer 2009 Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 100:7, s. 1055-60 Tidskriftsartikel (refereegranskat)abstract Cyclin B1 regulates the G(2)-M transition of the cell cycle. Cyclin B1 expression is higher in premalignant and malignant than normal breast lesions. Correlation of cyclin B1 expression with other histopathological variables and prognostic role in breast cancer are not fully understood. Traditionally used prognostic criteria identify large subset of patients to receive adjuvant chemotherapy and to be exposed to adverse effects. A reliable and simple method helping prognostic evaluation in breast cancer is needed. We analysed cyclin B1 expression on 1348 invasive breast cancers and studied correlations with other histopathological variables and survival. High cyclin B1 correlated with high tumour grade, large tumour size and positive nodal status, oestrogen and progesterone receptor negativity, positive HER2 and p53 status, young age at diagnosis, and high cyclin E, cyclin A and Ki67 expression. Among patients not given adjuvant chemotherapy high cyclin B1 was a strong predictor of shorter overall and metastasis-free survival (RR 3.74, P<0.0005 and RR 3.51, P<0.0005, respectively), and remained as an independent prognostic factor also in multivariate analysis (RR 1.80, P=0.04 and RR 2.31, P=0.02, respectively). This study suggests high cyclin B1 associates with aggressive phenotype and is an independent prognostic factor in breast cancer.
4.	Bartkova, Jirina, et al. (författare) Aberrations of the MRE11-RAD50-NBS1 DNA damage sensor complex in human breast cancer : MRE11 as a candidate familial cancer-predisposing gene 2008 Ingår i: Molecular Oncology. - : Wiley. - 1574-7891. ; 2:4, s. 296-316 Tidskriftsartikel (refereegranskat)abstract The MRE11, RAD50, and NBS1 genes encode proteins of the MRE11-RAD50-NBS1 (MRN) complex critical for proper maintenance of genomic integrity and tumour suppression; however, the extent and impact of their cancer-predisposing defects, and potential clinical value remain to be determined. Here, we report that among a large series of approximately 1000 breast carcinomas, around 3%, 7% and 10% tumours showed aberrantly reduced protein expression for RAD50, MRE11 and NBS1, respectively. Such defects were more frequent among the ER/PR/ERBB2 triple-negative and higher-grade tumours, among familial (especially BRCA1/BRCA2-associated) rather than sporadic cases, and the NBS1 defects correlated with shorter patients' survival. The BRCA1-associated and ER/PR/ERBB2 triple-negative tumours also showed high incidence of constitutively active DNA damage signalling (gamma H2AX) and p53 aberrations. Sequencing the RAD50, MRE11 and NBS1 genes of 8 patients from non-BRCA1/2 breast cancer families whose tumours showed concomitant reduction/loss of all three MRN-complex proteins revealed two germline mutations in MRE11: a missense mutation R202G and a truncating mutation R633STOP (R633X). Gene transfer and protein analysis of cell culture models with mutant MRE11 implicated various destabilization patterns among the MRN complex proteins including NBS1, the abundance of which was restored by re-expression of wild-type MRE11. We propose that germline mutations qualify MRE11 as a novel candidate breast cancer susceptibility gene in a subset of non-BRCA1/2 families. Our data have implications for the concept of the DNA damage response as an intrinsic anti-cancer barrier, various components of which become inactivated during cancer progression and also represent the bulk of breast cancer susceptibility genes discovered to date.
5.	Berglund, Annika, et al. (författare) Factors facilitating or hampering nurses identification of stroke in emergency calls 2015 Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 71:11, s. 2609-2621 Tidskriftsartikel (refereegranskat)abstract Aims. To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position.Background. Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke.Design. A qualitative study using interpretive phenomenology.Methods. Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position.Findings. Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own.Conclusion. To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.
6.	Berglund, A., et al. (författare) Obstacles and facilitators in emergency calls about stroke : Nurses' skills enable identification of stroke 2015 Ingår i: International Journal of Stroke. - 1747-4930 .- 1747-4949. ; 10, s. 113-113 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
7.	Berlin Hallrup, Leena, et al. (författare) Adults with intellectual disabilities experiences of institutional care in Sweden Annan publikation (övrigt vetenskapligt/konstnärligt)
8.	Berlin Hallrup, Leena, 1967-, et al. (författare) Care workers´ experiences of working in a Swedish institutional care setting 2010 Ingår i: Learning Disability Practice journal. - United Kingdom : Royal College of Nursing (RCN). - 1465-8712 .- 2047-8968. ; 13:7, s. 21-25 Tidskriftsartikel (refereegranskat)abstract Despite the general move to support people with learning disabilities in their own homes or in home-like settings, many institutional settings still exist and little research has been carried out on the role of the care workers who work in them. In this study, participant observations over a 16-month period describe care workers’ experiences of working in an institutional care setting in Sweden, and 18 care workers were interviewed. The three main themes to emerge from the thematic analysis were: care workers were engaged in creating a family-like atmosphere; they were engaged in making the everyday ordered and structured; and they were exposed to stress factors. It became evident that care workers need additional support, training and opportunities for reflection to handle their complex work situation.
9.	Dalvandi, Asghar, et al. (författare) Everyday Life Condition in Stroke Survivors and Their Family Caregivers in Iranian Context 2013 Ingår i: International Journal of Community Based Nursing & Midwifery. - Tehran. - 2322-2476. ; 1:1, s. 3-15 Tidskriftsartikel (refereegranskat)abstract BackgroundStroke is an unexpected major life incident that effect on physical functioning and can lead tochanges in lifestyle and inability to manage self care, work or leisure. To explore the everydaylife situation as experienced by stroke survivors, and their family caregivers, this study wasconducted 3-6 month after stroke.MethodsTwelve stroke survivors and thirteen family caregivers were interviewed and a qualitativecontent analysis was conducted to analyze data.ResultsThe results were categorized into two central themes that were identified as; (1) Being challengedby changes in everyday life situation including; the struggle with physical dysfunctions,inappropriate daily plan for leisure activities, changes in mood, being faced with economicalproblems and being worried about changing roles (2) striving to cope with new conditionsincluding; trying to preserve self-worth, seeking to support from spirituality, learning andre-learning and regaining independency.ConclusionPhysical dysfunction was the major concern for both the survivors and their family caregiversin their everyday life situation. This problem led to, and forced them, to be dependent on others.Training is needed to teach stroke survivors and their families strategies of how to cope withand overcome ongoing challenges of everyday life after stroke and to re-organize their livesand improve skills of the survivors to deal with the new situation at home.A daily plan for spending their time and leisure activities would ease this work. Moreinvestigation will be needed to clarify the process of life after stroke to cover this gap.
10.	Dalvandi, Asghar, et al. (författare) Lack of continuity of rehabilitation care for stroke survivors : Iranian family caregivers' experience 2011 Ingår i: Middle East Journal of Age and Aging. - 1449-8677. ; 8:4, s. 28-34 Tidskriftsartikel (refereegranskat)abstract Background and Objective: Stroke is a common disabling disorder that requires the involvement of family caregivers to successfully encourage the patient's rehabilitation. This is especially true in Iran, where the family members commonly have the main responsibility of care of disabled persons. The aim of this study was to explore the Iranian family caregivers' experience of providing rehabilitation care at home. Method: A grounded theory approach and the main tenets of constant comparative method were used. Twelve participants were interviewed using semi-structured in-depth interviews. Findings: The core concept was identified as "lack of continuity of rehabilitation care". Seven main categories were identified. Three of them were related to the problems family caregivers faced, including inadequate knowledge and skills, inappropriate accessibility to rehabilitative services, and inadequate social insurance. Four categories were about the strategies that family caregivers used to deal with the major concerns; modifying home environment, managing coexisting medical conditions, improving nurses' roles and, relying on family unity. Conclusion: Family caregivers need continuity of rehabilitative care besides their family engagement, to enable access to care. They also need support from adequate social insurance and increased access to rehabilitation care. Undergoing rehabilitation at home gives people the advantage of practicing skills and developing compensatory strategies in the context of their own living environment by training and helping family caregivers and stroke survivors in terms of modifying home environment and managing coexisting medical conditions. Here, nurses can have an important role by helping the family caregivers with education and training.
11.	Dalvandi, Asghar, et al. (författare) Life experiences after stroke among Iranian stroke survivors 2010 Ingår i: International Nursing Review. - : Wiley. - 0020-8132 .- 1466-7657. ; 57, s. 247-253 Tidskriftsartikel (refereegranskat)abstract Background: Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving.Aim: To illuminate how stroke survivors experience and perceive life after stroke.Method: A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors.Findings: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances.Conclusions: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.
12.	Dalvandi, Asghar, et al. (författare) Post stroke life in iranian people: used recommendations and strategies 2009 Ingår i: Iranian Rehabilitation Journal. ; 7:9, s. 17-24 Tidskriftsartikel (refereegranskat)
13.	Dalvandi, Asghar, et al. (författare) Rehabilitation Experts' Experience of Community Rehabilitation Services for Stroke Survivors in Iran 2012 Ingår i: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 19:5, s. 395-404 Tidskriftsartikel (refereegranskat)abstract Purpose: Successful stroke rehabilitation is a complex process involving teamwork by members of several professions. The aims of this study were to explore the experiences of Iranian rehabilitationexperts concerning community rehabilitation services for stroke survivors and obtain their opinions on how to further develop and improve these services. Method: A qualitative research method with grounded theory was used, including purposive and theoretical sampling. A constant comparative analysis was conducted. Data were gathered from 2 focus group discussions including 10 Iranian rehabilitation experts and 4 in-depth individual interviews. Results: Nonintegrated rehabilitation services emerged as the core concept of the study. The explored concepts were identified as deficiently allocated budget, inadequate public insurance, lack of availability of rehabilitative care, negative public opinion, lack of consistency in care, and split services and professional separation. Areas identified for potential improvement included need to change policymakers' attitudes, need to refine rehabilitation in the health care system, need to establish a registration system, need to provide information and skills, and need to see the family as a whole. Conclusion: Experts should participate in educational rehabilitation programs to become more aware of current rehabilitationservices within the community. Stroke survivors and their families should also participate in the rehabilitation programs as this would allow them to gain knowledge and skills for dealing withstroke management. This can help reduce problems, change public opinion, and eliminate mistrust between health care providers and families.
14.	Eerola, Hannaleena, et al. (författare) Basal cytokeratins in breast tumours among BRCA1, BRCA2 and mutation-negative breast cancer families 2008 Ingår i: Breast cancer research : BCR. - : Springer Science and Business Media LLC. - 1465-542X. ; 10:1, s. R17- Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Finding new immunohistochemical markers that are specific to hereditary breast cancer could help us to select candidates for BRCA1/BRCA2 mutation testing and to understand the biological pathways of tumour development. METHODS: Using breast cancer tumour microarrays, immunohistochemical expression of cytokeratin (CK)-5/6, CK-14 and CK-17 was evaluated in breast tumours from BRCA1 families (n = 46), BRCA2 families (n = 40), non-BRCA1/BRCA2 families (n = 358) and familial breast cancer patients with one first-degree relative affected by breast or ovarian cancer (n = 270), as well as from patients with sporadic breast cancer (n = 364). Staining for CK-5/6, CK-14 and CK-17 was compared between these groups and correlated with other clinical and histological factors. RESULTS: CK-5/6, CK-14 and CK-17 were detected mostly among oestrogen receptor (ER)-negative, progesterone receptor (PR)-negative and high-grade tumours. We found the highest percentages of samples positive for these CKs among ER-negative/HER2-negative tumours. In univariate analysis, CK-14 was significantly associated with tumours from BRCA1 (39%; P < 0.0005), BRCA2 (27%; P = 0.011), and non-BRCA1/BRCA2 (21%; P < 0.005) families, as compared with sporadic tumours (10%). However, in multivariate analysis, CKs were not found to be independently associated with BRCA1 or BRCA2 mutation status, and the most effective predictors of BRCA1 mutations were age at onset, HER2 status, and either ER or PR status. CONCLUSION: Although our study confirms that basal CKs can help to identify BRCA1 mutation carriers, this effect was weaker than previously suggested and CKs did not independently predict BRCA1 mutation either from sporadic or familial breast cancer cases. The most effective, independent predictors of BRCA1 mutations were age at onset, HER2 status, and either ER or PR status, as compared with sporadic or non-BRCA1/BRCA2 cancers.
15.	Ehrlich, Kethy, et al. (författare) Family caregivers’ assessments of caring for a relative with dementia : A comparison of urban and rural areas 2015 Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 10:1, s. 27-37 Tidskriftsartikel (refereegranskat)abstract Aim: This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors. Background: Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas. Design: A cross-sectional study design was used. Methods: A total of 102 caregivers (response rate 85%) from urban (n = 57) and rural (n = 46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models. Results: Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales. Conclusions: The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas. Implications for practice: To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.
16.	Ehrlich, Kethy, et al. (författare) The relationship between geographical and social space and approaches to care among rural and urban caregivers caring for a family member with Dementia : a qualitative study 2017 Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 12:1, s. 1-11 Tidskriftsartikel (refereegranskat)abstract Knowledge about family caregivers in rural areas remains sparse. No studies to date have addressed the sociocultural aspects in caregiving, thus neglecting potentially significant data. This study aimed to explore and better understand family caregivers’ experiences in rural and urban areas and the sociocultural spheres that these two areas represent. How do family caregivers approach their caregiving situation? A hermeneutical approach was chosen to uncover the underlying meanings of experiences. Open-ended in-depth interviews were conducted. The ontological and epistemological roots are based on hermeneutic philosophy, where a human being’s existence is viewed as socially constructed. The study followed a purposeful sampling. Semi-structured in-depth interviews were conducted with 12 rural and 11 urban family caregivers to persons with dementia. These were then analyzed in accordance with the hermeneutical process. The findings provide insight into the variations of family caregiver approaches to caregiving in rural and urban areas of Sweden. There seemed to be a prevalence of a more accepting and maintaining approach in the rural areas as compared to the urban areas, where caregiving was more often viewed as an obligation and something that limited one’s space. Differences in the construction of family identity seemed to influence the participants approach to family caregiving. Therefore, community-based caregiving for the elderly needs to become aware of how living within a family differs and how this affects their views on being a caregiver. Thus, support systems must be individually adjusted to each family’s lifestyles so that this is more in tune with their everyday lives.
17.	Fagerholm, Rainer, et al. (författare) NAD(P)H:quinone oxidoreductase 1 NQO12 genotype (P187S) is a strong prognostic and predictive factor in breast cancer 2008 Ingår i:* Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 40:7, s. 844-53 Tidskriftsartikel (refereegranskat)abstract NQO1 guards against oxidative stress and carcinogenesis and stabilizes p53. We find that a homozygous common missense variant (NQO1()2, rs1800566(T), NM_000903.2:c.558C>T) that disables NQO1 strongly predicts poor survival among two independent series of women with breast cancer (P = 0.002, N = 1,005; P = 0.005, N = 1,162), an effect particularly evident after anthracycline-based adjuvant chemotherapy with epirubicin (P = 7.52 x 10(-6)) and in p53-aberrant tumors (P = 6.15 x 10(-5)). Survival after metastasis was reduced among NQO1()2 homozygotes, further implicating NQO1 deficiency in cancer progression and treatment resistance. Consistently, response to epirubicin was impaired in NQO1(*)2-homozygous breast carcinoma cells in vitro, reflecting both p53-linked and p53-independent roles of NQO1. We propose a model of defective anthracycline response in NQO1-deficient breast tumors, along with increased genomic instability promoted by elevated reactive oxygen species (ROS), and suggest that the NQO1 genotype is a prognostic and predictive marker for breast cancer.
18.	Fonad, Edith, et al. (författare) Moving to and living in a retirement home : focusing on older people´s sense of safety and security 2006 Ingår i: Journal of Housing for the Elderly. - : Taylor & Francis. - 0276-3893 .- 1540-353X. ; 3:20, s. 45-60 Tidskriftsartikel (refereegranskat)abstract Bad health combined witii deteriorating physical functions force many elderly people to move to a retirement home. The primary focus of this study was to investigate the resident's experience of safety and security. From a sample of 57 residents, 12 persons volunteered to participate in the interview. Data were analyzed with qualitative content analysis. The standard and design of the participant's previous home made mobility difficult and this affected their sense of security. This motivated them to move into an environment where they felt more secure. The environment at the retirement home was predominantly described as secure and safe. The finding shows that the participants felt that safety and security were more important than independence.
19.	Fryden, Hanna, et al. (författare) Roles, tasks and educational functions of postgraduate programme directors : a qualitative study 2015 Ingår i: Postgraduate medical journal. - : Oxford University Press (OUP). - 0032-5473 .- 1469-0756. ; 91:1080, s. 588-593 Tidskriftsartikel (refereegranskat)abstract Background A programme director is often required to organise postgraduate medical education. This leadership role can include educational as well as managerial duties. Only a few published studies have explored programme directors' own perceptions of their role. There is a need to explore the use of theoretical frameworks to improve the understanding of educational roles.Objective To explore programme directors' own perceptions of their role in terms of tasks and functions, and to relate these roles to the theoretical framework developed by Bolman and Deal.Methods Semi-structured interviews were conducted with 17 programme directors between February and August 2013. The data were subjected to content analysis using a deductive approach.Results The various roles and tasks included by participants in their perceptions of their work could be categorised within the framework of functions described by Bolman and Deal. These included: structuring the education (structural function); supporting individuals and handling relations (human resource function); negotiating between different interests (political function); and influencing the culture at the departmental level (symbolic function). The functions most often emphasised by participants were the structural and human resource functions. Some tasks involved several functions which varied over time.Conclusions Programme directors' own perceptions of their roles, tasks and functions varied widely. The theoretical framework of Bolman and Deal might be helpful when explaining and developing these roles.
20.	Gustafsson, Birgitta Åkesdotter, et al. (författare) The lived body and the perioperative period in replacement surgery: older people´s experiences 2007 Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 60:1, s. 20-28 Tidskriftsartikel (refereegranskat)abstract Aim. This paper is a report of a study to explore older people´s expereinces of their lived bodies during the perioperative period of hip or knee replacement.Background. replacement surgery of a major joint for older people suffering from osteoarthtitis is an established treatment in developed countries. Scientific knowledge is awailable on replacement surgery from several perspectives, but not about older people´s experiences of the entire perioperative period of replacement procedure.Method. A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data was analysed using latent qualitative content analysis.Findings. The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with a dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole.Conclusion. The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.
21.	Gustafsson Åkesdotter, Birgitta, et al. (författare) In the hands of formal caregivers: older patients' expereinces of care across the perioperative period for hip and knee replacements 2010 Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 14:2, s. 96-108 Tidskriftsartikel (refereegranskat)abstract Summary Total joint replacements of the hip or knee have become standard surgicalprocedures and lately more focus has been placed on the patient’s perspective.Aim: The aim of this study was to illuminate the meaning of care from all formalcarers before, during, and after joint replacement surgery of the hip or knee. Study design: A qualitative longitudinal design was chosen to capture thepatients’ experiences from the time they were placed on the waiting list untilone year after the operation. Analysis revealed that, initially, the operation itselfwas regarded as the key for reaching the goal of independence in every-day life.Patients became aware that all care related to the operation was essential. Themeaning of care from formal carers appeared to be: wanting to be ‘in safe hands’with competent formal carers across the entire perioperative period for thereplacement surgery. Conclusion: Our findings indicate that for a good outcome care characterized bycontinuous guidance from formal carers with expert knowledge of care and jointreplacement surgery (competent) was necessary for patients to feel that they were‘in safe hands’ across the perioperative period. This requires organisation of carethat can offer guidance across the perioperative period.
22.	Gustafsson Åkesdotter, Birgitta, et al. (författare) The hip and knee replacement operation: : a throrough life event 2010 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:4, s. 663-670 Tidskriftsartikel (refereegranskat)abstract Background: A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation.Aim: The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery.Method: A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants’ experiences of the hip and knee replacement intervention across the entire perioperative period.Findings: Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted.Conclusion: Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.
23.	Hadziabdic, Emina, 1974-, et al. (författare) Experiences of nurses educated outside the European Union of a Swedish bridging program and the program’s role in their integration into the nursing profession : a qualitative interview study 2021 Ingår i: BMC Nursing. - : BioMed Central (BMC). - 1472-6955. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background: Countries all over the world are experiencing a shortage of registered nurses (RNs). Therefore, some countries, including Sweden, have tried to solve this by recruiting internationally educated nurses (IENs). Countries offer bridging programs as educational support to qualify IENs for nursing work in the destination country. However, there is little research on IENs’ experiences of bridging programs in European countries and how these programs facilitate their integration into the world of work and their new society. The aim of this study is to explore the experiences of nurses, originally educated outside the EU (European Union)/EES, of the Swedish bridging program and of the program’s role in facilitating their integration into the nursing profession in Sweden.Methods: A qualitative descriptive design was used to explore the topic based on 11 informants’ perspectives and experiences. Purposive sampling was used to recruit participants at one university in Sweden. Data were collected by individual interviews using a semi- structured interview guide during the year 2019 and were analysed using an interpretative thematic approach.Results: Two main themes emerged from the analysis: 1) Return to nursing, and 2) The bridging program as a tool for transition to nursing in Sweden. The first theme includes conditions and experiences such as personal motivation and determination, and support from others that the participants described as important in order to achieve the goal of re-establishing themselves as registered nurses in Sweden. Furthermore, the second theme describes the participants’ experiences of the bridging program as mostly positive because it led to new learning and achievements that were valuable for the transition to nursing in Sweden; however, the participants also emphasised the challenges of their transition into the nursing profession, which were related to instances of misrecognition of their professional competence and the uncertain outcome of the program.Conclusions: This study found that the bridging program facilitated integration into the nursing profession for nurses educated outside the EU/EES, especially knowledge gained in clinical-based training. Thus, it is important to recognise and value the IENs’ experience and previous knowledge and training when developing the bridging program’s curriculum.
24.	Hadziabdic, Emina, et al. (författare) Family members’ experiences of the use of interpreters in healthcare 2014 Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 15:2, s. 156-169 Tidskriftsartikel (refereegranskat)abstract Aim The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters.Background Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found.Method A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups.Findings Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.
25.	Hadziabdic, Emina, 1974-, et al. (författare) Healthcare staffs perceptions of using interpreters : a qualitative study 2010 Ingår i: Primary Health Care Research and Development. - Cambridge, UK. - 1463-4236 .- 1477-1128. ; 11:3, s. 260-270 Tidskriftsartikel (refereegranskat)abstract Aim: To describe how healthcare professionals experience and perceive the use of interpreters in their contacts with patients with whom they do not share a common language. Methods: An explorative descriptive study. The study was conducted in different healthcare settings in Sweden and included 24 healthcare staff, of whom 11 were physicians, 9 nurses, 2 physiotherapists and 2 assistant nurses. Data were generated through written descriptions of the use of interpreters in healthcare and analysed using qualitative content analysis. Findings: Two main categories emerged: 1) aspects related to the interpreter and 2) organizational aspects. It was shown that having a face-to-face, professional, trained interpreter, with a good knowledge of both languages and of medical terminology, translating literally and objectively, was perceived positively. The organizational aspects that affected the perception were functioning or non-functioning technical equipment, calm in the interpretation environment, documentation of the patients’ language ability, respect for the appointed time, and the level of availability and service provided by the interpreter agency. Conclusion: It is important to develop a well-functioning interpreter organization that offers trained interpreters with a professional attitude to improve and ensure cost-effective and high-quality encounters and care.
26.	Hadziabdic, Emina, et al. (författare) Migrants' perceptions of using interpreters in health care 2009 Ingår i: International Nursing Review. - West Sussex, UK : Wiley-Blackwell. - 0020-8132 .- 1466-7657. ; 56:4, s. 461-469 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The number of foreign-born people who do not share a common language has increased due to extensive international migration, which will increase in the future. There is limited knowledge about the users' perceptions of interpreters in health care. Aim: To describe how individuals from former Yugoslavia, living in Sweden, perceived the use of interpreters in Swedish healthcare services.METHOD: A phenomenographic approach was employed. Data were collected by semi-structured interviews during 2006-2007 with 17 people, aged 29-75 years, from former Yugoslavia, living in Sweden.FINDINGS: Three descriptive categories were identified: (1) prerequisites for good interpretation situations; (2) the interpretation situation - aspects of satisfaction or dissatisfaction; and (3) measures to facilitate and improve the interpreter situation. The interpreter's competence, attitude, appearance and an appropriate environment are important prerequisites for interpretation. The interpreter was perceived as being a communication aid and a guide in the healthcare system in terms of information and practical issues, but also as a hindrance. A desirable professional interpreter was perceived as highly skilled in medical terminology and language, working in face-to-face interaction.CONCLUSION: Using an interpreter was perceived as a hindrance, though also needed in communication with healthcare staff and as a guide in the healthcare system. Face-to-face interaction was preferred, with the interpreter as an aid to communication. As part of individual care planning it is important to use interpreters according to the patients' desires. Healthcare organizations and guidelines for interpreters need to be developed in order for patients to have easy access to highly skilled professional interpreters.
27.	Hadziabdic, Emina, et al. (författare) Problems and consequences in the use of professional interpreters : qualitative analysis of incidents from primary healthcare. 2011 Ingår i: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 18:3, s. 253-261 Tidskriftsartikel (refereegranskat)abstract The aim was to explore what probklems were reported by healthcare straff in primary healthcare concerning the use of interpreters and what consequences that might lead to. A single-case study of a real life situation was implemented by analysing 60 incident reports written by different health care professionals. Qualitative content analysis was applied. The results showed that the main problems were related to language in terms of lack of available interpreters in a particular language, and to organisational routines with difficulties in availability of interpreters and access to the interpreter agency. The consequences reported were incorrect use of time and resources, with increased workload and thus delayed treatment. Other consequences were limited possibilities to communicate and consultations carried out without a professional interpreter and instead using family members.
28.	Heikkilä, Kristiina, et al. (författare) Culturally congruent care for older people: Finnish care in Sweden 2007 Ingår i: Scandinavian Journal of Caring Science. ; 21, s. 354-361 Tidskriftsartikel (refereegranskat)abstract An increasing number of older people belong to minority and immigrant groups. This calls for new models on the subject of how to provide culturally adjusted care for these populations. The aim of this study is to describe how culturally congruency is used in care for older Finnish immigrants in order to promote their well-being. The study was conducted with an ethnographic design, based on participant observations and interviews among residents, staff and visitors in the Finnish Home in Sweden. In the core of the cultural congruency is the use of the Finnish language, and the fact that both residents and staff have Finnish backgrounds. In addition to this, Finnish customs and celebrations, popular culture and topics of discussion, are actively used in order to create a common ground for communication and shared understanding of the individual person. Cultural congruency, based on the residents' mother language, shared athnic background with staff, and shared customs creates a common ground for communication and an understanding. This enables caring relationships, which, in turn, increases the residents' well-being.
29.	Heikkilä, Kristiina, 1958-, et al. (författare) Elderly care for ethnic minorities : Wishes and expectations among elderly Finns in Sweden 2003 Ingår i: Ethnicity and Health. - BASINGSTOKE : Taylor & Francis. - 1355-7858 .- 1465-3419. ; 8:2, s. 135-146 Tidskriftsartikel (refereegranskat)abstract Objectives. Although elderly people from immigrant and minority groups utilise elderly care facilities to a lesser extent than elderly people from majority groups, there is a lack of research on how elderly people with different ethnic backgrounds wish and expect to be cared for when they are in need of institutional elderly care. This study aims to illuminate the role that culturally appropriate care plays in elderly Finnish immigrants’ wishes and expectations of institutional elderly care in Sweden. Design. Thirty-nine elderly Finnish immigrants in Sweden, aged 75 years or more, were interviewed in their homes. The data were analysed with latent qualitative content analysis. Results. The elderly Finnish immigrants in Sweden wished to be able to continue living in their current homes for as long as possible. Later on, when entering institutional elderly care, they wanted to feel continuity, familiarity, security and companionship with others. As immigrants, they had to choose to be cared for either in well-known physical environments close to their current homes, or in a culturally appropriate care setting with familiar socio-cultural conditions. Conclusions. To be able to provide institutional elderly care for minority groups it is important to ease the access to elderly care amenities by providing care that results in maintaining as much continuity and familiarity as possible in the lives of the elderly people. This includes the care providers and other residents who share the familiar aspects of their lives. This involves providing culturally appropriate elderly care close to the elderly people’s current homes.
30.	Heikkilä, Kristiina (författare) Förklaringsmodeller för äldre migranters tillgång till och nyttjande av vård och omsorg - en pilotstudie. 2008 Ingår i: Efterfrågat arbetskraft?. - : Växjö university press, Växjö. ; , s. 177-190 Bokkapitel (övrigt vetenskapligt/konstnärligt)
31.	Heikkilä, Kristiina, 1958-, et al. (författare) Health care experiences and beliefs of elderly Finnish immigrants in Sweden 2000 Ingår i: Journal of Transcultural Nursing. - : Sage Publications. - 1043-6596 .- 1552-7832. ; 11:4, s. 281-289 Tidskriftsartikel (refereegranskat)abstract Purpose: To elucidate the experiences and beliefs of care of elderly Finnish immigrants living in Sweden (Sweden-Finns) in order to gain an understanding of the role ethnic background plays in these experiences and beliefs. Design: 39 elderly Sweden-Finns living in Stockholm were interviewed. The data were analysed hermeneutically. Results: On a surface level, the care in Sweden was culturally congruent to elderly Sweden-Finns’ experiences and beliefs of care. However, care in Finland and the care providers with Finnish background were regarded as superior to Swedish caregivers, giving a deeper sense of familiarity and trust in anticipation of good care. Implications for practice: Culturally appropriate care with care providers sharing the same ethnic background is important for ethnic elderly persons in enabling familiarity and trust between staff and patients.
32.	Heikkilä, Kristiina, 1958-, et al. (författare) Mealtime interventions and their outcomes in care homes for older people considering the five aspects meal model : An integrative review 2022 Ingår i: Geriatric Nursing. - : Elsevier. - 0197-4572 .- 1528-3984. ; 47, s. 171-182 Tidskriftsartikel (refereegranskat)abstract Mealtimes are important events in care homes for physical and social well-being. However, residents usually have little input concerning meal timings, what food is offered, and how it is served. This integrative review explored mealtime interventions and their outcomes in care homes related to the Five Aspects Meal Model (FAMM). Research articles published 2010–2021 were searched for in ASSIA, CINAHL, PsycINFO, PubMed, and SveMed+ and resulted in 13 articles focusing on interventions. The analysis was based on the aspects of FAMM: room, meeting, product, management control system, and atmosphere. The result shows that even though interventions specifically focused on one aspect, they often evaluated outcomes related to several aspects. Different aspects can work together to foster effective mealtimes. FAMM eased to visualise the usefulness of mealtime interventions from a broad perspective and can be a useful tool for assessing and improving mealtime situations in clinical practice.
33.	Heikkilä, Kristiina (författare) The role of ethnic identity in care of elderly Finnish immigrants 2004 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The role of ethnicity in care of elderly Finnish immigrants Most Western countries are becoming increasingly multicultural because of immigration. Many of these immigrants grow old in a second homeland and will need health and elderly care in the future. In Sweden, the largest immigrant group comes from its neighbouring country, Finland. Little is known about how this group experiences present health care or their expectations of future elderly care. The overall aim of the thesis was to describe and to deepen the understanding of elderly Finnish immigrants' experiences of health care and elderly care and the role that ethnicity played in these experiences. The specific aims were to: elucidate the elderly Sweden-Finns' experiences and beliefs about health care in Sweden, in order to gain an understanding of how ethnic background affects the elderly immigrated persons' experiences and beliefs in the host country (I); illuminate the role that culturally appropriate care plays in relation to the elderly Finnish immigrants' wishes and expectations of institutional elderly care (II); describe and compare the elderly Finnish immigrants' perceptions of health care, both among those who have continued to live in Sweden and those who have re-migrated to Finland (III); describe the cultural adjustments that had been made at a specific elderly care setting, the Finnish Home, and illustrate the impact of cultural adjustments on care, as conditions that promoted the well-being of the residents (IV). All the participants were born in Finland and Finnish was their native language and they lived (I-II and IV) or had lived in Sweden. In I-II, the 39 participants were 75 years or older and in III-IV, 65 years or older. In III, 217 persons participated in Finland, and 643 persons participated in Sweden. All residents, staff and visitors of Finnish Home participated in IV. Qualitative interviews were conducted in the participants' homes (I-II), a mailed questionnaire was used in Study III, and an ethnographic study design was used in Study IV. Several different analysis methods were used: Hermeneutical ad hoc analysis (I), latent content analysis (II), statistical analysis (III), and an ethnographic method (IV). The results show that the Swedish health care system is congruent with the elderly Finnish immigrants' expectations (I), and their experiences of care were good (III). Their experiences of the Finnish health care system were also good (III). However, sharing the same ethnic background as the care providers was believed to lead to better care (I). When thinking about future elderly care, the elderly Finnish immigrants wished to feel familiarity, continuity in life, security, and companionship. This could be achieved either in the well-known physical environment of their current homes, in an elderly care setting in their part of town, or in a well-known socio-cultural environment at an elderly care setting where Finnish was spoken and the care providers and fellow-residents were Finns (II). When being cared for in a culturally adjusted elderly care setting, the care became culturally congruent as the care providers, and the residents played the same language and ethnicity game (IV). The conclusions from the thesis show that ethnicity and ethnic identity, a shared mother language, and the place, play an important role in the care of elderly Finnish immigrants. In addition to this, the elderly Finns experienced a feeling of at-homeness when being cared for by members of their own ethnic group, in a familiar place, with people who spoke the same native language.
34.	Heikkinen, Tuomas, et al. (författare) The breast cancer susceptibility mutation PALB2 1592delT is associated with an aggressive tumor phenotype 2009 Ingår i: Clinical Cancer Research. - 1078-0432 .- 1557-3265. ; 15:9, s. 3214-22 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To determine the effect of the breast cancer susceptibility mutation PALB2 1592delT on tumor phenotype and patient survival. EXPERIMENTAL DESIGN: We defined the PALB2 mutation status in 947 familial and 1,274 sporadic breast cancer patients and 1,079 population controls, and compared tumor characteristics and survival in mutation carriers relative to other familial and sporadic cases and to 79 BRCA1 and 104 BRCA2 mutation carrier cases. RESULTS: The PALB2 1592delT mutation was found in 19 familial [2.0%; odds ratio, 11.03; 95% confidence interval (95% CI), 2.65-97.78; P < 0.0001] and eight sporadic patients (0.6%; odds ratio, 3.40; 95% CI, 0.68-32.95; P = 0.1207) compared with two (0.2%) control individuals. Tumors of the PALB2 mutation carriers presented triple negative (estrogen receptor negative/progesterone receptor negative/HER negative) phenotype more often (54.5%; P < 0.0001) than those of other familial (12.2%) or sporadic (9.4%) breast cancer patients. They were also more often of higher grade (P = 0.0027 and P = 0.0017, respectively) and had higher expression of Ki67 (P = 0.0004 and P = 0.0490, respectively). Carrying a PALB2 mutation was also associated with reduced survival, especially in familial cases (hazard ratio, 2.30; 95% CI, 1.01-5.24; P = 0.0466) and among familial patients with HER2-negative tumors (hazard ratio, 4.57; 95% CI, 1.96-10.64; P = 0.0004). Carrying a BRCA2 mutation was also found to be an independent predictor of poor survival at 10-year follow-up (P = 0.04). CONCLUSIONS: The PALB2 1592delT mutation has a strong effect on familial breast cancer risk. The tumors rising in patients carrying this mutation manifest a phenotype associated with aggressive disease. Our results also suggest a significant impact of carrying a BRCA2 mutation on long-term breast cancer survival.
35.	Heikkinen, Tuomas, et al. (författare) Variants on the promoter region of PTEN affect breast cancer progression and patient survival 2011 Ingår i: Breast Cancer Research. - : Springer Science and Business Media LLC. - 1465-5411 .- 1465-542X. ; 13:6, s. R130- Tidskriftsartikel (refereegranskat)abstract INTRODUTION:The PTEN gene, a regulator of the phosphatidylinositol-3-kinase (PI3K)/Akt oncogenic pathway, is mutated in various cancers and its expression has been associated with tumor progression in a dose-dependent fashion. We investigated the effect of germline variation in the promoter region of the PTEN gene on clinical characteristics and survival in breast cancer.METHODS:We screened the promoter region of the PTEN gene for germline variation in 330 familial breast cancer cases and further determined the genotypes of three detected PTEN promoter polymorphisms -903GA, -975GC, and -1026CA in a total of 2,412 breast cancer patients to evaluate the effects of the variants on tumor characteristics and disease outcome. We compared the gene expression profiles in breast cancers of 10 variant carriers and 10 matched non-carriers and performed further survival analyses based on the differentially expressed genes.RESULTS: All three promoter variants associated with worse prognosis. The Cox's regression hazard ratio for 10-year breast cancer specific survival in multivariate analysis was 2.01 (95% CI 1.17 to 3.46) P = 0.0119, and for 5-year breast cancer death or distant metastasis free survival 1.79 (95% CI 1.03 to 3.11) P = 0.0381 for the variant carriers, indicating PTEN promoter variants as an independent prognostic factor. The breast tumors from the promoter variant carriers exhibited a similar gene expression signature of 160 differentially expressed genes compared to matched non-carrier tumors. The signature further stratified patients into two groups with different recurrence free survival in independent breast cancer gene expression data sets.CONCLUSIONS:Inherited variation in the PTEN promoter region affects the tumor progression and gene expression profile in breast cancer. Further studies are warranted to establish PTEN promoter variants as clinical markers for prognosis in breast cancer.
36.	Heinonen, Mira, et al. (författare) Prognostic role of HuR in hereditary breast cancer 2007 Ingår i: Clinical Cancer Research. - 1078-0432 .- 1557-3265. ; 13:23, s. 6959-6963 Tidskriftsartikel (refereegranskat)abstract Purpose: HuR is an mRNA-binding protein that enhances the stability of certain transcripts and can regulate their translation. Elevated cytoplasmic expression of HuR protein has been linked to carcinogenesis and is associated with reduced survival in breast, ovarian, and gastric adenocarcinomas. Experimental Design: Here, we have explored the relevance of HuR in familial breast cancer. Tumor samples were collected from patients with identified BRCA1 (n = 51) or BRCA2 (n = 47) mutations or familial non-BRCA1/2 cases (n = 525), and analyzed by immunohistochemistry. Results: Among familial non-BRCAI/2 breast cancer patients, cytoplasmic HuR protein expression was present in 39.4% of the cases and was associated with estrogen receptor negativity, progesterone receptor negativity, p53 positivity, high tumor grade, and ductal type of the tumor. In multivariate analysis, cytoplasmic HuR expression was an independent marker of reduced survival in the non-BRCAI/2 group along with tumor size >2 cm, lymph node metastasis, and high histologic grade. In patients with BRCA1 or BRCA2 mutations, cytoplasmic HuR expression was more frequent (62.7% for BRCA1 and 61.7% for BRCA2) than in the non-BRCA1/ 2 group, but in BRCA -mutated subgroups cytoplasmic HuR expression did not associate with survival. Conclusions: Our results show that HuR is an important prognostic factor in familial breast cancer patients and may contribute to carcinogenesis in this disease.
37.	Kulla, Gunilla, et al. (författare) Differences in self-rated health among older immigrants : A comparison between older Finland-Swedes and Finns in Sweden 2010 Ingår i: Scandinavian Journal of Public Health. - : Sage Journals. - 1403-4948 .- 1651-1905. ; 38:1, s. 25-31 Tidskriftsartikel (refereegranskat)abstract Aims: Research has shown a tendency among immigrants and ethnic minorities to have a lower health status compared with the majority population. This applies to Finnish immigrants in Sweden. This group, however, also consists of persons who belong to a small ethnic minority in Finland, the Finland-Swedes, who speak Swedish as their mother tongue. In Finland, this minority has been shown to have better health and longer lives than the majority of Finnish-speaking people. Most of the previous research has studied the objective health of immigrants and minorities, while less is known about their subjective health. The aim of this study was to describe and compare self-rated health in older Finland-Swedes and Finns living as immigrants in Sweden. Methods: The study was carried out as a sample-based cross-sectional study. Data was collected by a postal structured questionnaire. The response rate among the Finland-Swedes was 47% (n = 169) and among the Finns was 54% (n = 643). Data was analyzed descriptively and tested with Pearson’s chi-square test. Results: The results showed significant differences between the language groups in self-rated health, age of retirement and causes for retirement. The Finland-Swede immigrants rated their health as better than the Finnish-speaking ones. They had retired at an older age and less frequently because of health problems. Conclusions: The results indicate that there may be significant differences in health, at least in subjective health, between immigrant groups. Due to the low response rate, the results cannot be generalized.
38.	Lindqvist, Gunilla, et al. (författare) Conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease 2013 Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 14:02, s. 140-150 Tidskriftsartikel (refereegranskat)abstract Aim To describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. BACKGROUND: A chronic disease like COPD affects not only the person living with the illness, but also the spouse. Significant tasks and demands are placed on husbands. COPD has for a long time been considered more a man's disease than a woman's disease, but according to new evidence COPD is a vast problem in women, which requires support from their spouses. The literature review did not reveal any previous studies concerning conceptions of daily life in men living with women suffering from COPD in different stages. METHODS: A phenomenographic study was conducted. Data were collected from October 2008 to October 2009 through semi-structured interviews with 19 men living with a woman suffering from COPD. Findings Two main descriptive categories were found: (1) unchanged life situation where no support was needed; (2) changed life situation related to severity of COPD, where support was needed. The categories were described from the perspective 'ME and my spouse'. Even in their caregiving situation, the men continued with their own life and activities and did not put themselves in second place. No support was needed from healthcare or municipality when the women had mild COPD, but this changed when the COPD progressed. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.
39.	Lindqvist, Gunilla, et al. (författare) Conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease 2013 Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 14:01, s. 40-51 Tidskriftsartikel (refereegranskat)abstract Aim To describe conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease (COPD) in different stages.Background The spouse is often the primary caregiver to someone with COPD, and thus also affected by the consequences of the disease. No previous studies have been found focusing on conceptions of daily life in women living with a man suffering from COPD in different stages.Methods A phenomenographic study was conducted. Data were collected in 2008–2009 through semi-structured interviews with 21 women living with men suffering from COPD in different stages.Findings Four main descriptive categories were found: unchanged life situation where no support was needed; socially restricted life and changed roles; changes in health; and changes in the couple's relationship where support was needed. The categories are described in relation to the woman herself, in relation to the man, and in relation to others. No support was needed from society or health care when the men had mild COPD and the women experienced no change in their daily life. As the disease progressed, the women's responsibilities increased and their role changed from being a spouse to being an informal carer. Social contacts became limited, and they began to feel isolated. The women prioritized their spouse's health and well-being and compromised their own health. They experienced lack of support from health professionals and from the municipality.
40.	Lindstrom, Veronica, et al. (författare) Barriers and opportunities in assessing calls to emergency medical communication centre : a qualitative study 2014 Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 22 Tidskriftsartikel (refereegranskat)abstract Introduction: Previous studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher's (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC). Aim: The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. Method: A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. Results: One hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN's assessment of calls to the EMCC. The opportunities appeared in the callers' symptom description and the communication strategies used by the RN. The barriers appeared in callers' descriptions of unclear symptoms, paradoxes and the RN's lack of communication strategies during the call. Conclusion: Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN's use of different communication strategies such as closed loop communication.
41.	Mazaheri, Monir, et al. (författare) Experiences of dementia in a foreign country : qualitative content analysis of interviews with people with dementia 2014 Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14, s. 794- Tidskriftsartikel (refereegranskat)abstract Background: Dementia is a worldwide health concern of epidemic proportions. Research in the field of subjective experience of dementia suffers from a lack of diversity of their participants including immigrants. Different portraits of life with dementia could help us understand how people with dementia conceptualise their experiences of dementia and how they live. Our study aimed to explore the subjective experiences of living with dementia among Iranian immigrants in Sweden.Methods: Qualitative content analysis of interviews with fifteen people with dementia from Iranian immigrant backgrounds were conducted (8 females and 7 males).Results: Three themes and seven associated sub-themes were revealed. The themes included: Being a person with dementia means living with forgetfulness (personal sphere), living with forgetfulness in the private sphere means feeling incompetent but still loved, living with forgetfulness in the public sphere means feeling confident and secure but also isolated.Conclusions: Living with dementia for the participants meant living with forgetfulness. They experienced feeling incompetent but still loved within their families and feeling confident and secure but also isolated in the society. Educating people with dementia and their families about the course and process of dementia may help them understand the changes better and adjust their expectations. Our study can provide a basis for healthcare workers to understand the experiences of living with dementia from this specific perspective.
42.	Mazaheri, Monir, et al. (författare) Experiences of living with dementia : qualitative content analysis of semi-structured interviews 2013 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:21-22, s. 3032-3041 Tidskriftsartikel (refereegranskat)abstract Aims and objectives To describe people's experiences of living with dementia in Iran. BackgroundA knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses' ability to provide adequate and meaningful care. DesignQualitative, cross-sectional design. MethodsQualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60-87years old). ResultsThe participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility. ConclusionExperiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience. Relevance to clinical practiceThe results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.
43.	Möller, Riitta, et al. (författare) What is the reward? : Medical students’ learning and personal development during a research project course 2015 Ingår i: Medical Education Online. - : CoAction Publishing. - 1087-2981. ; 20, s. 1-9 Tidskriftsartikel (refereegranskat)abstract Background: Until recently, the outcome of medical students’ research projects has mainly been assessed in terms of scientific publications, whereas other results important for students’ development have been less studied. The aim of this study was to investigate medical students’ experiences of learning as an outcome of the research project course.Method: Written reflections of 50 students were analyzed by manifest inductive content analysis.Results: Three categories emerged: ‘thinking as a scientist’, ‘working as a scientist’, and ‘personal development’. Students became more aware about the nature of knowledge, how to generate new knowledge, and developed skills in scientific thinking and critical appraisal. Unexpectedly, effects on personal characteristics, such as self-confidence, self-discipline, independence, and time management skills were also acknowledged.Conclusions: We conclude that individual research projects enhance research-specific skills and competencies needed in evidence-based clinical work and are beneficial for personal and professional development.
44.	Peurala, Hanna, et al. (författare) MiR-34a expression has an effect for lower risk of metastasis and associates with expression patterns predicting clinical outcome in breast cancer 2011 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:11, s. e26122- Tidskriftsartikel (refereegranskat)abstract MiR-34a acts as a candidate tumour suppressor gene, and its expression is reduced in several cancer types. We aimed to study miR-34a expression in breast cancer and its correlation with tumour characteristics and clinical outcome, and regulatory links with other genes. We analysed miR-34a expression in 1,172 breast tumours on TMAs. 25% of the tumours showed high, 43% medium and 32% low expression of miR-34a. High miR-34a expression associated with poor prognostic factors for breast cancer: positive nodal status (p = 0.006), high tumour grade (p<0.0001), ER-negativity (p = 0.0002), HER2-positivity (p = 0.0002), high proliferation rate (p<0.0001), p53-positivity (p<0.0001), high cyclin E (p<0.0001) and γH2AX (p<0.0001). However, multivariate analysis adjusting for conventional prognostic factors indicated that high miR-34a expression in fact associated with a lower risk of recurrence or death from breast cancer (HR = 0.63, 95% CI = 0.41-0.96, p = 0.031). Gene expression analysis by differential miR-34a expression revealed an expression signature with an effect on both the 5-year and 10-year survival of the patients (p<0.001). Functional genomic analysis highlighted a novel regulatory role of the transcription factor MAZ, apart from the known control by p53, on the expression of miR-34a and a number of miR-34a targets. Our findings suggest that while miR-34a expression activation is a marker of aggressive breast tumour phenotype it exerts an independent effect for a lower risk of recurrence or death from breast cancer. We also present an expression signature of 190 genes associated with miR-34a expression. Our analysis for regulatory loops suggest that MAZ and p53 transcription factors co-operate in modulating miR-34a, as well as miR-34a targets involved in several cellular pathways. Taken together, these results suggest that the network of genes co-regulated with and targeted by miR-34a form a group of down-stream effectors that maybe of use in predicting clinical outcome, and that highlight novel regulatory mechanisms in breast cancer.
45.	Qvistgaard, Maria, et al. (författare) Patients' experiences with at-home preoperative skin disinfection before elective hip replacement surgery. 2017 Ingår i: Journal of Perioperative Practice. - : SAGE Publications. - 1750-4589 .- 2515-7949. ; 27:7, s. 162-166 Tidskriftsartikel (refereegranskat)abstract The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.
46.	Rydholm Hedman, Ann-Marie, et al. (författare) Hip fracture patients’ cognitive state affects family members’ experiences : a diary study of the hip fracture recovery 2011 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 25:3, s. 451-458 Tidskriftsartikel (refereegranskat)abstract Background: Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members – spouses, daughters, sons, or even neighbours become informal carers.Aim: To explore how hip fracture patients’ cognitive state affect family members’ experiences during the recovery period.Methods: Eleven diaries written by family members’ of hip fracture patients were analysed by means of qualitative content analysis.Findings: The analysis generated two main categories with four categories. The first main category was; ‘Being a family member of a cognitively impaired patient’ with the categories ‘Dissatisfaction with lack of support’ and ‘Emotional distress due to the patient’s suffering’. The second main category was ‘Being a family member of a cognitively intact patient’ with the categories ‘Satisfaction with a relative’s successful recovery’ and ‘Strain due to their caring responsibilities’. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients’ suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members.Conclusions: The findings suggest the hip fracture patient’s cognitive state is more decisive than the hip fracture itself for the family members’ experiences.
47.	Rydholm Hedman, Ann-Marie, et al. (författare) Hip fractures and cognitive state : patient outcomes and proxies’ perceptions of the rehabilitation period 2008 Ingår i: International Journal of Older People Nursing. - Oxford : Wiley-Blackwell. - 1748-3735 .- 1748-3743. ; 3:3, s. 178-186 Tidskriftsartikel (refereegranskat)abstract Background. Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective.Aim. To investigate whether cognitive state influences the hip fracture patients’ rehabilitation outcomes as well as the proxies’ perceptions of the 6-month rehabilitation period.Design. A survey with structured and unstructured questions. Statistics and content analysis.Methods. The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data.Results. In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists.Conclusions and relevance for clinical practice. Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.
48.	Sarvimäki, Anneli, et al. (författare) Så blev livet : reflektioner kring migration 2006. - 1 Ingår i: Mellan majoriteter och minoriteter. - Helsingfors : Svenska litteratursällskapet i Finland (SLS). - 9515831334 ; , s. 442-470 Bokkapitel (refereegranskat)
49.	Sarvimäki, Anneli, et al. (författare) Äldre finländska emigranter berättar 2006. - 1 Ingår i: Mellan majoriteter och minoriteter. - Helsingfors : Svenska litteratursällskapet i Finland (SLS). - 9515831334 ; , s. 47-74 Bokkapitel (refereegranskat)
50.	Suvanto, Anna-Liisa, et al. (författare) Att minnas kriget : sverigefinska erfarenheter 2014. - 1 Ingår i: Äldres psykiska hälsa och ohälsa. - Stockholm : Gothia Förlag AB. - 9789172058552 ; , s. 64-89 Bokkapitel (övrigt vetenskapligt/konstnärligt)

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