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Sökning: WFRF:(Kristensson Jimmie)

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1.
  • Kristensson Ekwall, Anna, et al. (författare)
  • Compensating, Controlling, Resigning and Accepting-Older Person's Perception of Physical Decline.
  • 2012
  • Ingår i: Current Aging Science. - : Bentham Science Publishers Ltd.. - 1874-6128 .- 1874-6098. ; 5:1, s. 13-18
  • Tidskriftsartikel (refereegranskat)abstract
    • It is important to know about how frail older people experience their physical decline and how they adapt to their bodily changes so that the health system can design preventive interventions targeting this group early on in the disability process. The aim of this study was to explore how older people perceive their physical decline. The study is qualitative in design and based on interviews with older persons, who were in an acute care process. Fourteen people, five men and nine women, aged 74 - 92 years (mean 81 years) were included in the study. Content analysis was used. The main finding was that physical decline was marked as occurring in two dimensions. One dimension was the physical decline and its impact on the individual's physical body (labelled individual body). The other dimension was the impact on the body in its environmental context such as the home or the society (labelled contextual body). The strategies for adapting constituted the two sub-themes, which were labeled compensating/controlling and accepting/resignation. The strategies were executed both on an intellectual level and practical level. For healthcare workers striving to increase physical activity, knowledge about how closely related self-image and physical ability are is useful when helping the frail older people. Increasing coping strategies for handling the general life situation may be a useful way of increasing physical activity and making it feel meaningful, despite the person's frail health situation with limited physical and sometimes psychological resources.
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2.
  • Kristensson, Jimmie, et al. (författare)
  • Case managers for frail older people: a randomised controlled pilot study.
  • 2010
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; May 4, s. 755-763
  • Tidskriftsartikel (refereegranskat)abstract
    • Scand J Caring Sci; 2010 Case managers for frail older people; a randomised controlled pilot study Aim: The aim was to test sampling and explore sample characteristics in a pilot study using a case management intervention for older people with functional dependency and repeated contact with the healthcare services as well as to investigate the effects of the intervention on perceived health and depressed mood after 3 months. The aim was also to explore internal consistency in the life satisfaction index Z, activities of daily living-staircase and Geriatric Depression Scale-20. Method: This pilot study was carried out in a randomised controlled design with repeated follow-ups. In all, 46 people were consecutively and randomly assigned to either an intervention (n = 23) or a control (n = 23) group. Two nurses worked as case managers and carried out the intervention, which consisted of four parts. Result: No differences were found between the groups at baseline. The results showed the participants had low life satisfaction (median 14 vs. 12), several health complaints (median 11) and a high score on the Geriatric Depression Scale (median 6) at baseline, indicating the risk of depression. No significant effects were observed regarding depressed mood or perceived health between or within groups at follow-up after 3 months. Cronbach's alpha showed satisfactory internal consistency for group comparisons. Conclusions: The sampling procedure led to similar groups. The life satisfaction, functional dependency and symptoms of depression measures were reliable to use. No changes in perceived health and symptoms of depression were found after 3 months, indicating that it may be too early to expect effects. The low depression score is noteworthy and requires further research.
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3.
  • Kristensson, Jimmie, et al. (författare)
  • Frail Older Adults' Experiences of Receiving Health Care and Social Services
  • 2010
  • Ingår i: Journal of Gerontological Nursing. - : SLACK, Inc.. - 0098-9134 .- 1938-243X. ; 36:10, s. 20-28
  • Tidskriftsartikel (refereegranskat)abstract
    • This study explored frail older adults' overall experience of receiving health care and/or social services. Frail older adults with unstable health are dependent on the health care system because of the frequency of their contacts with it. More knowledge is needed about how they experience the health care and social services they receive. Interviews with 14 older adults (mean age = 81) revealed one main category, Having Power or Being Powerless, that incorporated three categories: Autonomous or Without Control in Relation to the Health Care and/or Social Services System, Being Confirmed or Violated in Relation to Caregivers, and Paradoxes in Health Care or Social Services. Each category comprised subcategories reflecting aspects of having power or being powerless. The findings indicate it is important for health care and social services to ensure a high level of interpersonal continuity to empower frail older adults. This may contribute to more relationship-based care and help older adults remain in control of their life situations.
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4.
  • Kristensson, Jimmie, et al. (författare)
  • Psychometric properties of the consumer emergency care satisfaction scale: tested on persons accompanying patients in emergency department.
  • 2008
  • Ingår i: Journal of Nursing Care Quality. - 1550-5065. ; 23:3, s. 277-282
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate construct validity and internal consistency of a modified version of the Consumer Emergency Care Satisfaction Scale used on persons accompanying emergency department patients. The sample comprised 128 persons. The results showed satisfactory reliability, and an exploratory factor analysis revealed 3 factors: caring, teaching, and clinical competence. The modified version of this scale seems feasible and may be a useful tool for measuring satisfaction in persons accompanying patients in the emergency department.
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5.
  • Modig, Sara, et al. (författare)
  • Frail elderly patients in primary care-their medication knowledge and beliefs about prescribed medicines.
  • 2009
  • Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 151-155
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to describe elderly patients' knowledge about and attitudes towards their medicines in Swedish primary care. METHODS: Thirty-four patients aged 65 years and above with multiple illnesses were included. Medication knowledge was assessed with a questionnaire measuring knowledge about indication and possible adverse effects for each medicine. Attitudes were investigated with the Beliefs about Medicines Questionnaire. RESULTS: The indication of at least 75% of their medicines was known to 71% of the patients. Patients with polypharmacy and multi-dose drug distribution respectively had significantly less knowledge. Eighty-four percent had no knowledge about possible adverse effects. For 93% of the patients, the benefits of the medication outweighed the costs (concerns). No correlation was found between attitudes and knowledge. CONCLUSIONS: The knowledge about indication was higher than previously seen, but the knowledge about possible adverse effects was poor. The patients had strong beliefs in the benefits of their medication.
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6.
  • Ahlström, Gerd, et al. (författare)
  • Collaboration and guidelines for the coordination of health care for frail older persons with intellectual disability : A national survey of nurses working in municipal care
  • 2021
  • Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 8:3, s. 1369-1379
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To describe and compare perceptions of collaboration between care providers on the part of three groups of Registered Nurses working in municipal care and having particular responsibility concerning the care of frail older people with intellectual disability (ID); and, furthermore, to investigate the presence of and compliance with guidelines for the coordination of care. Design: National survey study with cross-sectional design. Methods: Nurses (N = 110) with key positions concerning people with ID answered a national questionnaire about collaboration, guidelines and coordinated individual plans. Descriptive and comparative statistical analyses were applied. Results: The meetings on cooperation and coordination of interventions were attended most frequently by nurses, and least frequently by social workers. The nurses were overall satisfied with the collaboration but perceived shortcomings in the case of inpatient and outpatient psychiatric care. Only in about half of the meetings for making care plans participated the people with intellectual disability and next of kin.
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8.
  • Axmon, Anna, et al. (författare)
  • Use of antipsychotics, benzodiazepine derivatives, and dementia medication among older people with intellectual disability and/or autism spectrum disorder and dementia
  • 2017
  • Ingår i: Research in Developmental Disabilities. - : Elsevier. - 0891-4222 .- 1873-3379. ; 62, s. 50-57
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Although people with intellectual disability (ID) and people with dementia have high drug prescription rates, there is a lack of studies investigating drug use among those with concurrent diagnoses of ID and dementia. Aim To investigate the use of antipsychotics, benzodiazepine derivatives, and drugs recommended for dementia treatment (anticholinesterases [AChEIs] and memantine) among people with ID and dementia. Methods and procedures Having received support available for people with ID and/or autism spectrum disorder (ASD) was used as a proxy for ID. The ID cohort consisted of 7936 individuals, aged at least 55 years in 2012, and the referent cohort of age- and sex-matched people from the general population (gPop). People with a specialists’ diagnosis of dementia during 2002–2012 were identified (ID, n = 180; gPop, n = 67), and data on prescription of the investigated drugs during the period 2006–2012 were collected. Outcome and results People with ID/ASD and dementia were more likely than people with ID/ASD but without dementia to be prescribed antipsychotics (50% vs 39% over the study period; odds ratio (OR) 1.85, 95% confidence interval 1.13–30.3) and benzodiazepine derivatives (55% vs 36%; OR 2.42, 1.48–3.98). They were also more likely than people with dementia from the general population to be prescribed antipsychotics (50% vs 25%; OR 3.18, 1.59–6.34), but less likely to be prescribed AChEIs (28% vs 45%; OR 0.32, 0.16–0.64).
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9.
  • Bartosch, Patrik, et al. (författare)
  • A “snap-shot” visual estimation of health and objectively measured frailty : capturing general health in aging older women
  • 2022
  • Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 34:7, s. 1663-1671
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In clinic, a subjective visual estimation of a patient’s general health often guides interventions, yet little is known of how this assessment relates to objectively measured frailty. Aims: To characterize the relationship between these two assessments and explore the implication of discordance. Methods: The study was performed in the OPRA cohort of 75-year old community-dwelling women (n = 1044). Visual perception of health (VPH) was estimated within 15 s from first sight and stratified into tertiles (poor/intermediate/good health). Frailty was measured using a frailty index (FI) (scored 0.0–1.0) and stratified into tertiles: ‘frail’ (≥ 0.22), ‘pre-frail’ (0.13–0-21) and ‘non-frail’ (≤ 0.12). Association between VPH and FI and with 10-year mortality was evaluated using Kaplan Meier curves and Cox proportional hazard models. Results: VPH and FI correlated, but was strongest in those perceived to be in poor health (rs = 0.424, p < 0.001). Approximately half of these women were also objectively frail (53.7%). Similarly, 50.7% perceived to be in good health were also objectively non-frail. However, for one in ten, perceived health was discordant with measured frailty. Subjective and objective measures were associated with mortality, but VPH lacked discrimination in healthier looking women (p = 0.372) compared to FI (p = 0.002). Discussion: Detecting pre-frailty is important to prevent or slow the transition into a frail state. The frailest can be identified with a visual estimation, but only objective frailty assessments can reliably identity pre-frailty. Conclusions: A visual estimation of health provides valuable complementary information on health, whereas objective assessment of frailty has a broader applicability for health in aging.
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10.
  • Bartosch, Patrik S., et al. (författare)
  • Frailty and prediction of recurrent falls over 10 years in a community cohort of 75-year-old women
  • 2020
  • Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:11, s. 2241-2250
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Frailty captures the age-related declines in health leading to increased vulnerability, including falls which are commonplace in older women. The relationship between frailty and falls is complex, with one leading to the other in a vicious cycle. Aims: This study addresses the gap in understanding how patterns of frailty and falls propensity interact, particularly in those who have not yet entered the falls-frailty cycle. Methods: The Osteoporosis Risk Assessment cohort consists of 1044 community-dwelling women aged 75, with 10 years of follow-up. Investigations were performed and a frailty index constructed at baseline, 5 and 10 years. Falls were self-reported for each previous 12 months. Analysis was two-directional, firstly based on frailty status and second, based on falls status. Recurrent falls was the primary outcome. Results: Baseline frailty was a significant predictor of recurrent falls after 5 and 10 years [(OR 2.55 (1.62–3.99); 3.04 (1.63–5.67)]. Among women who had no history of falls at age 75, frailty was a stronger predictor of falls at 5 years [OR 3.06 (1.59–5.89)] than among women who had previously fallen. Discussion: Frailty is significantly associated with recurrent falls and most pronounced in those who are frail but have not yet fallen. Conclusions: This suggests that frailty should be an integral part of falls-risk assessment to improve identification of those at risk of becoming fallers.
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11.
  • Berthelsen, Connie Bøttcher (CB), et al. (författare)
  • A sense of security : Spouses' experiences of participating in an orthopaedic case management intervention (the SICAM-trial)
  • 2017
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1292 .- 1878-1241. ; 24, s. 21-30
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to explore and describe spouses' experiences of participating in a case management intervention during older patients' fast-track programme having total hip replacement as well as which intervention elements they found useful. Data were collected through qualitative interviews with 10 spouses from the intervention group of the SICAM-trial, directed by predetermined codes based on elements of the intervention. Data were analysed by both authors using directed content analysis. The results showed that the spouses were very pleased about being a part of the case management intervention. They enjoyed being active participants even though problems sometimes occurred such as coordination difficulties between the case manager and other healthcare professionals and their feeling of being burdened. The spouses experienced the contact with the case manager as the most meaningful part of their participation and the telephone contact with her as the most useful element of the intervention. The fact that not all spouses participated in all the available intervention elements could be explained by their feeling of being burdened and that they were not fully aware of what the intervention elements were.
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12.
  • Berthelsen, Connie Bottcher, et al. (författare)
  • Spouses' involvement in older patients' fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial
  • 2015
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402. ; 71:5, s. 1169-1180
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo present the protocol of a two-group quasi-experimental study of spouses' involvement through case management (The SICAM-trial) in older patients' fast-track programmes during total hip replacement. BackgroundPatients in fast-track programmes are required to take an active part in their treatment and rehabilitation. Spouses of older patients can often provide valued practical and emotional support, reducing stress, pain and length of stay - yet they are seldom invited to participate in a supporting role. DesignA two-group quasi-experimental design with pre-test and repeated post-test measures (protocol approved in November 2012). MethodsA total of 120 patients aged 65years or older going through a fast-track programme for a total hip replacement and their spouses will be recruited from one Danish orthopaedic ward. We will initially include the control group for data collection and subsequently include the intervention group to avoid contamination of the control group. A case manager will be recruited to perform the case management intervention. Data will be collected from both groups at baseline, 2weeks and 3months after surgery. Outcome measures for patients include: functional status, nutrition, pain, depression and healthcare consumptions; and for spouses: caregiver satisfaction and difficulties and anxiety. ConclusionThe intervention will give further evidence on the need for relatives' participation in the patients' fast-track programmes and the results will contribute to education of the health professionals in their need to include relatives in fast-track programmes. The study was funded by the Novo Nordisk Foundation and the Regional Health Scientific Foundation of Sealand.
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14.
  • Berthelsen, Connie Bøttcher, et al. (författare)
  • The SICAM-trial : evaluating the effect of spouses' involvement through case management in older patients' fast-track programmes during and after total hip replacement
  • 2017
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 73:1, s. 112-126
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to evaluate the effect of spouses' involvement in older patients' care trajectories, using case management as intervention in total hip replacement through fast-track programmes. Background: Patients need their spouses to be involved in their fast-track programmes and this involvement is often associated with improvements in patient outcomes. However, the effect of spouses' involvement in older patients' fast-track programmes has not yet been investigated. Design: A two-group quasi-experimental design with pre-test and repeated post-test measures was conducted in an orthopaedic ward of a Danish Regional Hospital from February 2014–June 2015. Spouse–patient dyads were initially recruited for the control group (n = 14), receiving usual care; dyads for the intervention group (n = 15) were recruited afterwards, receiving case management intervention elements before, during and after admission. Methods: Face-to-face interviews on questionnaires were conducted with spouses and patients at baseline, 2 weeks and 3 months after discharge, measuring spouses' caregiver satisfaction, difficulties and level of anxiety and patients' functional and nutritional status, pain and level of depression. Results: The results showed that there were no differences between the groups with regard to any of the outcome measures. However, statistically significant improvements were found in the patient groups on functional status, pain and depression and in the groups of spouses on caregiver satisfaction. Conclusion: The case management intervention seemed to have an effect in patient and spousal groups; however, this improvement could also have been caused by the effect of fast-track treatment.
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15.
  • Birgisdóttir, Dröfn, et al. (författare)
  • Family cohesion predicts long-term health and well-being after losing a parent to cancer as a teenager : :A nationwide population-based study
  • 2023
  • Ingår i: PLoS ONE. - : PLOS. - 1932-6203. ; 18:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:Parentally bereaved children are at increased risk of negative consequences, and the mediating factors most consistently identified are found to be related to family function after the loss, including cohesion. However, existing evidence is limited, especially with respect to children and youths’ own perception of family cohesion and its long-term effects on health and well-being. Therefore, the aim of this study was to investigate self-reported family cohesion the first year after the loss of a parent to cancer and its association to long-term psychological health and well-being among young adults that were bereaved during their teenage years.Method and participants:In this nationwide population-based study, 622 of 851 (73%) young adults (aged 18–26) responded to a study-specific questionnaire six to nine years after losing a parent to cancer at the age of 13 to 16. Associations were assessed with modified Poisson regression.Results:Bereaved youth that reported poor family cohesion the first year after losing a parent to cancer had a higher risk of reporting symptoms of moderate to severe depression six to nine years after the loss compared to those reporting good family cohesion. They also had a higher risk of reporting low levels of well-being, symptoms of anxiety, problematic sleeping and emotional numbness once a week or more at the time of the survey. These results remained statistically significant after adjusting for a variety of possible confounding factors.Conclusion:Self-reported poor family cohesion the first year after the loss of a parent to cancer was strongly associated with long-term negative psychological health-related outcomes among bereaved youth. To pay attention to family cohesion and, if needed, to provide support to strengthen family cohesion in families facing bereavement might prevent long-term suffering for their teenage children.
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16.
  • Björk, Sabine, 1978- (författare)
  • Exploring resident thriving in Swedish nursing homes : the Umeå Ageing and Health Research Programme (U-Age) Thesis I
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • BackgroundThe population living in nursing homes is generally characterized by high age and female sex, as well as by physical and cognitive impairments. Also, negative symptoms such as pain and neuropsychiatric symptoms are reportedly common. Care in Swedish nursing homes is regulated by law and national guidelines implying that care is to be tailored to resident preferences and needs in order to facilitate their well-being. However, there is no national data source on the characteristics of nursing home residents or on measures of their well-being. Thriving and not merely surviving in nursing homes has been described as a subjective experience of place-related well-being resulting from interaction between residents and the nursing home environment in terms of the quality of care and caregivers, as well as from the physical and psychosocial environment. However, there is a gap in knowledge of whether and, if so, to what extent resident characteristics and factors in the nursing home environment are associated with resident thriving in nursing homes.AimThe overall aim of this thesis is to explore resident thriving in Swedish nursing homes, and the extent to which resident characteristics, neuropsychiatric symptoms, activities, and environmental factors are associated with resident thriving.MethodsThis thesis is based on cross-sectional baseline data from a national inventory of health and care in Swedish nursing homes collected in 2013–2014. The resident sample covered 4831 residents in 548 units from 172 nursing homes in 35 Swedish municipalities. The data were explored using descriptive statistics, as well as simple and multiple linear regression analyses and multilevel linear regression analyses. Resident characteristics and symptom prevalence as well as their associations with thriving; and engagement in everyday activities and their associations with thriving were explored in a sample comprising 4831 nursing home residents from 172 nursing homes. Associations between resident thriving and resident living conditions, nursing home facility and unit characteristics, and the psychosocial climate of units were explored in a sample comprising 4205 residents from 147 nursing homes.ResultsEngagement in everyday activities was positively associated with resident thriving, the strongest associations being found for engagement in an activity programme, dressing nicely, and spending time with someone the resident likes. Environmental factors associated with thriving were a positive psychosocial climate at the unit, having access to newspapers, residing in a special care unit, and residing in a facility that was unlocked during the day. Cognitive functioning was strongly associated with resident thriving. Aggressive and depressive symptoms were found to be negatively associated with resident thriving regardless of levels of cognitive functioning.ConclusionsEngagement in everyday activities can support thriving and can be conceptualized and implemented as nursing interventions to facilitate thriving in nursing homes. Factors in the nursing home environment can support resident thriving; in particular, the psychosocial climate of units seems to have a great influence. Aggressive and depressive symptoms were associated with lower levels of thriving. Targeting these symptoms would therefore seem to be a priority in nursing homes. The population living in Swedish nursing homes has a high prevalence of neuropsychiatric symptoms and cognitive impairment. Residents with cognitive impairment also commonly resided in general units. As all data were cross-sectional, longitudinal studies would be valuable to further explore causality. As resident data were based on proxy ratings, future research exploring residents’ perspectives on thriving would be valuable. The present findings contribute to our understanding of nursing home residents’ complex care needs and identify factors that could have an impact on their well-being. These findings can provide benchmark estimates for further research, quality assessment activities, as well as further clinical development work. 
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17.
  • Bylund-Grenklo, Tove, et al. (författare)
  • Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers
  • 2021
  • Ingår i: Bmc Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 20
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had "an okay way to grieve" in the first months post-loss. Methods We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6-9 years earlier, at ages 13-16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression. Results Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99-6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22-2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35-3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62-4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23-2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent. Conclusion More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6-9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.
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18.
  • Dalhammar, Karin, et al. (författare)
  • Health care utilization among patients with oesophageal and gastric cancer : the impact of initial treatment strategy and assignment of a contact nurse
  • 2021
  • Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Patients diagnosed with oesophageal and gastric cancer face a poor prognosis and numerous challenges of symptom management, lifestyle adjustments and complex treatment regimens. The multifaceted care needs and rapid disease progression reinforce the need for proactive and coherent health care. According to the national cancer strategy, providing coherent health care and palliative support is an area of priority. More knowledge is needed about health care utilization and the characteristics of the health care service in order to understand the readiness, accessibility and quality of current health care. The aim of this study was to describe individuals’ health care use from the time of treatment decision until death, and investigate the impact of the initial treatment strategy and assignment of a contact nurse (CN) on health care use among patients with oesophageal and gastric cancer. Methods: This population-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014–2016. Through linking data from the National Register for Oesophageal and Gastric Cancer, the National Cause of Death Register, and the National Patient Register, 2614 individuals were identified. Associations between the initial treatment strategy and CN assignment, and health care use were investigated. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression. Results: Patients receiving palliative treatment and those receiving no tumour-directed treatment had a higher IRR for unplanned hospital stays and unplanned outpatient care visits compared with patients who received curative treatment. Patients receiving no tumour-directed treatment also had a lower IRR for planned hospital stays and planned outpatient care visits compared with patients given curative treatment. Compared with this latter group, patients with palliative treatment had a higher IRR for planned outpatient care visits. Patients assigned a CN had a higher IRR for unplanned hospital stays, unplanned outpatient care visits and planned outpatient care visits, compared with patients not assigned a CN. Conclusions: A palliative treatment strategy and no tumour-directed treatment were associated with higher rates of unplanned health care compared with a curative treatment strategy, suggesting that a proactive approach is imperative to ensure quality palliative care.
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19.
  • Dalhammar, Karin, et al. (författare)
  • Striving towards normality in an unpredictable situation. A qualitative interview study of how persons newly diagnosed with incurable oesophageal and gastric cancer manage everyday life
  • 2023
  • Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889. ; 63
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Getting an incurable oesophageal or gastric cancer diagnosis is a major stressful life event associated with severe physical, psychosocial and existential challenges. To provide timely and efficient support, based on patients' experiences, the aim of the study was to explore how patients newly diagnosed with incurable oesophageal and gastric cancer manage everyday life. Method: Semi-structured interviews were conducted with 12 patients 1–3 months after being diagnosed with incurable oesophageal or gastric cancer. Four participants were interviewed twice, which resulted in 16 interviews. Data were analysed with qualitative content analysis. Results: An overall theme, “Striving towards normality in an unpredictable situation”, with three related themes – “Trying to comprehend the disease”, “Dealing with the consequences of illness” and “Re-evaluating what is important in everyday life” – and seven sub-themes were identified. The participants described an unexpected and unpredictable situation, in which they strived to maintain their normal life. Amidst struggling to manage problems related to eating, fatigue and an incurable diagnosis the participants talked about the importance of focusing on the positive and normal aspects of life. Conclusions: The findings in this study point to the importance of supporting patients’ confidence and skills, particularly with regard to managing eating, so that they can hold on to their normal life as much as possible. The findings further point to the possible benefit of integrating an early palliative care approach and could provide guidance for nurses and other professionals on how to support patients post diagnosis.
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20.
  • Dalhammar, Karin, et al. (författare)
  • Symptoms, problems and quality of life in patients newly diagnosed with oesophageal and gastric cancer - a comparative study of treatment strategy
  • 2022
  • Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 22, s. 1-14
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with oesophageal and gastric cancer have a low likelihood of being cured and suffer from a broad spectrum of symptoms and problems that negatively affect their quality-of-life (QOL). Although the majority (67-75%) of patients at the time of diagnosis suffer from an incurable disease, research has primarily focused on the pre- and postoperative phase among patients treated with curative intent, with little attention to symptoms and problems in the diagnostic phase, especially in those who cannot be offered a cure.METHODS: In this cross-sectional study 158 patients newly diagnosed with oesophageal and gastric cancer visiting the surgical outpatient department for a preplanned care visit were included consecutively during 2018-2020. The validated instruments QLQ-C30 and QLQ-OG25, developed by the European Organization for Research and Treatment of Cancer (EORTC), and selected items from the Integrated Patient Outcome Scale (IPOS) were used to assess QOL, symptoms and problems. Differences between patients with a curative and a palliative treatment strategy were analysed using t-test and Mann-Whitney U test. The QLQ-C30 and QLQ-OG25 scores were compared to published reference data on the general Swedish population.RESULTS: Among all, the QOL was markedly lower, compared with general Swedish population (mean ± SD, 55.9 ± 24.7 vs 76.4 ± 22.8, p < 0.001). Compared to general population, the patients had significant impairment in all QOL aspects, particularly for role and emotional functioning and for symptoms such as eating-related problems, fatigue, insomnia and dyspnea. Majority of patients also reported severe anxiety among family and friends. Among patients with oesophageal cancer those with a palliative treatment strategy, compared with curative strategy, reported significantly lower QOL (mean ± SD, 50.8 ± 28.6 vs 62.0 ± 22.9 p = 0.030), physical (65.5 ± 22.6 vs 83.9 ± 16.5, p < 0.001) and role functioning (55.7 ± 36.6 vs 73.9 ± 33.3, p = 0.012), and a higher burden of several symptoms and problems. No significant differences between treatment groups were shown among patients with gastric cancer.CONCLUSIONS: Patients newly diagnosed with oesophageal and gastric cancer, and especially those with incurable oesophageal cancer, have a severely affected QOL and several burdensome symptoms and problems. To better address patients' needs, it seems important to integrate a palliative approach into oesophageal and gastric cancer care.
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21.
  • Dalhammar, Karin, et al. (författare)
  • The impact of initial treatment strategy and survival time on quality of end-of-life care among patients with oesophageal and gastric cancer : A population-based cohort study
  • 2020
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:6
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Oesophageal and gastric cancer are highly lethal malignancies with a 5-year survival rate of 15-29%. More knowledge is needed about the quality of end-of-life care in order to understand the burden of the illness and the ability of the current health care system to deliver timely and appropriate end-of-life care. The aim of this study was to describe the impact of initial treatment strategy and survival time on the quality of end-of-life care among patients with oesophageal and gastric cancer. METHODS: This register-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Esophageal and Gastric Cancer, the National Cause of Death Register, and the Swedish Register of Palliative Care, 2156 individuals were included. Associations between initial treatment strategy and survival time and end-of-life care quality indicators were investigated. Adjusted risk ratios (RRs) with 95% confidence intervals were calculated using modified Poisson regression. RESULTS: Patients with a survival of ≤3 months and 4-7 months had higher RRs for hospital death compared to patients with a survival ≥17 months. Patients with a survival of ≤3 months also had a lower RR for end-of-life information and bereavement support compared to patients with a survival ≥17 months, while the risks of pain assessment and oral assessment were not associated with survival time. Compared to patients with curative treatment, patients with no tumour-directed treatment had a lower RR for pain assessment. No significant differences were shown between the treatment groups regarding hospital death, end-of-life information, oral health assessment, and bereavement support. CONCLUSIONS: Short survival time is associated with several indicators of low quality end-of-life care among patients with oesophageal and gastric cancer, suggesting that a proactive palliative care approach is imperative to ensure quality end-of-life care.
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22.
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23.
  • Eekholm, Signe, et al. (författare)
  • Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia : a descriptive cross-sectional study
  • 2020
  • Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. METHODS: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. RESULTS: Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. CONCLUSIONS: Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.
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24.
  • Ge, Li, 1974- (författare)
  • Women's call for caring care : perspectives of Chinese women with gestational diabetes mellitus about beliefs, self-care behavior, quality of care and lived experience
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of the thesis was to explore the perspectives of Chinese women with gestational diabetes mellitus (GDM) focused on their beliefs about health and illness and self-care behavior, the quality of care in China, and their lived experience.                      All the studies were conducted with qualitative methodology using individual interviews. Data were collected in obstetric clinics or wards at three different hospitals or the participants’ workplaces in the south east of China. Content analysis, according to Mayring, was used for data analysis in Study І (15 interviews) and Study II (17 interviews). Content analysis, according to Graneheim & Lundman, was used for data analysis in Study III (44 interviews). In Study IV (18 interviews), data were analyzed by using phenomenological hermeneutics, according to Lindseth & Norberg.     Three styles of beliefs about GDM among the Chinese women were explored in the thesis: GDM should be considered seriously; GDM was not a severe illness; and GDM was nothing to worry about. Correspondingly, three self-care behavior models were revealed: women strove to control GDM, and maintained their blood glucose values at a normal level; or women tried to control GDM based on the knowledge they received, but some of them felt helpless because the blood glucose level could not be maintained within the normal range; or women almost ignored GDM. They mainly sought help from professional sector and popular sector, and regarded health professionals and husbands as important people. They showed, however, that they sought a balance between following professionals’ advice and avoiding practical difficulties, which demonstrated the influence of health professionals, people around, and Chinese culture. The thesis highlighted a lack of knowledge, a lower level of risk awareness and poor self-care behavior among the women with GDM, as well as a lack of professional care resources for GDM and the lack of high-quality personalized care for the women. The core problem could be an resource imbalance between over-stretched hospitals and low-efficiency under-utilized primary healthcare centers. Their lived experience showed an eagerness to be cared for.    The thesis highlighted women’s call for caring care in China. The care of GDM for these women can most likely be improved by reform of clinical practice, particularly in primary healthcare services. It is necessary to increase the number of health professionals and material resources to a reasonable level, and to strengthen caring care in China.
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25.
  • Granbom, Marianne, et al. (författare)
  • Effects on leisure activities and social participation of a case management intervention for frail older people living at home : A randomised controlled trial
  • 2017
  • Ingår i: Health and Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 25:4, s. 1416-1429
  • Tidskriftsartikel (refereegranskat)abstract
    • Frailty causes disability and restrictions on older people's ability to engage in leisure activities and for social participation. The objective of this study was to evaluate the effects of a 1-year case management intervention for frail older people living at home in Sweden in terms of social participation and leisure activities. The study was a randomised controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to intervention (n = 80) or control groups (n = 73). The intervention group received monthly home visits over the course of a year by nurses and physiotherapists working as case managers, using a multifactorial preventive approach. Data collections on social participation, leisure activities and rating of important leisure activities were performed at baseline, 3, 6, 9 and 12 months, with recruitment between October 2006 and April 2011. The results did not show any differences in favour of the intervention on social participation. However, the intervention group performed leisure activities in general, and important physical leisure activities, to a greater extent than the control group at the 3-month follow-up (median 13 vs. 11, P = 0.034 and median 3 vs. 3, P = 0.031 respectively). A statistically significantly greater proportion of participants from the intervention group had an increased or unchanged number of important social leisure activities that they performed for the periods from baseline to 3 months (93.2% vs. 75.4%, OR = 4.48, 95% CI: 1.37-14.58). Even though statistically significant findings in favour of the intervention were found, more research on activity-focused case management interventions is needed to achieve clear effects on social participation and leisure activities.
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26.
  • Gustafsson, Markus, et al. (författare)
  • Case managers’ experiences of their everyday practice
  • 2013
  • Ingår i: European Geriatric Medicine. - Venice : Elsevier Masson SAS. - 1878-7649.
  • Konferensbidrag (refereegranskat)abstract
    • Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.
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27.
  • Gustafsson, Markus, et al. (författare)
  • Case managers for older persons with multi-morbidity and their everyday work -- a focused ethnography
  • 2013
  • Ingår i: BMC Health Services Research. - : Biomed Central. - 1472-6963. ; 13:496
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.
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28.
  • Hansson, Jan-Åke, et al. (författare)
  • The Importance of a Co-Ordinated Care For Older People With Intellectual and Developmental Disability (Idd)
  • 2019
  • Ingår i: Journal of Intellectual Disability Research. - : John Wiley & Sons. - 0964-2633 .- 1365-2788. ; 63:7, s. 818-819
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Health problems in people with intellectual and developmental disability (IDD) are traditionally known to be common in adults of all age, with at least twice as many health problems in this group as the general ageing population. In addition, there is considerable international evidence indicating an earlier death for people with IDD compared to the general population, exacerbated by fragmentation in health care systems and resulting in poor coordination between various health care services (WHO, 2018). Methods: An evaluation was done in Sweden, to estimate the effectiveness of the health system integration for people with IDD, and quality of coordinated care by professional health care personnel who had a coordinating function. In a survey, 114 medically responsible nurses, operating in key positions in 109 municipalities throughout Sweden, were asked to assess quality of co‐ordination between various centres for social services and health‐care units for frail older people with IDD who in need of both social service and healthcare. Results: Results showed diverse coordinated care, ranging from very good to very poor cooperation between the nurses and various types of care and service units. Implications: The study findings emphasise the importance of effective coordinated care.
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29.
  • Hjelm, Markus, et al. (författare)
  • The work of case managers as experienced by older persons (+75) with multi-morbidity : a focused ethnography
  • 2015
  • Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers. Methods The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013. Results The data revealed four themes illustrating the older persons’ experiences of case managers: 1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present. Conclusions This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.
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30.
  • Jakobsson, Ulf, et al. (författare)
  • Psychosocial perspectives on health care utilization among frail elderly people: An explorative study.
  • 2011
  • Ingår i: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 1872-6976 .- 0167-4943. ; 52, s. 290-294
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to explore the relationship between health care utilization over 2 years and psychosocial variables measured at the end of this period in a sample of older people with high health care consumption. Sixty-three people aged 69-96 years were included in the study. Data were collected from two different registers covering health care utilization from 2004 to the end of 2008, and baseline data from an ongoing RCT. A cluster analysis (based on the health care utilization variables) was used to divide the sample into subgroups. The cluster analysis resulted in a two cluster and a three cluster solutions. The latter was found to be more appropriate because it more clearly discriminated between the groups regarding health care utilization and psychosocial variables. The three clusters were classified as "high consumers" (Cluster I), and "low consumers" (Clusters II and III). Cluster II seemed to be characterized by low outpatient but high inpatient care utilization, while the opposite utilization pattern can be seen in Cluster III, which also contained those with the largest social network, lowest risk of depression, highest life satisfaction and who felt least lonely. Cluster II contained those who felt the loneliest. Thus, older people whose health care consumption mainly comprises outpatient care appeared to have the least impact on the psychosocial variables (e.g., the highest life satisfaction, felt least lonely and were at the lowest risk of depression). Thus, measures taken to prevent health care utilization, especially among those with high utilization of inpatient care, will most likely have a positive effect on psychosocial variables and life satisfaction/quality of life (QoL).
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31.
  • Jakobsson, Ulf, et al. (författare)
  • The Pain Impact Inventory-Further Validation in Various Subgroups.
  • 2012
  • Ingår i: Pain Practice. - : Wiley. - 1533-2500 .- 1530-7085. ; 12, s. 350-356
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of the study was to further psychometrically evaluate the instrument "Pain Impact Inventory" (PII) in various subgroups. Methods: The sample comprised 384 persons (aged between 18 and 102 years) who reported chronic pain. The instrument PII was evaluated in terms of construct validity as well as reliability. The instrument's validity was investigated through corrected item-total correlation, floor and ceiling effects, and item response rate. Reliability was assessed by means of test-retest (with a 2-week interval) and Cronbach's alpha. All analyses were performed in various subgroups, men and women, as well as in 6 different age-groups and 5 primary pain location. Results: The result showed an item-total correlation above 0.30 for all items in all subgroups with exception for the 2 items in F5 in the age-group, 30 to 44. In the test-retest analysis, all kappa coefficients in the test-retest analysis were significant (P < 0.001) and varied between 0.482 and 0.879. The alpha values for factor 1 to 4 ranged between 0.80 and 0.94. Alpha values below 0.7 were only found for F5. Conclusion: The PII showed satisfactory psychometric properties in terms of construct validity and reliability with regard to gender, age-groups, and primary pain location.
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32.
  • Kivekäs, Niku, et al. (författare)
  • Coupling an aerosol box model with one-dimensional flow : A tool for understanding observations of new particle formation events
  • 2016
  • Ingår i: Tellus. Series B: Chemical and Physical Meteorology. - : Stockholm University Press. - 1600-0889 .- 0280-6509. ; 68:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Field observations of new particle formation and the subsequent particle growth are typically only possible at a fixed measurement location, and hence do not follow the temporal evolution of an air parcel in a Lagrangian sense. Standard analysis for determining formation and growth rates requires that the time-dependent formation rate and growth rate of the particles are spatially invariant; air parcel advection means that the observed temporal evolution of the particle size distribution at a fixed measurement location may not represent the true evolution if there are spatial variations in the formation and growth rates. Here we present a zerodimensional aerosol box model coupled with one-dimensional atmospheric flow to describe the impact of advection on the evolution of simulated new particle formation events. Wind speed, particle formation rates and growth rates are input parameters that can vary as a function of time and location, using wind speed to connect location to time. The output simulates measurements at a fixed location; formation and growth rates of the particle mode can then be calculated from the simulated observations at a stationary point for different scenarios and be compared with the 'true' input parameters. Hence, we can investigate how spatial variations in the formation and growth rates of new particles would appear in observations of particle number size distributions at a fixed measurement site. We show that the particle size distribution and growth rate at a fixed location is dependent on the formation and growth parameters upwind, even if local conditions do not vary. We also show that different input parameters used may result in very similar simulated measurements. Erroneous interpretation of observations in terms of particle formation and growth rates, and the time span and areal extent of new particle formation, is possible if the spatial effects are not accounted for.
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33.
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34.
  • Kristensson, Jimmie (författare)
  • Healthcare consumption, experiences of care and test of and intervention in frail old people. Implications for case management
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of thesis was to explore frail older people’s experiences of receiving healthcare and/or social services and to investigate healthcare consumption and costs in both men and women and in different age groups in the two years prior to the introduction of long-term municipal care. A second aim was to explore a preventive intervention in a pilot study using case managers to older people with functional dependency and repeated healthcare contacts. Study I was qualitative and comprised 14 people (mean age 81) who were interviewed about their experiences of the healthcare and social services delivered to them. The results were analysed using content analysis. A cross-sectional, comparative design was used in studies II and III, which comprised 362 people who received a decision about the provision of municipal care or/and services during 2002-2003 and the participants were drawn from the Swedish National Study of Aging and Care (SNAC) and the county council register of healthcare consumption and costs. Study IV was a pilot trial with an experimental design and comprised 35 people who were consecutively and randomly assigned to either an intervention (n=19) or a control (n=16) group. Two nurses worked as case managers and carried out the intervention, which had four dimensions. Data were collected at baseline and after the intervention had been in place for about three months. Study I showed that the experience of receiving healthcare and/or social services in old age could be interpreted according to the overall theme “Having power or being powerless”, divided into three main categories: Autonomous or without control in relation to the healthcare and/or social service system; Confirmed or violated in relation to caregivers and Paradoxes in healthcare and social services. The results from Study II showed that about 50% of the acute hospital stays occurred within the five months prior to receiving municipal care. The men (n= 115, mean age 80.8) had significantly more bed days in hospital, more diagnoses and contacts with other staff groups besides physicians in outpatient care compared to the women (n=247, mean age 83.8). The results from study III showed that 13% of the sample had overall higher healthcare costs throughout the two years of observation. A majority (58% for the women and 54% for the men) of the costs for acute inpatient care occurred within five months prior to municipal care. The results from Study IV showed no differences between groups at baseline. Those included reported low life satisfaction, low perceived health and were also at risk of suffering from depression. The Life Satisfaction Index, Geriatric Depression Scale-20 and the ADL staircase had satisfactory internal consistency. Healthcare staff must be aware of the risk that older people loose control over their life situation when receiving healthcare and/or social services from various agencies. Preventive interventions and a more empowering approach are seemingly needed. This requires continuity and accessibility on an individual and organisational level. Early detection through a systematic clinical assessment, a more proactive and integrated care and applying preventive interventions to people in a transitional stage of becoming increasingly dependent on continuous care and services seems urgent to prevent escalating acute hospital admissions and thereby costs. The intervention had a feasible design. The sampling procedure led to similar groups and the measures were reliable to use. Both groups had a low life satisfaction, a low self reported health and were at risk of having a depression and could benefit from preventive interventions. No effects were found on self perceived health and depressed mood after three months. This might be due to the follow up time being too short. Further investigations about the content of the interventions are needed in the future.
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35.
  • Kristensson, Jimmie, et al. (författare)
  • Healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care
  • 2007
  • Ingår i: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410. ; 15:5, s. 474-485
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to investigate healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care at home or in special accommodation and to investigate determinants for healthcare consumption. The study comprised 362 people (aged 65 or over), all subject to a decision about municipal care and/or services during 2002-2003, drawn from the Swedish National Study on Aging and Care (SNAC). Data were collected from three existing registers, the SNAC data covered age, gender, marital status, functional ability, informal care and living conditions and were merged with the Skane County Council's patient administration system PASiS and PrivaStat covering healthcare consumption from the year 2000 and forward. About 50% of the acute hospital stays (n = 392) occurred within 5 months prior to municipal care. The men (n = 115, mean age 80.8) had significantly longer stays in hospital (P = 0.025), more diagnoses (P = 0.004) and contacts with other staff groups beside physicians in outpatient care (P < 0.001) compared to the women (n = 247, mean age 83.8). The regression analysis showed heart conditions, cancer, musculoskeletal problems, genitourinary diseases, injuries and unspecified symptoms to be significantly associated with various kinds of healthcare consumption. The findings indicated a breakpoint in terms of hospital admissions about 5 months prior to municipal care and service and a share of 15% having several admissions to hospital. Early detection and preventive interventions to these people in a transitional stage of becoming increasingly dependent on continuous care and services seems urgent to prevent escalating acute healthcare consumption.
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36.
  • Kristensson, Jimmie, et al. (författare)
  • Healthcare costs for people aged 65+ two years prior to their receiving long-term municipal care.
  • 2008
  • Ingår i: Aging clinical and experimental research. - 1720-8319. ; 20:6, s. 547-555
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND AIMS: More knowledge is needed about patterns of healthcare consumption at different times during old age, particularly with regard to the relationship between various agents in the healthcare and social services system. One aim was to investigate healthcare costs in the public medical healthcare system in men and women (65+) and, with regard to age, in the two years prior to the start of long-term municipal care and services. Another aim was to investigate patterns and determinants of costs. METHODS: The study comprised 362 people who received decisions about municipal care and/or services during 2002-2003, and data were derived from the Swedish National Study of Aging and Care (SNAC) and county councils registers about healthcare consumption. SNAC provided data concerning demographics, functional dependency and informal care at the time of the decision, which were merged with data from the Skåne County Council patient administrative system regarding costs in the two years prior to decision. RESULTS: Cluster analysis revealed 13% overall higher healthcare costs. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Most (58% for women, 54% for men) of the costs for acute inpatient care occurred within five months prior to municipal care. Men had significantly higher costs compared with women for visits to outpatient physicians (EUR 700 vs 400) and inpatient care (EUR 4700 vs 700) 12-0 months prior to municipal care. CONCLUSIONS: A share of 13% had higher healthcare costs throughout the two years. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Those older people at risk of high healthcare costs should benefit from systematic clinical assessments and more proactive and integrated care, to prevent escalating costs in the period preceding long-term municipal care and services.
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37.
  • Kristensson, Jimmie, et al. (författare)
  • Healthcare utilisation and knowledge concerning prescribed drugs among older people.
  • 2010
  • Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 66, s. 1047-1054
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to explore healthcare consumption in relation to more versus less knowledge concerning prescribed drugs among older people with functional dependency and repeated healthcare contacts, and to explore the determinants of more versus less knowledge METHODS: The sample comprised 63 persons (mean age 82.8 years). Data concerning use and knowledge about drugs, demographics, health complaints and self-reported diseases were collected from the baseline measure in an ongoing randomised controlled trial (RCT) and merged with data from two public registers about healthcare consumption 2 years prior to baseline measurement. Data were analysed descriptively and using regression analysis. RESULTS: Fifty-two percent of the sample (n = 33) had less knowledge (defined as not knowing the indications for 50% or less of their prescribed drugs) and these had more acute hospitals stays (median 2 vs 0), more total hospital stays (median 2 vs 1) and more bed days in hospital (median 18 vs 3) than those with more knowledge. Bed days and visits to other outpatient staff groups were associated with less knowledge; visits to physicians were associated with more knowledge. CONCLUSIONS: The healthcare consumption pattern of those with less knowledge differed from that of those with more knowledge in terms of more acute inpatient care. The results indicate that there is a need for the health system to create mechanisms to ensure that patients do not lose their knowledge about their drugs when admitted in an acute situation; there is also an apparent need for educational intervention with patients, starting at the time of admission.
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38.
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39.
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40.
  • Kristensson, Jimmie, et al. (författare)
  • Olika perspektiv på åldrandet.
  • 2010. - 1
  • Ingår i: Äldres hälsa och ohälsa – en introduktion till geriatrisk omvårdnad. - 9789144053530 ; , s. 15-27
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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41.
  • Kristensson, Jimmie, et al. (författare)
  • The establishment of a shared care plan as it is experienced by elderly people and their next of kin : A qualitative study
  • 2018
  • Ingår i: Archives of gerontology and geriatrics (Print). - Shannon : Elsevier. - 0167-4943 .- 1872-6976. ; 79, s. 131-136
  • Tidskriftsartikel (refereegranskat)abstract
    • One strategy to achieve coordination of care for older people with complex care needs is the establishment of shared care plans. The aim of this study was to explore the process of establishing a shared care plan from the perspective of elderly people and their next of kin. Data were collected via 12 semi-structured interviews with 12 older persons targeted in joint care planning and 11 next of kin, either alone or together. The analysis was conducted using content analysis. The results reflect the process of establishing a shared care plan in the three categories; Preparation, Content and Results with belonging sub-categories. Preparation showed that the possibility to influence the preparation of the joint care plan meeting was sometimes limited and the purpose was not always clear. The Content category showed that the meeting was sometimes experienced as an unstructured, general conversation or focused on practical matters. And Results of the process were shown to be successful in terms of having positive effects or fulfilling needs, but also sometimes as being pointless. Thus, the results show that the process of establishing a shared care plan is somewhat unclear to the older person and their next of kin and that they are rarely involved in the decisions regarding when and if a shared care plan is needed. If joint care planning is expected to serve as a tool to accomplish a more person-centred care, then the person must be regarded as an equal partner all throughout the decision-making and planning process. © 2018 Elsevier B.V.
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42.
  • Liebenhagen, Andreas (författare)
  • Development and Psychometric Exploration of the Anesthesia Surrendering Instrument (ASI)
  • 2019
  • Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1532-8473 .- 1089-9472. ; 34:1, s. 169-179
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeThe aim of this study was to develop and test an instrument to measure surrendering at the time of anesthesia induction and to explore the construct validity.DesignAn instrumental cross-sectional design was used and construct validity was evaluated via psychometric testing.MethodsThe anesthesia surrendering instrument (ASI) comprised 36 items. A total of 202 adults (older than 18 years) answered the questionnaire. Principal component analysis was used for item reduction and identification of defining constructs.FindingsSurrendering to anesthesia was defined by four constructs: preparation by avoidance, control, preparation by understanding, and acceptance, explaining 43.2% of the variance in the matrix.ConclusionsThe findings show that it is possible to measure the concept of surrendering by means of four dimensions as preparation by avoidance, control, preparation by understanding, and acceptance, although the dimensional variance of 43% could be considered weak. The ASI will constitute context-specific patient-reported experience measures for anesthesia, whereas further item refinement and testing of the ASI are necessary to achieve a better variance.
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43.
  • Lindvall, Agneta, et al. (författare)
  • Informal Care Provided by Family Caregivers : Experiences of Older Adults With Multimorbidity
  • 2016
  • Ingår i: Journal of Gerontological Nursing. - : Slack. - 0098-9134 .- 1938-243X. ; 8:42, s. 24-31
  • Tidskriftsartikel (refereegranskat)abstract
    • Informal care given by family caregivers is an important part of the total care provided to older adults with multimorbidity. The current study aimed to describe how older adults with multimorbidity experienced care from family caregivers. Interviews were conducted with 24 participants (mean age = 86 years). Older adults with multimorbidity felt gratitude toward family caregivers for their willingness to help with everyday life and for representing their interests in contacts with health care providers. Family caregivers also had a significant impact on older adults’ psychological well-being. However, the results also showed that older adults often felt they were a burden to their family caregivers and that their independence might be reduced. Older adults with multimorbidity should have the opportunity to be more involved in and have more influence over their health care so that they do not have to depend on representation by family caregivers.
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44.
  •  
45.
  • Modig, Sara, et al. (författare)
  • Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?
  • 2014
  • Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1364-6915 .- 1360-7863. ; 18:8, s. 1022-1028
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Depression is common but not always recognized and often undertreated among elderly. Cardiovascular diagnoses have been reported to be associated with depression. The study examined if this association could be confirmed in a frail elderly population. It also assessed the association between high depressive scores and certain health complaints and the use of certain drugs, respectively.Method: A total of 153 frail elderly in ordinary living were included. The association between depressive symptoms, assessed by geriatric depression scale (GDS) 20, and an inpatient diagnose of cerebrovascular disease or heart failure was assessed. Depressive symptoms were also compared with health complaints and background data. Furthermore, the use of certain drugs, such as antidepressants and other psychotropics, was compared with depressive symptoms.Results: Risk of depression was seen in 52% of the patients. Those showing risk of depression more often received municipal care or help with medication distribution and were more often treated with sedatives. They also had significantly more health complaints. No differences were found between those who had or did not have a diagnosis of heart failure or transient ischemic attack (TIA)/stroke during hospital care the previous year regarding risk for depression or treatment with antidepressants, respectively. Sixteen per cent were treated with antidepressants and this group was significantly younger than those who were not treated.Conclusion: Those elderly with a GDS score indicating a risk for depression have poorer health, are more dependent on help and are more often treated with sedatives. The study could not confirm an association between heart failure or TIA/stroke and risk for depression.
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46.
  • Modig, Sara, et al. (författare)
  • Frail elderly patients' experiences of information on medication. A qualitative study
  • 2012
  • Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Older patients generally have only poor knowledge about their medicines. Knowledge is important for good adherence and for participating in decisions about treatment. Patients are entitled to be informed on an individual and adequate level. The aim of the study was to explore frail elderly patients' experiences of receiving information about their medications and their views on how the information should best be given. Methods: The study was qualitative in design and was carried out in 2011. Twelve frail elderly (aged 68-88) participants taking cardiovascular medications participated in semi-structured interviews covering issues related to receiving information about prescribed medicines. The interviews were recorded, transcribed and subjected to content analysis, in which the text was analysed in five steps, inspired by Graneheim and Lundman. Results: The results revealed that the experiences which the elderly participants had regarding the receiving of medical information fell into two main categories: "Comfortable with information" or "Insecure with information". The elderly felt comfortable when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Conclusions: Factors that frequently caused insecurity about information and anxiety were too short consultations, lack of availability of someone to answer questions or of the opportunity to contact the physician if adverse effects are suspected. These factors could easily be dealt with and there must be improvements in the clinics if the patients' feelings of security are to be increased.
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47.
  •  
48.
  • Olsson Möller, Ulrika, et al. (författare)
  • Fighting for control in an unpredictable life : a qualitative study of older persons' experiences of living with chronic dizziness
  • 2014
  • Ingår i: BMC Geriatrics. - 1471-2318 .- 1471-2318. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Dizziness in older people is associated with disability and reduced quality of life. Few studies have investigated how daily life is affected from the older person's perspective. Identifying barriers and resources in daily life could guide health care in how to direct efficient interventions. The aim of this study was to explore older persons' experiences of living with chronic dizziness.METHODS: In this qualitative study seven women aged 74-84 years and six men aged 73-87 years with chronic dizziness (≥3 months) recruited from a primary health care centre in 2012 participated in semi-structured interviews. The interviews were analysed by content analysis.RESULTS: Interpretation of the interviews resulted in the overall theme "Fighting for control in an unpredictable life" with two themes. The first theme "Striving towards normality" revealed a struggle in daily life in searching for a cure or improvement and finding a way to maintain ordinary life. This process could result in feelings of resignation or adaption to daily life, and factors that supported living with chronic dizziness were described. The second theme "Having a precarious existence" revealed that daily life included being exposed to threats such as a fear of recurrent attacks or of falling, which resulted in an insecure and inflexible way of life. A feeling that symptoms were not taken seriously was described.CONCLUSIONS: The present study showed that older persons with chronic dizziness have needs that are not met by health care. Despite the fact that frequent contact with health care was described, the respondents described barriers in daily life that led to a restricted, inflexible and insecure daily life. Health care should therefore be individually tailored with focus on aspects of daily life, especially safety aspects. Support should also be continued until the older persons with chronic dizziness have developed coping strategies to gain control of their daily life.
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49.
  • Olsson Möller, Ulrika, et al. (författare)
  • Fighting for control in an unpredictable life - a qualitative study of older persons' experiences of living with chronic dizziness.
  • 2014
  • Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Dizziness in older people is associated with disability and reduced quality of life. Few studies have investigated how daily life is affected from the older person's perspective. Identifying barriers and resources in daily life could guide health care in how to direct efficient interventions. The aim of this study was to explore older persons' experiences of living with chronic dizziness.
  •  
50.
  • Olsson Möller, Ulrika, et al. (författare)
  • Modern technology against falls : A description of the MoTFall project
  • 2021
  • Ingår i: Health Informatics Journal. - 1460-4582 .- 1741-2811. ; 27:2, s. 1-10
  • Tidskriftsartikel (refereegranskat)abstract
    • To meet future challenges from an older and physically less active population innovative solutions are needed. Modern Technology against Falls (MoTFall) aims to prevent falls, increase physical activity and improve self-rated health among older people by means of an information and communication technology based system. The project has developed technology-based solutions, focusing on person-centred care. A participatory research design was applied in the development of a mobile application, a wearable inertial movement measurement unit (IMMU), called the Snubblometer ('snubbla' is 'stumble' in Swedish) and a web-based education programme for health care professionals. The mobile application includes a fall risk index, exercises and information related to falls prevention. By linking the app to the IMMU, person-centred interventions can be developed and implemented in various health care settings and with different target populations. The IMMU has shown good validity and reliability for measuring postural sway and high sensitivity and specificity for measuring a near fall. The education programme is directed at non-graduate health care professionals in nursing homes and home care. The technical solutions have potential for use in research and in clinical practice.
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