| 1. |
- Athanassiadis, Dimitris, et al.
(författare)
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HARVESTING POTENTIAL AND PROCUREMENT COSTS OF LOGGING RESIDUES IN SWEDEN
- 2009
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was (i) to provide an estimation of the potential amount of logging residues (branches, tops and stumps with attached root system) that will be produced in Sweden (thinning and regeneration fellings) during the next decade (2010-2019) and (ii) calculate the costs for harvesting the residue, comminute it and bring it to the end user. Depending on the level of ecological, technical and economical restrictions the potential amount of slash (branches, tops and stumps) in regeneration fellings varied from 3.2 to 7.4 Mt OD annually while the potential amount (Mt OD) of stumps varied from 4.2 to 11.7 annually. The corresponding annual figures in thinning for slash and stumps were 1.7 to 3.9 and 1.8 to 5.7 Mt OD annually, respectively. 80% of the potential amount of slash and stumps at level 3 of ecological, technical and economical restrictions in regeneration fellings would be available for 85 EUR/ODT and 110 EUR/ODT, respectively
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| 2. |
- Athanassiadis, Dimitris, et al.
(författare)
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Marginalkostnader för skörd av grot och stubbar från föryngringsavverkningar i Sverige
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Kostnaden för att ta ut grot och stubbar från föryngringsavverkningar i Sverige har uppskattats och redovisas i form av marginalkostnadskurvor. Beräkningarna baseras på den mängd grot och stubbar som faller ut till följd av föryngringsavverkningar som utförs i referensscenariot i SKA-VB 08 för perioden 2010 - 2019. De potentialer som använts är efter avdrag för ekologiska, tekniska och ekonomiska restriktioner, dvs. nivå 3 i SKA-VB 08. Kostnaderna för uttag av grot och stubbar har beräknats för de maskinsystem som är vanligast förekommande i Sverige och Finland idag. Ersättning till markägare, administrationsomkostnader och kostnader för skörd, sönderdelning, maskinflyttningar och transport av grot och stubbar är de kostnadsposter som ingår i beräkningarna. Grot kan tas ut till en lägre kostnad än stubbar vilket leder till att marginalkostnadskurvan för grot startar på en lägre nivå än marginalkostnadskurvan för stubbar; 600 kr/ton TS för grot respektive 800 kr/ton TS för stubbar. Om kostnaden får öka från 770 till 920 kr/ton TS kan tillvaratagandet av grot öka från dagens ca 2 till 2,9 Mton TS, dvs. 90 % av den tillgängliga potentialen som är 3,2 Mton TS. Först vid en kostnad på 850 kr/ton TS trädbränsle uppgår andelen stubbar till 10 % av sortimentsfördelningen. Vid en kostnad på 1 100 kr/ton TS är sortimentsfördelningen så gott som lika för grot och stubbar. Om 2,5 Mton TS (60 %) av tillgänglig potential stubbar i nuläget ska bli aktuella för skörd blir uttagskostnaden upp till 1 000 kr/ton TS. Omräkningstalet 1 ton TS = 4,9 MWh har använts vid omvandling mellan massa och energi. Detta värde anger mängden energi som kan avges som värme vid förbränning av skogsbränsle med en fukthalt på 40 % när vattnets ångbildningsenergi inte utnyttjas. Om prestationen för de maskiner som ingår i stubbsystemet ökar med 15 % så kan man få ut samma mängd vid 920 kr/ton TS. Kostnadsfördelningen visar att transportkostnaderna är den viktigaste kostnadsposten, speciellt när det gäller små avverkningstrakter, belägna långt från tätort
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| 3. |
- Dannapfel, Petra, et al.
(författare)
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A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready) : Formative Evaluation
- 2022
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Ingår i: JMIR Formative Research. - : JMIR Publications Inc.. - 2561-326X. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: eHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings. Objective: The aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care. Methods: A first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated. Results: The E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87). Conclusions: E-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample.
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| 4. |
- Eggers, Jeannette, et al.
(författare)
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Management Strategies for Wood Fuel Harvesting-Trade-Offs with Biodiversity and Forest Ecosystem Services
- 2020
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Ingår i: Sustainability. - : MDPI AG. - 2071-1050. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Bioenergy is expected to contribute to mitigating climate change. One major source for bioenergy is woody biomass from forests, including logging residues, stumps, and whole trees from young dense stands. However, at increased extraction rates of woody biomass, the forest ecosystem, its biodiversity, and its ability to contribute to fundamental ecosystem services will be affected. We used simulation and optimization techniques to assess the impact of different management strategies on the supply of bioenergy and the trade-offs between wood fuel harvesting, biodiversity, and three other ecosystem services-reindeer husbandry, carbon storage, and recreation. The projections covered 100 years and a forest area of 3 million ha in northern Sweden. We found that the development of novel and cost-effective management systems for biomass outtake from young dense stands may provide options for a significant supply of bioenergy to the emerging bioeconomy, while at the same time securing biodiversity and important ecosystem values in future stand developments. In addition, there is potential to increase the extraction of harvest residues and stumps while simultaneously improving conditions for biodiversity and the amount of carbon stored in forest ecosystems compared to current levels. However, the projected continuing trend of increased forest density (in terms of basal area) has a negative impact on the potential for reindeer husbandry and recreation, which calls for researching new management strategies on landscape levels.
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| 5. |
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| 6. |
- Hellsten, Sofie, et al.
(författare)
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Halter av baskatjoner, fosfor och kväve i stubbar i Sverige, Finland och Danmark
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Intresset för stubbskörd har ökat kraftigt på senare år, i takt med att efterfrågan på förnyelsebar energi ökat. Idag saknas det information om näringshalter i stubbar för att utröna effekten av stubbuttag på näringsbalans och försurning. Denna studie syftar till att ta fram ett större dataunderlag för halter i stubbar i Sverige, Finland och Danmark. Lokalerna representerar olika nedfallsnivåer, olika markförhållanden samt olika beståndsdata. Studien omfattar granstubbar från Sverige, Finland och Danmark, samt tall- och björkstubbar från Sverige. Följande näringsämnen ingick i studien: kväve (N), fosfor (P), kalcium (Ca), kalium (K), magnesium (Mg) och Natrium (Na). Resultaten indikerade att näringshalten i björkstubbar är högre jämfört med gran och tall. I Sverige och Finland noterades generellt sett högre näringshalter i stubbarna i södra delen av landet jämfört med norra delen, med undantag av fosfor. Näringshalterna är betydligt högre i stubbens och rötternas bark jämfört med veden. Halterna i rötterna ökade signifikant med minskad rotdiameter. För tallstubbarna i Jädraås noterades signifikant minskande näringshalter i stubbarna med åldern upp till 65 år för kväve, kalium, magnesium och fosfor. För Jädraås, som har den största representationen av ståndortsindex, noterades ökande halter med ståndortsindex för fosfor och kalium. Studien har medfört att dataunderlaget för halter i stubbar har ökat väsentligt vilket kan bidra till att minska osäkerheterna i beräkningar av näringsbalansen i skogsmark vid stubbskörd.
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| 7. |
- Hellsten, Sofie, et al.
(författare)
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Nutrient concentrations in stumps and coarse roots of Norway spruce, Scots pine and silver birch in Sweden, Finland and Denmark
- 2013
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 1872-7042 .- 0378-1127. ; 290, s. 40-48
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the concentrations of nutrients in stumps and coarse roots in Norway spruce, Scots pine and silver birch in Sweden, Finland and Denmark, and to assess how nutrient concentrations vary with site characteristics, stand age and root size. Concentrations of nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg) and sodium (Na) in spruce, pine and birch stumps were assessed in eight sites across Scandinavia. Nutrient concentrations were higher in birch than in spruce and pine. In Sweden and Finland, the nutrient concentrations were generally higher at the southern sites than at the sites located in the northern part of the countries, except for P. For all nutrients, concentrations were significantly higher in the bark of the stump and roots than in the wood. Furthermore, nutrient concentrations increased significantly with decreasing root diameter. This study did not demonstrate any correlations with stand age. Further studies are needed to provide a broader picture of how the stump nutrient contents vary with site characteristics and forest management practices to provide a better foundation for nutrient balance calculations when setting up recommendations for stump removal. (C) 2012 Elsevier B.V. All rights reserved.
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| 8. |
- Lindgren, Britt-Marie, et al.
(författare)
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From Resistance to Existence-Experiences of Medication-Assisted Treatment as Disclosed by People with Opioid Dependence
- 2015
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 36:12, s. 963-970
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to describe the lived experiences of participating in a medication-assisted treatment as disclosed by individuals with opioid dependence. Eleven narrative interviews were conducted and subjected to qualitative content analysis. The experiences of participating in the programme were described as a process from resistance to existence. The participants seized the chance to claim a life lived with dignity, struggled with hidden challenges, and eventually were freed from their pasts and were grateful for an existence with dignity. The recovery process was a long-term commitment and participants asked for a more individual and flexible process based on personal needs and values.
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| 9. |
- Melin, Jeanette, et al.
(författare)
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A Questionnaire for Assessing User Satisfaction With Mobile Health Apps : Development Using Rasch Measurement Theory
- 2020
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Ingår i: JMIR mhealth and uhealth. - : NLM (Medline). - 2291-5222. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mobile health (mHealth) apps offer great opportunities to deliver large-scale, cost-efficient digital solutions for implementing lifestyle changes. Furthermore, many mHealth apps act as medical devices. Yet, there is little research on how to assess user satisfaction with an mHealth solution. OBJECTIVE: This study presents the development of the mHealth Satisfaction Questionnaire and evaluates its measurement properties. METHODS: Respondents who took part in the Health Integrator Study and were randomized to use the Health Integrator smartphone app for lifestyle changes (n=112), with and without additional telephone coaching, rated their satisfaction with the app using the new 14-item mHealth Satisfaction Questionnaire. The ratings were given on a 5-point Likert scale and measurement properties were evaluated using Rasch measurement theory (RMT). RESULTS: Optimal scoring was reached when response options 2, 3, and 4 were collapsed, giving three response categories. After omitting two items that did not fit into the scale, fit residuals were within, or close to, the recommended range of ±2.5. There was no differential item functioning between intervention group, age group, or sex. The Person Separation Index was 0.79, indicating that the scale's ability to discriminate correctly between person leniency was acceptable for group comparisons but not for individual evaluations. The scale did not meet the criterion of unidimensionality; 16.1% (18/112) of the respondents were outside the desired range of -1.96 to 1.96. In addition, several items showed local dependency and three underlying dimensions emerged: negative experiences, positive experiences, and lifestyle consequences of using the mHealth solution. CONCLUSIONS: In times where mHealth apps and digital solutions are given more attention, the mHealth Satisfaction Questionnaire provides a new possibility to measure user satisfaction to ensure usability and improve development of new apps. Our study is one of only a few cases where RMT has been used to evaluate the usability of such an instrument. There is, though, a need for further development of the mHealth Satisfaction Questionnaire, including the addition of more items and consideration of further response options. The mHealth Satisfaction Questionnaire should also be evaluated in a larger sample and with other mHealth apps and in other contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT03579342; http://clinicaltrials.gov/ct2/show/NCT03579342. ©Jeanette Melin, Stephanie Erika Bonn, Leslie Pendrill, Ylva Trolle Lagerros. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 26.05.2020.
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| 10. |
- Melin, Ylva
(författare)
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Alternativ användning av marina fintrådiga alger (EU-Life Algae)
- 2001
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Slutsatserna från gödslingsförsöken på Åland och i Sverige visar att användning av enbart alger som gödningsmedel vid odling av höstvete har låg användningspotential. En möjlighet är lokal användning i liten skala på salttoleranta grödor. Alger kan också användas som gödning och jordförbättringsmedel i exempelvis parker där växterna inte ska användas som livsmedel. Nödvändigheten av att kompostera algerna före spridning bör diskuteras.
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| 11. |
- Melin, Ylva, et al.
(författare)
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Assessing carbon balance trade-offs between bioenergy and carbon sequestration of stumps at varying time scales and harvest intensities
- 2010
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 260, s. 536-542
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Tidskriftsartikel (refereegranskat)abstract
- Mitigating climate change and securing a supply of energy may be achieved, in part, by substituting fossil fuels with bioenergy from stumps and roots. However, the use of stumps would result in a reduction of the carbon pool and thus, from a greenhouse gas emission perspective, there is a trade-off between using stumps for bioenergy and retaining them in the carbon pool associated with dead organic matter. The objective of this study was to show whether, from a carbon balance perspective and over the short and long-terms, stumps are more important as a source of energy that replaces fossil fuels, or as a carbon sink.The study was based on the estimated bioenergy potential of stumps for three harvest scenarios and the corresponding effects on stump-carbon sequestration, if stump harvesting had been practiced in Sweden during the period 1984-2003. Approximately 30,000 permanent plots from the Swedish National Forest Inventory (NFI) were used for estimates of bioenergy potential. For the scenario "Medium intensity", the bioenergy potential was estimated to 51 PJ yr(-1) (or 5.7 Tg CO(2) yr(-1)). The corresponding carbon sequestration potential from the retained biomass in the ground was 15 Tg CO(2) yr(-1). Using these stumps and roots as bioenergy substituting coal would result in a reduction of emission from coal combustion of 5.0 Tg CO(2) yr(-1). In the short-term, the choice of coal or stumps as an energy source has a minor effect on the gross emissions to the atmosphere but the removal from an increasing stump-carbon pool would slightly favor the use of coal. However, this study indicates that the most effective way of achieving a net reduction of emissions in the long-term is to burn stumps. (C) 2010 Elsevier B.V. All rights reserved.
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| 12. |
- Melin, Ylva, et al.
(författare)
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Decomposition of stump and root systems of Norway spruce in Sweden-A modelling approach
- 2009
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 257, s. 1445-1451
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Tidskriftsartikel (refereegranskat)abstract
- The demand for quantifying the biomass of stumps and roots and the carbon stored therein is related to aspects of biodiversity, site productivity, atmospheric carbon cycling issues, and the demand for bioenergy. This, in turn, creates a need to develop high-quality tools for estimating biomass and carbon-equivalents in the ground. The objective of this study was to develop decomposition functions for quantifying the remaining dry weight of the biomass of individual stumps and their associated roots in Norway spruce (Picea abies (L.) Karst.). The negative exponential model was chosen for this purpose, combined with a chronosequence approach, involving 99 stumps and their roots from three sites in Sweden. The results showed a relative decay rate of 4.6% annually for stump and root systems. Based on this rate, the time required for the loss of 50% (t(0.5)) and 95% (t(0.95)) of the wood is 15 and 64 years, respectively. Although there are many variables that affect decomposition, residual studies indicated that the remaining biomass could be predicted fairly accurately on the basis of the independent variables stump diameter and time. (C) 2008 Elsevier B.V. All rights reserved.
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| 13. |
- Melin, Ylva, et al.
(författare)
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Experiences of living with opioid dependence : an interview study with individuals participating in medication-assisted treatment
- 2017
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Ingår i: Issues in Mental Health Nursing. - Philadelpia : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 38:1, s. 9-17
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Tidskriftsartikel (refereegranskat)abstract
- In order to describe experiences of living with opioid dependence, thirteen interviews were conducted with people participating in medication-assisted treatment. The results showed that living with opioid dependence is about the two-faced drug. The participant's past was a constant burden in life, and the drug filled a spiritual emptiness. The participant's described a life in chaos and pain, and furthermore, a life without dignity and in alienation. Opioid dependence means great suffering. Having a holistic view and by gaining an understanding of the complexities of opioid dependence, healthcare professionals can provide nonjudgmental and respectful treatment.
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| 14. |
- Melin, Ylva
(författare)
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Impacts of stumps and roots on carbon storage and bioenergy use in a climate change context
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As a result of national and international greenhouse gas emissions reduction targets, economic incentives and political desires to be more independent regarding energy supplies, there is interest in substituting fossil fuels with renewable energy sources, such as forest fuels. Stump harvesting could be an option to further increase the bioenergy potential in forested countries; currently stump harvesting is carried out on a pilot basis in Sweden. In this thesis, the Swedish stump harvest potential is studied in a national and European climate change mitigation context. One main objective was to develop a general system for estimating and monitoring carbon stocks and carbon stock changes in stump and root systems on a national scale. A core part of this system was a decomposition function for Norway spruce stumps and roots that was developed as part of this thesis. The decomposition rate in Norway spruce stumps and roots was estimated to be 4.6% annually. Another objective included assessment of the carbon balance trade-offs between the use of stumps for either bioenergy or carbon sequestration. This was carried out over different time scales and harvest intensities and, further, the substitution effect of using stumps for bioenergy in comparison with coal was investigated. The risks of nutrient loss linked to stump harvesting were also studied and discussed. Data from the Swedish national forest inventory and from specifically designed studies on stumps and roots were used for the analyses. The results showed that it takes about nine years for a stump harvest scenario to become more climate-friendly than if coal were used i.e. there is a certain lag period during which the CO₂ emissions from the stump harvest scheme exceed the emissions from utilizing coal as fuel; this is due to higher calorific value in fossil fuels. However, in the long-term, the CO₂ emissions decrease if stumps and roots are used instead of coal. In the medium scenario studied, the CO₂ emissions decreased by 5.0 Tg CO₂ yr-1 - this corresponds to 8.6% of Sweden's current greenhouse gas emissions. It was also shown that the Swedish carbon pool in stumps and roots would start to decrease if more than approximately 107 PJ were harvested annually. Without stump harvesting, the carbon pool in stumps and roots increased over the study period (1984 – 2003) by, on average, 6.9 Tg CO₂ yr-1. Also, the nutrient pools would be at risk if intensive stump harvest schemes after stem and slash harvesting were implemented. However, from a nutrient perspective, depletion of forest soils would be at least risk if a proportion of slash rather than stumps and coarse roots were left after harvesting.
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| 15. |
- Oxfeldt, Mikkel, et al.
(författare)
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Low Energy Availability Followed by Optimal Energy Availability Does Not Benefit Performance in Trained Females
- 2024
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Ingår i: Medicine & Science in Sports & Exercise. - : Lippincott Williams & Wilkins. - 0195-9131 .- 1530-0315. ; 56:5, s. 902-916
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Short periods of reduced energy availability are commonly undertaken by athletes to decrease body mass, possibly improve the power-to-mass ratio, and enhance physical performance. Our primary aim was to investigate the impact of 10 d of low energy availability (LEA) followed by 2 d of optimal energy availability (OEA) on physical performance parameters in trained females. Second, physiological markers at the whole-body and molecular level related to performance were evaluated. Methods: Thirty young trained eumenorrheic females were matched in pairs based on training history and randomized to a 10-d intervention period of LEA (25 kcal.fat-free mass (FFM)(-1).d(-1)) or OEA (50 kcal.FFM-1.d(-1)) along with supervised exercise training. Before the intervention, participants underwent a 5-d run-in period with OEA + supervised exercise training. After the LEA intervention, 2 d of recovery with OEA was completed. Participants underwent muscle biopsies, blood sampling, physical performance tests, body composition measurements, and resting metabolic rate measurements. A linear mixed model was used with group and time as fixed effects and subject as random effects. Results: Compared with OEA, LEA resulted in reduced body mass, muscle glycogen content, repeated sprint ability, 4-min time-trial performance, and rate of force development of the knee extensors (absolute values; P < 0.05). Two days of recovery restored 4-min time-trial performance and partly restored repeated sprint ability, but performance remained inferior to the OEA group. When the performance data were expressed relative to body mass, LEA did not enhance performance. Conclusions: Ten days of LEA resulted in impaired performance (absolute values), with concomitant reductions in muscle glycogen. Two days of recovery with OEA partially restored these impairments, although physical performance (absolute values) was still inferior to being in OEA. Our findings do not support the thesis that LEA giving rise to small reductions in body mass improves the power-to-mass ratio and thus increases physical performance.
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| 16. |
- Petersson, Hans, et al.
(författare)
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Estimating the biomass and carbon pool of stump systems at a national scale
- 2010
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 260, s. 466-471
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Tidskriftsartikel (refereegranskat)abstract
- Countries that are signatories to the UNFCCC and its supplementary Kyoto Protocol are obliged to report changes in carbon pools. These should include the pool of carbon held in tree stumps and roots but, to date, few countries have been able to report this or separate it from the dead-wood pool. The aim of this study was to develop a general system for estimating and monitoring changes in stump system carbon using data from a traditional National Forest Inventory. The system was derived using data based on measurements of carbon (biomass) in inventoried permanent sample plots representing all relevant classes of land-use. With this design it was possible to trace matched carbon at the level of individual trees or stumps back to land-use prior to the 1990 baseline year. Between 1990 and 2003 in Sweden, the average annual net sink of stump systems was estimated to amount to 6.7 Mt CO(2) equiv.year(-1) - comparable to the reported net sink in 2008 of about 15 Mt CO(2) equiv.year(-1) from the whole Land Use, Land-Use Change and Forestry sector, which excluded any carbon in stump systems. In 2003 the carbon stock of stumps and roots was estimated at 495 Mt CO(2) equiv.; approximately five times that of the deadwood pool as defined in Sweden, i.e. dead wood that mainly consists of boles. The Intergovernmental Panel on Climate Change requests that reported carbon should be matched to land-use and traced back to the 1990 base year; however, the present study confirms expectations that most carbon in stumps and roots is found on Forest land. The minimum requirements for estimating the carbon pool in stump systems at a national scale using the proposed methodology are that there should be: (i) a consistent time-series of harvest data, usually estimated as merchantable volume; (ii) conversion factors from merchantable volume to stump system biomass at death; and (iii) a representative decomposition model. (C) 2010 Elsevier B.V. All rights reserved.
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| 17. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs : a qualitative interview study
- 2023
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Ingår i: BMC Palliative Care. - : Springer Nature. - 1472-684X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn palliative care, registered nurses provide advanced nursing care to relieve patients’ symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described.AimTo gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients.MethodSecondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content.ResultsThe confidential conversation was considered an important part of palliative care and is the nurse’s responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient’s terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation.ConclusionNurses’ confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.
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| 18. |
- Stenman, Tove, 1975-, et al.
(författare)
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Förtroliga samtal i palliativ vård - Personalens och patienters erfarenheter
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: I palliativ omvårdnad identifierar, bedömer och bemöter sjuksköterskan fysisk, social, psykisk och existentiell hälsa för såväl patient som närstående samt planerar, genomför och utvärderar åtgärder. Samtal är en viktig omvårdnadshandling med syfte att förbättra patienternas livskvalitet och möjliggöra en värdig död. Samtalen om existentiella frågor har positiva effekter på livskvalitet och samtalet erbjuder existentiellt stöd i olika åldrar och sjukdomsgrupper vid obotlig sjukdom som exempelvis cancer, organsvikt, demenssjukdom. Det finns olika former av samtal i palliativ vård. Sjuksköterskans förtroliga samtal som ofta sker spontant vet vi lite om Det förtroliga samtalet finns inte heller explicit beskrivet som begrepp i vårdvetenskaplig forskning. Syfte: Att få en djupare förståelse för innebörden av förtroliga samtal i palliativ vård utifrån sjuksköterskors och patienters perspektiv. Metod: Kvalitativ ansats med sjuksköterskor och patienter som i intervjuer beskriver sina erfarenheter av förtroliga samtal. Resultat: Analys av insamlade data med sjuksköterskor pågår och beräknas avslutas hösten 2022. Rekrytering och insamling av data med patienter beräknas påbörjas hösten 2022. Preliminära resultat i delstudie I visar att samtalen är en viktig del i den palliativa omvårdanden och sjuksköterskans självklara ansvar. Såväl ansvaret som samtalet i sig beskrivs som komplext och ställer olika typer av krav på sjuksköterskan. I samtalet kan patienten med palliativ vårdbehov få möjlighet att bearbeta saker som inte tidigare bearbetats och sätta ord på det som behöver sättas ord på. Samtalet inte har något förutbestämt innehåll, sker ofta i anslutning till någon annan omvårdnadssituation och sker helt på patientens villkor då det är patienten somhåller i taktpinnen. Betydelse: Samtal är mycket viktig del av omvårdnaden, trots det upplever vårdpersonal av olika skälutmaningar i att genomföra samtal. Personalens vilja att hjälpa, lindra symtom och plågor samt att främja en värdig död är ofta en stark drivkraft. I förtroliga samtal med en sjuksköterska får patienter möjlighet att hantera sin situation, sin sjukdom, sina förluster, sitt beroende av hjälp och stöd samt sin livssituation vilket kan leda till ökad livskvalitet och känsla av oberoende och värdighet. Kontexten palliativ vård är viktig i det förtroliga samtalet, där livets sista tid, döendet och döden är närvarande. Studien med patienter kommer att ligga till grund för en digital interaktiv utbildningsintervention om existentiella samtal riktad till vårdpersonal. Det är centralt att medarbetare i teamet runt patienter med palliativ vårdbehov har kunskaper, förmåga och mod att initiera och samtala kring patienters existentiella tankar och funderingar vid obotlig sjukdom.
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| 19. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs
- 2024
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Ingår i: BMC Nursing. - : Springer Nature. - 1472-6955. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs. Methods: In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations. Results: The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences. Conclusions: Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.
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| 20. |
- Strömbom, Ylva, 1959-, et al.
(författare)
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Cognitive behavioral therapy for frequent attenders in primary care
- 2018
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Ingår i: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 1:9
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the study is to investigate if cognitive behavioral therapy given in a group setting affects anxiety and depression, stress, pain, coping strategies during daily life, and health-related quality of life (HRQoL), among frequent attenders (FAs) in primary care.Methods: Cognitive behavioral therapy was offered to 331 FAs between 18 and 65 years of age, of whom 89 accepted and 54 completed all steps in the protocol; patients were assigned to 1 of 3 groups: 0, 6, and 12-month waiting time. The therapy consisted of 12 sessions administered in group format. Outcome measures were Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Questionnaire, Multidimensional Pain Inventory-Swedish version, and Short Form-36.Results: Mean age among patients who completed cognitive behavioral therapy was 49.9 years, with a female majority (79.6%). Anxiety and depression scores were reduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS-Anxiety 8.41 vs 6.05; HADS-Depression 7.09 vs 5.69). Because waiting time itself did not affect symptoms, differences reflect treatment effects. Stress ratings were not affected by treatment. Use of nonadaptive coping strategies like praying and hoping and catastrophizing decreased. Frequent attenders experienced a higher sense of life control. Frequent attenders reported significantly lower HRQoL than general Swedish population norms in all 8 Short Form-36 domains including mental and physical component summary scores (MCS and PCS), and all domains were unaffected by treatment.Conclusion: Cognitive behavioral therapy exerts some beneficial effects in FAs. Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression. This broad approach resulted in reduced anxiety, depression, and impact of pain because of enhanced life control.
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| 21. |
- Strömbom, Ylva, 1959-
(författare)
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Frequent attenders in primary care : Patient characteristics, help seeking patterns and cognitive behavioral therapy
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Frequent attenders consist of a small proportion of the total population seek-ing health care non-proportionally often for various symptoms. This hetero-genic group of patients requires special attention as symptoms often cannot be explained medically and influence both physical and psychological well-being.The overall aim was to describe characteristics and health issues that insti-gate help seeking behavior among frequent attenders and to piece together a treatment program addressing heterogeneous health problems with the pur-pose to reduce psychological distress, enhance quality of life and reduce visiting rates at general practitioners. Study I aimed to characterize frequent attenders in primary care with respect to symptomatology and utilization of health care resources. Data was collected from medical journals and compar-isons were made between frequent attenders and a comparison group. Among frequent attenders proportionally more women than men visited the health care system and both sexes had a large diversity and amount of health complaints and utilized health care staff resources more frequently. In study II health related quality of life was examined in relation to frequent attend-ance. Questionnaires were sent out to frequent attenders and a comparison. Results show a substantially reduced life quality among frequent attenders affecting almost all facets of life and individual differences in complaints translated into corresponding areas of reduced life quality. Cognitive behav-ior therapy given in a group format was performed and evaluated in study III. Improvements of illness symptoms and negative affect were found and remained over a year, but visits to health care did not diminish.In summation, frequent attenders used more health care resources and dis-played more health complaints as compared to non-frequent attenders. The nature of complaints was relatively independent suggesting symptom speci-ficity. They also experienced lower health related quality of life and symp-tom profiles matched domains with reduced life quality. Group CBT may be an efficient way to deal with some aspects related to health issues connected to frequent attenders. Generally, a biopsychosocial model seemed to account better for data than a purely biological model.
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| 22. |
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| 23. |
- Wendt, Camilla, et al.
(författare)
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A search for modifying genetic factors in CHEK2:c.1100delC breast cancer patients
- 2021
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- The risk of breast cancer associated with CHEK2:c.1100delC is 2-threefold but higher in carriers with a family history of breast cancer than without, suggesting that other genetic loci in combination with CHEK2:c.1100delC confer an increased risk in a polygenic model. Part of the excess familial risk has been associated with common low-penetrance variants. This study aimed to identify genetic loci that modify CHEK2:c.1100delC-associated breast cancer risk by searching for candidate risk alleles that are overrepresented in CHEK2:c.1100delC carriers with breast cancer compared with controls. We performed whole-exome sequencing in 28 breast cancer cases with germline CHEK2:c.1100delC, 28 familial breast cancer cases and 70 controls. Candidate alleles were selected for validation in larger cohorts. One recessive synonymous variant, rs16897117, was suggested, but no overrepresentation of homozygous CHEK2:c.1100delC carriers was found in the following validation. Furthermore, 11 non-synonymous candidate alleles were suggested for further testing, but no significant difference in allele frequency could be detected in the validation in CHEK2:c.1100delC cases compared with familial breast cancer, sporadic breast cancer and controls. With this method, we found no support for a CHEK2:c.1100delC-specific genetic modifier. Further studies of CHEK2:c.1100delC genetic modifiers are warranted to improve risk assessment in clinical practice.
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| 24. |
- Öfverholm, Anna, et al.
(författare)
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Extended genetic analysis and tumor characteristics in over 4600 women with suspected hereditary breast and ovarian cancer
- 2023
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Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundGenetic screening for pathogenic variants (PVs) in cancer predisposition genes can affect treatment strategies, risk prediction and preventive measures for patients and families. For decades, hereditary breast and ovarian cancer (HBOC) has been attributed to PVs in the genes BRCA1 and BRCA2, and more recently other rare alleles have been firmly established as associated with a high or moderate increased risk of developing breast and/or ovarian cancer. Here, we assess the genetic variation and tumor characteristics in a large cohort of women with suspected HBOC in a clinical oncogenetic setting.MethodsWomen with suspected HBOC referred from all oncogenetic clinics in Sweden over a six-year inclusion period were screened for PVs in 13 clinically relevant genes. The genetic outcome was compared with tumor characteristics and other clinical data collected from national cancer registries and hospital records.ResultsIn 4622 women with breast and/or ovarian cancer the overall diagnostic yield (the proportion of women carrying at least one PV) was 16.6%. BRCA1/2 PVs were found in 8.9% of women (BRCA1 5.95% and BRCA2 2.94%) and PVs in the other breast and ovarian cancer predisposition genes in 8.2%: ATM (1.58%), BARD1 (0.45%), BRIP1 (0.43%), CDH1 (0.11%), CHEK2 (3.46%), PALB2 (0.84%), PTEN (0.02%), RAD51C (0.54%), RAD51D (0.15%), STK11 (0) and TP53 (0.56%). Thus, inclusion of the 11 genes in addition to BRCA1/2 increased diagnostic yield by 7.7%. The yield was, as expected, significantly higher in certain subgroups such as younger patients, medullary breast cancer, higher Nottingham Histologic Grade, ER-negative breast cancer, triple-negative breast cancer and high grade serous ovarian cancer. Age and tumor subtype distributions differed substantially depending on genetic finding.ConclusionsThis study contributes to understanding the clinical and genetic landscape of breast and ovarian cancer susceptibility. Extending clinical genetic screening from BRCA1 and BRCA2 to 13 established cancer predisposition genes almost doubles the diagnostic yield, which has implications for genetic counseling and clinical guidelines. The very low yield in the syndrome genes CDH1, PTEN and STK11 questions the usefulness of including these genes on routine gene panels.
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