| 1. |
- André, Malin, et al.
(författare)
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More physician consultations and antibiotic prescriptions in families with high concern about infectious illness-adequate response to infection-prone child or self-fulfilling prophecy?
- 2007
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 24:4, s. 302-307
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Tidskriftsartikel (refereegranskat)abstract
- Background. Respiratory tract infections (RTI) in children is the most common cause of prescription of antibiotics. It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics. Objectives. To compare families with high and low concern about infectious illness with regard to social variables, perception of infection proneness and beliefs in antibiotics and to relate the concern for infectious illness to reported morbidity, physician consultations and antibiotic prescriptions for the 18-month-old child in the family. Methods. A prospective, population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic treatments for 18-month-old children were noted. The 818 families also answered questions about their socio-economic situation, illness perception and concern about infectious illness. Results. High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics. There was no significant difference in reported days with symptoms of RTI, but the parents more often experienced their children with RTI without fever as being ill. The variables of infection proneness in the child, inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness. Conclusions. High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children. An adequate consultation, where the doctor deals with the parents' worries and gives appropriate information about symptoms and disease, might contribute to less antibiotic prescribing with preserved parental satisfaction.
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| 2. |
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| 3. |
- Hedin, Katarina, et al.
(författare)
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A population-based study of different antibiotic prescribing in different areas
- 2006
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Ingår i: British Journal of General Practice. - London, UK : Royal College of General Practitioners. - 0960-1643 .- 1478-5242. ; 56:530, s. 680-685
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Tidskriftsartikel (refereegranskat)abstract
- Background: Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious. Aim: To find possible explanations for different antibiotic prescription rates in children. Design of study Prospective population based study. Setting All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates. Method: During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases. Results: Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% in the low prescription area during the study month (crude odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.45 to 4.93). After multiple logistic regression analyses taking account of socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations, differences in antibiotic prescription rates remained (adjusted OR = 2.61; 95% CI = 1.14 to 5.98). The variable that impacted most on antibiotic prescription rates, although it was not relevant to the geographical differences, was a high level of concern about infectious illness in the family. Conclusions: The differences in antibiotic prescription rates could not be explained by socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations. The differences may be attributable to different prescription behaviour.
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| 4. |
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| 5. |
- Hedin, Katarina, et al.
(författare)
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Infectious morbidity in 18-month-old children with and without older siblings
- 2010
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 27:5, s. 507-512
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear. OBJECTIVES: To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions. METHODS: A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care. RESULTS: No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions. CONCLUSIONS: The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.
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| 6. |
- Hedin, Katarina, et al.
(författare)
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Physician consultation and antibiotic prescription in Swedish infants : population-based comparison of group daycare and home care.
- 2007
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:7, s. 1059-1063
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Tidskriftsartikel (refereegranskat)abstract
- Background: Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants. Aim: To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account. Methods: For a cohort of Swedish 18-month-old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month. Results: 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63–3.82) and for antibiotic prescription 2.43 (1.34–4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account. Conclusion: When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants.
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| 7. |
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| 8. |
- Kalliokoski, Paul, et al.
(författare)
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Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency : a before-and-after treatment study
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.
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| 9. |
- Kalliokoski, Paul, 1965-, et al.
(författare)
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Positive impact on vitamin D related lifestyle of medical advice in pregnant Somali-born women and new mothers : a mixed method study in Swedish primary care
- 2021
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA previous study showed that pregnant women/new mothers especially Somali-born and some Swedish-born had extremely low vitamin D levels and poor physical performance. Our study aimed to examine vitamin D related lifestyle, attitudes and behaviour before and after brief information about vitamin D, with special long-term focus on Somali-born women.MethodsA cohort of 91 pregnant women/new mothers having serum hydroxyvitamin D (S-25-OHD)<= 50nmol/L (n=51 Somali-born with one third <10nmol/L of S-25-OHD) in primary health care in Sweden was targeted for intervention. Brief individual oral and visual information on vitamin D was given by doctors at baseline and after four and ten months. Questionnaires with ordinal scales on vitamin D related lifestyle of food, clothing, and outdoor activities were distributed on all occasions. Focus-group interviews with 15 women from the target-group were performed after two years. A Somali interpreter was available.ResultsVeiled clothing, indoor living, and a low intake of milk, cheese, and fatty fish were common in the target group. Consumption pattern had increased significantly among the Somali-born women at the four-month follow-up but declined to non-significant levels at the ten-month follow-up. The focus-group interviews showed improved understanding of vitamin D deficiency, symptoms and attitudes, but varying applied behaviours related to sun exposure. Sun exposure for the children and increased fish consumption was the most evident positive results.ConclusionsVitamin D related lifestyle, attitudes and behaviour improved in a Somali-born group of pregnant women/new mothers with severe vitamin D deficiency. The preventive measures suggested in our study may have impact on public health in relation to bone and muscle strength and immunity especially in vitamin D deficiency risk groups.
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| 10. |
- Rodhe, Nils, et al.
(författare)
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Asymptomatic bacteriuria in a population of elderly residents living in a community setting : prevalence, characteristics and associated factors
- 2006
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 23:3, s. 303-7
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Tidskriftsartikel (refereegranskat)abstract
- Background. Asymptomatic bacteriuria (ASB) is common among the elderly in institutionalcare, but less is known about its prevalence among the elderly living in community settings.Knowledge of the prevalence of ASB in this population could contribute to a reduction inunnecessary use of antibiotics.Objective. To study the prevalence of ASB and associated health and social factors in apopulation of elderly people, aged 80 and over, in a community setting.Design. A cross-sectional study.Setting. The catchment area of a primary health care centre in a Swedish middle-sized town.Method. All residents, aged 80 and over, except for those in institutional living, were invited. Astructured interview was carried out and urinary culture obtained.Results. ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of themen. In women independent associations with ASB were found for urinary incontinence (OR:2.99, CI: 1.60–5.60), reduced mobility (OR: 2.68, CI: 1.42–5.03) and oestrogen treatment (OR: 2.20,CI: 1.09–4.45).Conclusion. Bacteriuria is common among the elderly living in non-institutional communitysettings, especially among women, although not as common as among the elderly in institutionalsettings. A woman over 80, with urinary incontinence, and needing support to walk has arisk of nearly 50% of presenting with ASB, a condition about which there is consensus not totreat with antibiotics. This should be borne in mind when examining patients with diffusesymptomatology and an accidental finding of bacteriuria.
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| 11. |
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| 12. |
- Rodhe, Nils, 1951-
(författare)
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Asymptomatic Bacteriuria in the Elderly
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI). All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls. ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB. There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.
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| 13. |
- Rodhe, Nils, et al.
(författare)
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Bacteriuria is associated with urge urinary incontinence in older women
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26:1, s. 35-39
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men. DESIGN: Cross-sectional study. SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town. SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537). MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence. RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence. CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.
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| 14. |
- Rodhe, Nils, et al.
(författare)
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Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria
- 2009
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27:2, s. 74-79
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. Design. Comparative laboratory. Setting. Primary care. Subjects. A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. Main outcome measures. Urinary levels of IL-1, TNF-, IL-12, IL-18, CXCL1 (GRO-), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. Results. Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36-84) and 96% (95% CI 77-100) (cut-off 285 pg/mg creatinine), 81% (95% CI 54-95) and 96% (95% CI 77-100) (cut-off 30 pg/mg creatinine), and 88% (95% CI 60-98) and 79% (95% CI 57-92) (cut-off 2, on a scale of 0-4), respectively. Conclusions. The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.
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| 15. |
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| 16. |
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| 17. |
- Sund-Levander, Märtha, et al.
(författare)
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Differences in predictors of 5-year survival over a 10-year period in two cohorts of elderly nursing home residents in Sweden
- 2016
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 30:4, s. 714-720
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to compare 5-year survival in two included cohorts (from year 2000 and year 2007) of 249 nursing home residents (NHR) in this retrospective, comparative study. Methods: The cohorts were compared regarding chronic diseases, medication, physical/cognitive/nutritional status, body mass index, body temperature and 5-year mortality. Factors correlated with 5-year survival were determined using Cox regression analysis. Results: In average, cohort 2007 survived 31 +/- 16 months and cohort 2000, 38 +/- 13 months, p < 0.001. Dementia, ageing and circulatory failure were more common as cause of death 2007, while stroke, chronic obstructive pulmonary disease (COPD) and pneumonia were less common, compared with 2000. NHR belonging to cohort 2007 were significantly older when admitted to nursing homes (NH), more dependent in activities of daily living (ADL), had dementia, stroke, autoimmune disease and treatment with antidepressants, while malnutrition and treatment with paracetamol were more common 2000. In 2000, medication with antidepressants, the presence of stroke and diabetes, irrespective of gender, and in women cardiovascular disease, two to threefold significantly increased survival, while autoimmune disease, influenza vaccination and dependency in ADL decreased survival. In 2007, maintaining BMI, irrespective of gender, and autoimmune disease and COPD in women significantly increased survival, while malnutrition, influenza vaccination, dependency in ADL and medication with sedatives/tranquillisers or paracetamol severely reduced survival. Conclusions: The present results indicate a trend that individuals are older and frailer when admitted to NH and that survival time after admission has been shortened. Hence, the need of daily support and care has increased, irrespective of housing. Also, predictors of survival, possible to influence, have changed.
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| 18. |
- Sundvall, Pär-Daniel, et al.
(författare)
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Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012
- 2014
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed. Methods: Urine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012. Results: The proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria. Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003-2012. In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production. Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months. Conclusions: The average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.
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| 19. |
- Sundvall, Pär-Daniel, et al.
(författare)
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Interleukin-6 concentrations in the urine and dipstick analyses were related to bacteriuria but not symptoms in the elderly: a cross sectional study of 421 nursing home residents
- 2014
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Up to half the residents of nursing homes for the elderly have asymptomatic bacteriuria (ABU), which should not be treated with antibiotics. A complementary test to discriminate between symptomatic urinary tract infections (UTI) and ABU is needed, as diagnostic uncertainty is likely to generate significant antibiotic overtreatment. Previous studies indicate that Interleukin-6 (IL-6) in the urine might be suitable as such a test. The aim of this study was to investigate the association between laboratory findings of bacteriuria, IL-6 in the urine, dipstick urinalysis and newly onset symptoms among residents of nursing homes. Methods: In this cross sectional study, voided urine specimens for culture, urine dipstick and IL-6 analyses were collected from all residents capable of providing a voided urine sample, regardless of the presence of symptoms. Urine specimens and symptom forms were provided from 421 residents of 22 nursing homes. The following new or increased nonspecific symptoms occurring during the previous month were registered; fatigue, restlessness, confusion, aggressiveness, loss of appetite, frequent falls and not being herself/himself, as well as symptoms from the urinary tract; dysuria, urinary urgency and frequency. Results: Recent onset of nonspecific symptoms was common among elderly residents of nursing homes (85/421). Urine cultures were positive in 32% (135/421), Escherichia coli was by far the most common bacterial finding. Residents without nonspecific symptoms had positive urine cultures as often as those with nonspecific symptoms with a duration of up to one month. Residents with positive urine cultures had higher concentrations of IL-6 in the urine (p < 0.001). However, among residents with positive urine cultures there were no differences in IL-6 concentrations or dipstick findings between those with or without nonspecific symptoms. Conclusions: Nonspecific symptoms among elderly residents of nursing homes are unlikely to be caused by bacteria in the urine. This study could not establish any clinical value of using dipstick urinalysis or IL-6 in the urine to verify if bacteriuria was linked to nonspecific symptoms.
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| 20. |
- Tingström, Pia, et al.
(författare)
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Nursing assistants : "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS)
- 2015
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Signs and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents. Methods: The early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as "no infection", "possible infection", and "infection". The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used. Results: Of the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 ("pain") to 8 ("general signs and symptoms of illness"). The construct validity showed that the items "temperature", "respiratory symptoms" and "general signs and symptoms of illness" were significantly related to "infection", and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases. Conclusion: The validation of EDIS suggests that the observation of "general signs and symptoms of illness", made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement "He/She is not as usual" should lead to follow-up.
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