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1.
  • Calais, Fredrik, 1971-, et al. (författare)
  • Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction
  • 2018
  • Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 261, s. 6-11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.Methods and results: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02-1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES >= 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9-4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1-3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1-4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2-3.1, P < 0.004).Conclusions: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.
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3.
  • Fattahi, Nina, et al. (författare)
  • Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm
  • 2020
  • Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 72:4, s. 1337-1346
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Abdominal aortic aneurysm (AAA) is a potentially lethal condition associated with several well-known risk factors including age, smoking, and male sex. The aim of this study was to identify risk factors predicting future development of AAA, which could influence future prevention strategies.Methods: This study collected the data sets of the Westmannia Cardiovascular Risk Factors Study (WICTORY) from 1990 to 1999 and combined them with cases of individuals who have undergone ultrasound examination of the infrarenal aortic diameter as part of the Vastmanland County's ongoing AAA screening program that commenced in 2007 or for other purposes. The study analyzed 5817 men aged 50 years at the time they participated in WICTORY and who underwent an ultrasound examination of the infrarenal aorta on average 15 years later.Results: The prevalence of AAA in our study was 2.6%. Age, smoking status, angina pectoris treatment, prior myocardial infarction, blood pressure treatment, body mass index, waist circumference, systolic blood pressure, heart rate, and total cholesterol level were found to be associated with the development of AAA later in life in the univariate analysis. In the multivariate analysis, current smokers at age 50 years had 11 times higher risk for later development of AAA (hazard ratio [HR], 11.178; confidence interval [CI], 6.277-19.908; P < .001). Former smokers did not suffer a similar risk of AAA development. Elevated total cholesterol concentration at baseline was associated with later AAA development (HR, 1.275; CI, 1.119-1.451; P < .001), as were increasing age (HR, 1.702; CI, 1.153-2.512; P = .007) and waist circumference (HR, 1.019; CI, 1.002-1.037; P = .031).Conclusions: Both the well-known and the somewhat less established possible predictors for future development of AAA identified in this study can support improvement of strategic preventive measures toward specific risk groups and thereby possibly reduce the risk for development of AAA later in life or at least increase the possibility of an early diagnosis in patients with intact AAA.
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4.
  • Gerhardsson, Emma, et al. (författare)
  • Mothers' Adaptation to a Late Preterm Infant When Breastfeeding
  • 2020
  • Ingår i: Journal of Perinatal & Neonatal Nursing. - : Wolters Kluwer. - 0893-2190 .- 1550-5073. ; 34:1, s. 88-95
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to psychometrically test the Adaptation to the Late Preterm Infant when Breastfeeding Scale (ALPIBS) and also to test how a mother's self-efficacy predicts adaptation to a late preterm infant when breastfeeding. This study had a longitudinal and prospective design, and data collection was consecutive. Mothers (n = 105) with infants born between and weeks were recruited from a neonatal intensive care unit or a maternity unit. The ALPIBS was developed using exploratory factor analysis, and the association between breastfeeding self-efficacy and ALPIBS score was examined using linear regression analysis. The Breastfeeding Self-Efficacy Scale-Short Form instrument was used to measure self-efficacy in breastfeeding. A higher degree of self-efficacy was significantly associated with a higher degree of adaptation to the late preterm infant's breastfeeding behavior (P < .001). We identified 4 separate underlying factors measured by 11 items in the ALPIBS: (A) breastfeeding is a stressful event; (B) the infant should breastfeed as often as he or she wants; (C) a mother has to breastfeed to be a good mother; and (D) it is important to ensure control over the infant's feeding behavior. There is a link between self-efficacy and ALPIBS score, and self-efficacy is a modifiable factor that influences breastfeeding.
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5.
  • Klarare, Anna, et al. (författare)
  • Translation, Cross-Cultural Adaptation, and Psychometric Analysis of the Attitudes Towards Homelessness Inventory for Use in Sweden
  • 2021
  • Ingår i: Worldviews on Evidence-Based Nursing. - : Wiley. - 1545-102X .- 1741-6787. ; 18:1, s. 42-49
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Homelessness is an increasing problem worldwide, and the origins of homelessness in high-income countries are multifaceted. Due to stigma and discrimination, persons in homelessness delay seeking health care, resulting in avoidable illness and death. The Attitudes Towards Homelessness Inventory (ATHI) was developed to cover multiple dimensions of attitudes toward persons in homelessness and to detect changes in multiple segments of populations. It has, however, not previously been translated to Swedish.AIMS: The aim of the present study was to translate, cross-culturally adapt, and psychometrically test the ATHI for use in a Swedish healthcare context.METHODS: The project used a traditional forward- and back-translation process in six stages: (1) two simultaneous translations by bilingual experts; (2) expert review committee synthesis; (3) blind back-translation; (4) expert review committee deliberations; (5) pre-testing with cognitive interviews including registered nurses (n = 5), nursing students (n = 5), and women in homelessness (n = 5); and (6) psychometric evaluations. The final ATHI questionnaire was answered by 228 registered nurses and nursing students in the year 2019.RESULTS: The translation process was systematically conducted and entailed discussions regarding semantic, idiomatic, experiential, and conceptual equivalence. Confirmatory factor analysis was used to examine if the collected data fitted the hypothesized four-factor structure of the ATHI. Overall, it was found that the model had an acceptable fit and that the Swedish version of ATHI may be used in a Swedish healthcare context.LINKING EVIDENCE TO ACTION: The ATHI has been shown to be a psychometrically acceptable research instrument for use in a Swedish healthcare context. The systematic and rigorous process applied in this study, including experts with diverse competencies in translation proceedings and testing, improved the reliability and validity of the final Swedish version of the ATHI. The instrument may be used to investigate attitudes toward women in homelessness among nursing students and RNs in Sweden.
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6.
  • Sundström, Johan, Professor, 1971-, et al. (författare)
  • Rationale for a Swedish cohort consortium
  • 2019
  • Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis Group. - 0300-9734 .- 2000-1967. ; 124:1, s. 21-28
  • Tidskriftsartikel (refereegranskat)abstract
    • We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.
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7.
  • Söderström, Lisa, 1982-, et al. (författare)
  • Associations between dietary advice on modified fibre and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy
  • 2022
  • Ingår i: Upsala Journal of Medical Sciences. - : Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: A variety of non-evidence-based dietary advice on modified fibre and lactose intakes are provided to patients undergoing pelvic radiotherapy to counteract treatment-related bowel symptoms. More knowledge on the nutritional consequences of such advice is needed. This study aimed to explore how advice on modified fibre and lactose intakes during pelvic radiotherapy was associated with nutrient intakes amongst patients with prostate cancer.Methods: A total of 77 Swedish men who underwent radiotherapy (50/2 Gy + boost 20–30 Gy) in 2009–2014 due to prostate cancer were given dietary advice at radiotherapy onset (baseline) and at 4 and 8 weeks after radiotherapy onset, to modify their fibre and lactose intakes. At baseline, the participants completed a food frequency questionnaire (FFQ) and a 24-h dietary recall. At 4 and 8 weeks, the participants completed the FFQ and a 4-day estimated food record.Fibre and lactose intakes were measured by intake scores calculated from the FFQs. Multiple linear regression models were used to analyse associations between intake scores and fibre- and lactose-related nutrients.Results: In adjusted analyses, there were few significant associations between dietary advice on modified fibre and lactose intakes and observed intakes of fibre- and lactose-related nutrients. A more modified lactose intake was thus associated with a lower intake of calcium (P = 0.041), whilst a more modified fibre intake was associated with a higher value for the change in intake of vitamin C (P = 0.016).Conclusions: Dietary advice on modified fibre and lactose intake was in most cases not significantly associated with altered nutrient intakes, rather the energy and nutrient intakes were mostly stable during the pelvic radiotherapy. More research is needed on the nutritional consequences of dietary advice on modified fibre and lactose intakes to reach consensus on if they should continue to be provided in the clinic.
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  • Söderström, Lisa, 1982-, et al. (författare)
  • Dietary advice and oral nutritional supplements do not increase survival in older malnourished adults : a multicentre randomised controlled trial
  • 2020
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:3, s. 240-249
  • Forskningsöversikt (refereegranskat)abstract
    • Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital. Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure. Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively). Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.
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  • Adolfsson, Eva Thors, et al. (författare)
  • Reporting systems, reporting rates and completeness of data reported from primary healthcare to a Swedish quality register : The National Diabetes Register
  • 2011
  • Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 80:9, s. 663-668
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:The aims of this paper were to study the reporting rate and completeness of data reported from primary healthcare centres (PHCCs) in Sweden to the Swedish National Diabetes Register (NDR), with a special attention on the relation between these measures and the reporting system used by the PHCCs.Method:A national survey conducted in Swedish primary healthcare covering the year 2006. A questionnaire was used to collect data from 523 PHCCs. Data on 87,099 adult diabetic patients attending these PHCCs and reported to the NDR were obtained from the register. In Sweden, participation in the NDR is voluntary. The data were reported through the Internet, either online using a web-based system or by direct transmission. The main outcome measures were reporting rate and completeness of reported data.Results:Of the 523 PHCCs, almost two-thirds had reported <75% of their diabetic patients to the NDR. The lowest reporting rate was found among the largest PHCCs, while the highest was found among small PHCCs (p < 0.001). Reasons given for not reporting data to the NDR were lack of time and lack of personnel resources. Altogether, 73.1% of the PHCCs reported data to the NDR online using a web-based system, 20.5% used direct transmission and 6.3% used both systems. The PHCCs that reported data through direct transmission systems reported almost 70% of their diabetic patients to the NDR, while PHCCs using web-based systems reported 54% of their diabetic patients to the NDR. Adjusted for other factors, using direct transmission increased the reporting rate by 13.0 percentage points. However, the web-based system contributed to a higher completeness of data than the direct transmission system.Conclusions:A direct transmission system facilitates a high reporting rate to the register at the expense of lower completeness of the reported data.
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10.
  • Adolfsson, Eva Thors, et al. (författare)
  • The Swedish National Survey of the Quality and Organization of Diabetes Care in Primary Healthcare—Swed-QOP
  • 2010
  • Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918 .- 1878-0210. ; 4:2, s. 91-97
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM:To describe the quality and organization of diabetes care in primary healthcare in Sweden regarding resources and ways of working.METHOD:A questionnaire was used to collect data from all 921 primary healthcare centres (PHCCs) in Sweden. Of these, 74.3% (n=684) responded to the questionnaire covering list size of the PHCCs, number of diabetic patients, personnel resources and ways of working.RESULTS:The median list size reported from the PHCCs was 9,000 patients, 294 of whom were diabetic patients. The majority (72%) of PHCCs had diabetes-responsible general practitioners (GPs) and almost all (97%) had diabetes specialist nurses (DSNs) with some degree of postgraduate education in diabetes. The PHCCs reported that they used regional/local diabetes guidelines (93%), were engaged in call-recall diabetic reviews by GP(s) (66%) and DSN(s) (89%), checked that patients had participated in the reviews by GP(s) (69%) and DSN(s) (78%), arranged group education programmes (23%) and reported data to a National Diabetes Register (82%).CONCLUSIONS:The presence of diabetes-responsible GP(s) and DSN(s) who use guidelines may contribute to good and equal quality of care. It is, however, necessary to improve the call-recall system and there is an urgent need for all diabetic patients to receive patient education.
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11.
  • Almdalal, Tarik, et al. (författare)
  • Predictive characteristics for disease recurrence and overall survival in non-metastatic clinical T1 renal cell carcinoma : results from the National Swedish Kidney Cancer Register
  • 2023
  • Ingår i: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 57:1-6, s. 67-74
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivePatients with clinical T1 renal cell carcinoma (cT1RCC) have risks for recurrence and reduced overall survival despite being in the best prognostic group. This study aimed to evaluate the association of different treatments on disease recurrence and overall survival using clinical and pathological characteristics in a nation-wide cT1RCC cohort.Materials and methodsA total of 4,965 patients, registered in the National Swedish Kidney Cancer Register (NSKCR) between 2005 and 2014, with ≥ 5-years follow-up were identified: 3,040 males and 1,925 females, mean age 65 years. Times to recurrence and overall survival were analyzed with Kaplan-Meier curves, log-rank test, and Cox regression models.ResultsAge, TNM-stage, tumor size, RCC-type, and performed treatment were all associated with disease recurrence. Patients selected for ablative treatments had increased risk for recurrent disease: hazard ratio (HR) = 3.79 [95% confidence interval (CI) = 2.69–5.32]. In multivariate analyses, age, gender, tumor size, RCC-type, N-stage, recurrence and performed treatment were all independently associated with overall survival. Patients with chRCC had a 41% better overall survival (HR = 0.59, 95% CI = 0.44–0.78; p < 0.001) than ccRCC. Patients treated with partial nephrectomy (PN) had an 18% better overall survival (HR = 0.83, 95% CI = 0.71–0.95, p < 0.001) than patients treated with radical nephrectomy.ConclusionsAge, gender, T-stage, tumor size, RCC type and treatment modality are all associated with risk of recurrence. Furthermore, age, male gender, tumor size, N-stage and recurrence are associated with reduced overall survival. Patients with chRCC, compared with ccRCC and pRCC patients, and PN compared with RN treated patients, had an advantageous overall survival, indicating a possible survival advantage of nephron sparing treatment.
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12.
  • Berling Holm, Katarina, et al. (författare)
  • Taste disturbance after stapes surgery : an evaluation of frequency, severity, duration, and quality-of-life
  • 2017
  • Ingår i: Acta Oto-Laryngologica. - : Taylor & Francis Group. - 0001-6489 .- 1651-2251. ; 37:1, s. 39-43
  • Tidskriftsartikel (refereegranskat)abstract
    •  Conclusion: The incidence of taste disturbance after stapes surgery is high (61.9 %), whereas the majority (94.8 %) recovers within 1 year. More severe surgical nerve trauma caused more disturbance, implying that the nerve should be handled carefully during surgery. Objectives: Patients operated on for otosclerosis seem more often to complain about post-operative taste disturbance than those operated on for chronic otitis media, although the chorda tympani nerve more seldom becomes maltreated in stapedotomy. These observations seem paradoxical. It is unclear to what extent a post-operative taste disturbance affects the quality-of-life. This study aims to shed light on the occurrence of post-operative taste disturbances, on possible prognostic factors, and to what extent post-operative taste disturbance impairs the quality-of-life. Methods: One hundred and thirty-four adults undergoing primary stapedotomy were included. Questionnaires on taste disturbance and quality-of-life (SF-36) were answered before and after surgery, until 1 year post-operatively. Results: Eighty-three (61.9%) study persons reported post-operative taste disturbance. Seven (5.2%) reported persisting disturbance at 1 year. Surgically more traumatized chorda tympani nerves correlated with more severe taste disturbance post-operatively than less traumatized.  Taste disturbance at 1 year post-operatively correlate with a decrease of the physical function domain in the SF-36.
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13.
  • Berling, Katarina, et al. (författare)
  • Evaluation of electrogustometry and the filter paper disc method for taste assessment
  • 2011
  • Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 131:5, s. 488-493
  • Tidskriftsartikel (refereegranskat)abstract
    • Conclusion:The results indicate that electrogustometry and the filter paper disc method are reliable methods to measure taste with a high degree of reproducibility.Objectives: To thoroughly evaluate the reliability of electrogustometry and the filter paper disc method for taste assessments.Methods:Thirty-nine healthy test persons without any history of chronic middle ear disease, aged between 27 and 62 years, were recruited. In all, 772 electrogustometry and 30 filter paper disc assessments were made. A nerve decay test was performed, with measures taken before and after eating sweet, sour, bitter, salt, a mild or spicy meal, after smoking, and after taking Swedish tobacco snuff ('snus'), as well as before and after local anesthesia of the tongue. Measurements were performed on 5 consecutive days and repeatedly during 1 day. The correlation between electrogustometry and the filter paper disc method was also studied.Results:The results indicate that electrogustometry and the filter paper disc method are reliable methods to measure taste with a high degree of reproducibility. The only actions causing significant changes in the electrogustometry readings were eating bitter a substance and having local anesthesia of the tongue. The correlation between the methods was statistically significant except for the bitter flavor, where the correlation was just below the level of significance.
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14.
  • Blixt, Ingrid, 1968-, et al. (författare)
  • Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support : A pre-post intervention study
  • 2023
  • Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 125
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program.DESIGN: Pre-post intervention study.SETTING: Antenatal care and child healthcare (CHC) centres in Sweden during 2020.PARTICIPANTS: An intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline.INTERVENTION: A breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding.MEASUREMENTS AND FINDINGS: The 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: "I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve" (p = 0.026) and "I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful" (p = 0.048).KEY CONCLUSIONS: The breastfeeding training program improved HCP' self-efficacy to provide evidence-based support to breastfeeding mothers.IMPLICATIONS FOR PRACTICE: This training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding.TRIAL REGISTRATION: ACTRN12623000648628.
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  • Casey, Jackie, et al. (författare)
  • Incidence and sequence of scoliosis and windswept hip deformity : which comes first in 4148 children with cerebral palsy? A longitudinal cohort study
  • 2024
  • Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 25:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe aim was to analyse whether scoliosis or windswept hip deformity (WSH) occurs first for children with cerebral palsy (CP).MethodsThis longitudinal cohort study using data from 1994 − 2020 (26 years) involved 41,600 measurements of 4148 children (2419 [58.3%] boys) with CP born 1990 − 2018 and registered into the Swedish CP follow-up program. Children were followed from a mean age of 2.8 [SD 1.4] years, until they developed either scoliosis or WSH or were removed at surgery.ResultsWSH developed first in 16.6% of the children (mean age 8.1 [SD 5.0] years), and scoliosis in 8.1% (mean age 8.1 [SD 4.9] years). The incidence of WSH was higher than scoliosis across all levels I–V of the Gross Motor Function Classification System (GMFCS), both sexes, and for those with dyskinetic (20.0%) or spastic (17.0%) CP. The incidence of scoliosis was highest (19.8%) and developed earliest in children with GMFCS level V (mean age 5.5 [SD 3.5] years), and in children with dyskinetic (17.9%) CP (mean age 7.0 [SD 4.7] years).ConclusionsWSH presents earlier than scoliosis in most children with CP. Children with higher GMFCS level or dyskinetic CP are more likely to develop these deformities at a younger age. 
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19.
  • Casey, Jackie, et al. (författare)
  • Postural asymmetries, pain, and ability to change position of children with cerebral palsy in sitting and supine : a cross-sectional study
  • 2022
  • Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:11, s. 2363-2371
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeTo examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions.MethodsA cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables.ResultsOver half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2).ConclusionsAn association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain.Implications for rehabilitationPostural asymmetries are present in children with cerebral palsy at all levels of gross motor function.Postural asymmetries increase with age and are associated with pain.Assessment of posture should be included in surveillance programs to enable early detection and treatment.
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20.
  • Casey, Jackie, et al. (författare)
  • Relationship between scoliosis, windswept hips and contractures with pain and asymmetries in sitting and supine in 2450 children with cerebral palsy
  • 2022
  • Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:22, s. 6738-6743
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: This cross-sectional study of 2450 children with cerebral palsy aimed to analyse the prevalence and association of scoliosis, windswept hips, hip and knee contractures. Methods: Logistic regression was used to estimate associations with pain, postural asymmetries, and ability to change position for children at Gross Motor Function Classification System (GMFCS) levels I–V, aged 0–18 years. Results: Most children with a deformity or contracture had postural asymmetries in both sitting and supine positions; 10.5% had scoliosis, 8.7% windswept hips, 6.6% hip flexion and 19.2% knee contractures. Severe postural asymmetries increased the likelihood for scoliosis 9 times, for windswept hips 6 to 9 times, and for hip and knee flexion contractures 7 and 12 times respectively, adjusted for age, sex and GMFCS level. Hip flexion contractures and windswept hips increased the likelihood for pain by 1.5–1.6 times. Conclusion: The likelihood of having scoliosis, windswept hips and flexion contractures in the hips and knees increased if the child had postural asymmetries, and for increased age and higher GMFCS levels. Efforts should focus on preventing postural asymmetries from occurring or progressing, and on increasing the child’s ability to change position. Reducing postural asymmetries may also reduce the likelihood of pain.Implications for Rehabilitation The risk of having scoliosis, windswept hip deformity and flexion contractures in the hips and knees increased if the child had postural asymmetries in sitting or lying. Efforts should focus on preventing or reducing postural asymmetries, and on increasing the child’s ability to change position. Reducing postural asymmetries may also reduce the risk of pain.
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21.
  • Cato, Karin, 1977-, et al. (författare)
  • Instrument development and an intervention to increase parents' self-efficacy regarding their infant's sleep
  • 2024
  • Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 39
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveMany Swedish parents experience that their infant has sleeping problems. Parents’ self-efficacy regarding their infants’ sleep may play an important role in how they perceive these problems. This pilot study aimed to develop an instrument measuring parents’ self-efficacy regarding their infant’s sleep and to examine if parents’ self-efficacy was affected by an intervention focusing on parental education.MethodMothers and fathers, at a maternity unit in Sweden, were drawn into either an intervention (n = 46) or a control (n = 42) group. The intervention group received a home visit from a nurse who provided information about infant sleep; the importance of attachment; and advice regarding sleep, breastfeeding and bed sharing, including guidelines for safe bed sharing. Three months later, the participants answered questions on background data, breastfeeding, sleep and self-efficacy.ResultsThe 11-item two-factor Uppsala Parental Self-Efficacy about Infant Sleep Instrument (UPPSEISI) was constructed to measure parents’ perceived self-efficacy. In adjusted analyses, being in the intervention group was associated with a higher self-efficacy (P = 0.035), as were being a mother (P = 0.003) and being satisfied with one’s own sleep (P = 0.007), while parents’ own sleeping problems were associated with a lower self-efficacy (P = 0.015).ConclusionImportantly, parental education may increase parents’ self-efficacy regarding their infant’s sleep.
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22.
  • Celiker, Shemal, et al. (författare)
  • A radiofrequency vs topical steroid treatment of chronic nasal obstruction : A prospective randomized study of 84 cases
  • 2011
  • Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 131:1, s. 79-83
  • Tidskriftsartikel (refereegranskat)abstract
    • Conclusions:Nasal congestion caused by mucosal swelling and conch hypertrophy impairs breathing and causes snoring and headaches. Treatment of conch hypertrophy with radiofrequency (RF) allows reduction of mucosal swelling, minimization of hyperplasia, and decreased mucus production. This treatment provides a clinically significant improvement in snoring, headaches, and mouth breathing.Objective:To compare the efficacy of RF surgery to nasal steroid; each method used separately and both in combination.Methods:This was a consecutive randomized study, which included 84 patients with 3 outpatient visits, where the first visit included a complete medical history, assessment of ENT status, and skin tests. Nasal flow measured with rhinomanometry was done at the first visit and then before and after each treatment. Patients were asked to respond to a questionnaire at the first visit and after each subsequent treatment. Thereafter the variables were analyzed with established statistical methods.Results:Measurement of variables and patient questionnaire responses showed a clear improvement in several symptoms, such as sneezing and headache, and a clinically significant improvement in nasal congestion and snoring.
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23.
  • Cloodt, Erika, et al. (författare)
  • Demographic and modifiable factors associated with knee contracture in children with cerebral palsy
  • 2018
  • Ingår i: Developmental Medicine & Child Neurology. - : John Wiley & Sons. - 0012-1622 .- 1469-8749. ; 60:4, s. 391-396
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP).MethodCross-sectional data for passive knee extension were analysed in 3045 children with CP (1756 males, 1289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's chi(2) test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length.ResultsKnee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). InterpretationKnee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture.
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24.
  • Condén, Emelie, et al. (författare)
  • Insomnia predicts long-term all-cause mortality after acute myocardial infarction : A prospective cohort study
  • 2016
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 215, s. 217-222
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Sleep impairment such as insomnia is an established risk factor for the development of cardiovascular disease and acute myocardial infarction (AMI). The aim of the current study was to examine the association between insomnia and all-cause mortality among AMI patients. Methods: This prospective cohort study used data on n = 732 patients recruited from September 2006 to May 2011 as part of the Vastmanland Myocardial Infarction Study (VaMIS), a prospective cohort study of AMI patients living in Vastmanland County, Sweden. Participants were followed up for all-cause mortality until December 9, 2015. The outcome of interest was time-to-death (TTD), with the presence of insomnia being the risk factor of main interest. Data were analyzed using a piecewise Cox regression model with change point for insomnia at two years of follow-up, adjusted for socioeconomic, lifestyle and clinical risk factors. Results: In total, n = 175 (23.9%) of the participants suffered from insomnia. During a mean (SD) follow-up time of 6.0 (2.5) years (4392 person-years), a total of n = 231 (31.6%) participants died, n = 77 (44.0%) in the insomnia group and n= 154 (27.6%) in the non-insomnia group (log-rank test p < 0.001). In a multiple adjusted piecewise Cox regression model, insomnia did not imply a higher risk of death during the first two years after AMI (HR 0.849; 95% CI 0.508-1.421; p = 0.534). During the period after the first two years, however, insomnia implied a 1.6 times higher risk of death (HR 1.597; 95% CI 1.090-2.341; p = 0.016). Conclusions: Insomnia implies a higher risk of death among AMI patients in the long term.
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25.
  • Condén, Emelie, 1979-, et al. (författare)
  • Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients?
  • 2017
  • Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 24:5, s. 522-533
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design: This was a prospective cohort study. Methods: Utilising data from the Vastmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results: In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions: No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.
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26.
  • Condén, Emelie, 1979-, et al. (författare)
  • Prevalence of Type D Personality and Factorial and Temporal Stability of the DS14 after Myocardial Infarction in a Swedish Population
  • 2014
  • Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 55:6, s. 601-610
  • Tidskriftsartikel (refereegranskat)abstract
    • This study examined the prevalence of Type D personality and the temporal stability, internal consistency, and construct validity of the DS14 at three time points after myocardial infarction. The prevalence of Type D personality was 14.0% during hospitalization, 25.1% at 1 month, and 19.2% at 12 months. A total of 6.1% of patients were classified as Type D personality at all three assessments, whereas 68.4% were stable non-Type D and 25.6% changed between personality classifications. The DS14 had stable structural validity, but low temporal stability over time, especially from hospitalization to the 1-month and 12-month follow-ups (k = 0.365 and 0.397, respectively).
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27.
  • Drevin, Jennifer, et al. (författare)
  • Childhood abuse and unplanned pregnancies : a cross-sectional study of women in the Norwegian Mother and Child Cohort Study
  • 2020
  • Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 127:4, s. 438-446
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse.Design A cross-sectional study.Setting The study is based on the Norwegian Mother and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway.Sample Women participating in the MoBa for the first time, >= 18 years of age who responded to questions regarding childhood abuse and pregnancy planning (n = 76 197).Methods Data were collected using questionnaires. We conducted analyses using modified Poisson regressions and the relative excess risks due to interaction (RERI). Sensitivity analyses were performed.Main outcome measure An unplanned pregnancy (yes/no).Results Exposure to childhood emotional (adjusted relative risk (RR) 1.14, 95% CI 1.10-1.19), physical (adjusted RR 1.11, 95% CI 1.04-1.18) and sexual (adjusted RR 1.20, 95% CI 1.14-1.27) abuse increased the risk of having an unplanned pregnancy. The effects could not be explained by the collider stratification bias. The different combinations of categories of abuse did not show any interaction effects.Conclusions Childhood emotional, physical and sexual abuses separately increase the risk of having an unplanned pregnancy. The results indicate that victims of childhood abuse are in greater need of support to achieve their reproductive goals. Tweetable abstract Childhood abuse increases the risk of having an unplanned pregnancy. #reproductivehealth #epitwitter.
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28.
  • Drevin, Jennifer, et al. (författare)
  • Measuring pregnancy planning : A psychometric evaluation and comparison of two scales
  • 2017
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 73:11, s. 2765-2775
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale.BACKGROUND: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level.DESIGN: Cross-sectional design.METHODS: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation.RESULTS: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability.CONCLUSION: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.
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29.
  • Ehrsson, Ylva Tiblom, et al. (författare)
  • Self-reported sexually transmitted infections among female university students.
  • 2016
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 121:1, s. 45-49
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.MATERIAL AND METHODS: Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.RESULTS: Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030-1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321-16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112-6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473-4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182-4.771, P = 0.015).CONCLUSIONS: Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.
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30.
  • Eklund, Arne, 1957-, et al. (författare)
  • A cost-minimisation analysis comparing TEP with Lichtenstein for treatment of inguinal hernia in Sweden
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Laparoscopic surgery has emerged as a new treatment modality for inguinal hernia. It is important to analyse its long-term costs in relation to other methods.Methods: A randomized multicenter study comparing totally extraperitoneal laparoscopic repair (TEP) with open repair according to Lichtenstein was performed on men with a primary inguinal hernia. Long-term follow-up collecting data on recurrences and complications up to five years after operation was carried out. Taking treatment costs into consideration, a cost-minimisation analysis was conducted.Results: Altogether 1370 patients were operated, 665 in the TEP and 705 in the Lichtenstein group. The total hospital cost for the index operation was €710.6 higher for TEP (P<0.001). Including costs for recurrences and complications, this difference increased to €795.1 (P<0.001). Taking community costs into account, the difference decreased with €503.1 to €292.0 (P=0.024).Conclusion: With five-year follow-up including complication, reoperation and community costs, there was a small but significant difference in total costs between the two methods.
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31.
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32.
  • Flink, Håkan, et al. (författare)
  • Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults
  • 2008
  • Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 36:6, s. 523-531
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES:Several studies have been conducted on the prevalence of hyposalivation in older adults but no population-based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate.METHODS:A randomized and stratified cross-sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco.RESULTS:The prevalence of very low (<0.1 ml/min) and low (0.10-0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3-22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50-69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60-69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 - 0.99 ml/min) SWSFR was between 0-5.5% and 0.8-8.2%, respectively, for the different age groups 20-69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR.CONCLUSIONS:Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.
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33.
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34.
  • Frid, Hanna, et al. (författare)
  • Agreement between different methods of measuring height in elderly patients
  • 2013
  • Ingår i: Journal of human nutrition and dietetics. - : Wiley. - 0952-3871 .- 1365-277X. ; 26:5, s. 504-511
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe present study aimed to examine the agreement between measurements of standing height and self-reported height, height measured with a sliding caliper, and height estimated from either demispan or knee height in elderly patients.MethodsFifty-five patients (mean age 79 years) at a Swedish hospital were included in this observational study. The participants' heights were evaluated as the standing height, self-reported height, height measured in a recumbent position with a sliding caliper, and height estimated from the demispan or knee height.ResultsThe measurements made with a sliding caliper in the recumbent position agreed most closely with the standing height. Ninety-five percent of the individuals' differences from standing height were within an interval of +1.1 to −4.8 cm (limits of agreement). Self-reported height and height estimated from knee height differed relatively strongly from standing height. The limits of agreement were +5.2 to −9.8 cm and +9.4 to −6.2 cm, respectively. The widest distribution of differences was found in the height estimated from the demispan, with limits of agreements from +11.2 to −9.3 cm.ConclusionsWhen measuring the height of patients who find it difficult to stand upright, a sliding caliper should be the method of choice, and the second choice should be self-reported height or the height estimated from knee height. Estimating height from the demispan should be the method of last resort.
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35.
  • Gaber, Sophie, et al. (författare)
  • A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students
  • 2023
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 37:4, s. 959-969
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The population of women in homelessness in Europe is increasing and women in homelessness experience multiple healthcare needs. However, there is insufficient understanding about how perceptions of caring behaviours compare between women in homelessness as patients and nurses in their clinical practice.AIM: This study aimed to investigate perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students.METHODS: A cross-sectional design was used with convenience sampling to recruit groups of women in homelessness (n = 37), Registered Nurses (n = 92) and nursing students (n = 142) in Stockholm, Sweden. Between August 2019 and December 2020, data were collected through face-to-face interviews or online, using the Caring Behaviours Inventory-24 instrument. Data were analysed using descriptive statistics and group-comparing hypothesis tests.RESULTS: Overall, women in homelessness' perceptions of caring behaviours were significantly lower than nursing students (p < 0.001), who in turn scored significantly lower than Registered Nurses (p < 0.001). The Knowledge and Skill domain had the highest score, and the Connectedness domain had the lowest score in all three groups. The ranking of the individual items according to score varied between the groups. However, all three groups had the highest score for the Knowing how to give shots, IVs, etc., item and the lowest score for the Helping the patient to grow item.CONCLUSION: Healthcare providers and nurse educators should consider incongruences and congruences in caring behaviours to better prepare Registered Nurses and nursing students to contribute to increased health equity, and more targeted clinical practice for women in homelessness.
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36.
  • Gaber, Sophie, et al. (författare)
  • A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students
  • 2023
  • Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:4, s. 959-969
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The population of women in homelessness in Europe is increasing and women in homelessness experience multiple healthcare needs. However, there is insufficient understanding about how perceptions of caring behaviours compare between women in homelessness as patients and nurses in their clinical practice.Aim: This study aimed to investigate perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students. Methods: A cross-sectional design was used with convenience sampling to recruit groups of women in homelessness (n = 37), Registered Nurses (n = 92) and nursing students (n = 142) in Stockholm, Sweden. Between August 2019 and December 2020, data were collected through face-to-face interviews or online, using the Caring Behaviours Inventory-24 instrument. Data were analysed using descriptive statistics and group-comparing hypothesis tests.Results: Overall, women in homelessness’ perceptions of caring behaviours were significantly lower than nursing students (p < 0.001), who in turn scored significantly lower than Registered Nurses (p < 0.001). The Knowledge and Skill domain had the highest score, and the Connectedness domain had the lowest score in all three groups. The ranking of the individual items according to score varied between the groups. However, all three groups had the highest score for the Knowing how to give shots, IVs, etc., item and the lowest score for the Helping the patient to grow item.Conclusion: Healthcare providers and nurse educators should consider incongruences and congruences in caring behaviours to better prepare Registered Nurses and nursing students to contribute to increased health equity, and more targeted clinical practice for women in homelessness. 
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37.
  • Gerhardsson, Emma, et al. (författare)
  • Developing the preterm breastfeeding attitudes instrument : A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care
  • 2021
  • Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 94
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care.DESIGN: The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme.SETTING AND PARTICIPANTS: A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis.MEASUREMENTS AND FINDINGS: Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Neonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.
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38.
  • Grandahl, Maria, et al. (författare)
  • A school-based educational intervention can increase adolescents’ knowledge and awareness about HPV
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • Background / ObjectivesBackground: In Sweden HPV vaccination is offered to girls aged 10-12 years within the school-based vaccination program, while older girls (13-26 years) are offered the vaccine through the primary care. The vaccination rates are substantially lower (59%) among the catch-up group compared to the younger age group (82%). Adolescents have low awareness and knowledge about HPV, especially regarding cancer risks. The providers - school nurses - play a key role in providing such information. Upper secondary school students, aged 16 years, are by the school nurse offered a health interview, which includes a dialogue regarding their health, including sexual health. The health interview does however not include systematic information about HPV.Objectives: To improve adolescents’ knowledge and awareness about primary prevention of high risk HPV infection.MethodsMethods: A cluster-randomised controlled trial among upper secondary schools (n=18) was performed. Schools were first randomised to an intervention or control group, after which individual classes were randomised. In total, 832 students, boys and girls aged 16 years attending theoretical or vocational programs were invited to participate. In the end, 741 (89.1%) students completed the256study. The intervention was based on the Health Belief Model (HBM). School nurses delivered 30 minutes of face-to-face structured information about HPV, including cancer risks and HPV prevention (i.e. condom use and HPV vaccination) to the intervention group. Students in both groups completed questionnaires at baseline and at follow-up after three months. The control group received standard treatment, i.e. the regular health interview with the school nurse. Generalized estimating equation analyses were used for examining the results of the intervention.ResultsResults: The intervention had positive effects on the adolescents’ knowledge (p<0.001), with a 0.582 higher score for the intervention group compared to the control group. There were no differences in knowledge due to sex (p=0.093) or immigrant background (p=0.592). The intervention also increased awareness (p<0.001), with a 0.590 higher score for the intervention compared to the control. Again, there were no differences in awareness due to sex (p=0.183) or immigrant background (p=0.319).ConclusionConclusions: The school-based intervention delivered by school nurses, had favourable effects on knowledge and awareness about primary prevention of HPV among adolescents aged 16 years.
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39.
  • Grandahl, Maria, et al. (författare)
  • School-based intervention for the prevention of HPV among adolescents : a randomised controlled study
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • Background: Vaccination against human papillomavirus (HPV) is one important factor for preconception health and care. In Sweden a national vaccination programme for girls was implemented in 2012.Aim: To improve primary prevention of HPV infection by promoting vaccination and increased condom use among upper secondary school students at time for the general health interview with the school nurse.Methods: Randomised controlled trial among upper secondary schools (n=18). Participant schools were first randomised to the intervention or the control group, after which individual classes were randomised to be included or not. 832 students, both boys and girls aged 16 were invited to participate and in the end, 741 (89.1%) students completed the study. The intervention was based on the Health Belief Model (HBM). According to HBM a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 minute face-to-face structured information about HPV, including cancer risks and HPV prevention, i.e. condom use and HPV vaccination. Students in both groups completed questionnaires at baseline and after three months.Results: The intervention had positive effect on behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). There was also a significant effect on HBM total score (p=0.003), students in the intervention group had more favourable beliefs compared to the controls. The influence on the HBM parameters susceptibility and severity were also significant (p<0.001 for both variables). In addition, the intervention had significant effect on the intention to use condom (p=0.004).Conclusion: The school-based intervention increased HPV vaccination rates and had favourable effects on beliefs towards primary prevention of HPV in a diverse population of adolescents. These resultss provide the scientific support for the implication of nation-wide educational interventions with the potential to improve preconception health.
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40.
  • Grandahl, Maria, et al. (författare)
  • School-based intervention for the prevention of HPV among adolescents : a cluster randomised controlled study
  • 2016
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.
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41.
  • Grandahl, Maria, et al. (författare)
  • School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden : a population-based survey
  • 2014
  • Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14:540, s. 1-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, andschool nurses are responsible for managing the vaccinations. The aim of the present study was to investigate theattitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after itsimplementation.Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) ofnurses responded.Results: There were strong associations between the nurses’ education about the HPV vaccine and their perceivedknowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses whoreceived a high level of education were more likely to have a positive attitude to HPV vaccination compared withnurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]:3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared withthose with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from thegovernment was used to fund an additional school nurse, nurses were more likely to have a positive attitude thanif the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI:1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostlyrelated to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with thevaccinations, and 337 (59.1%) of these considered the task to be time-consuming.Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positiveattitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education,skills and time to address the questions and concerns of parents, as well as providing information about HPV.Strategic financial support is required because HPV vaccination is a complex and time-consuming task.
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42.
  • Grandahl, Maria, et al. (författare)
  • To consent or decline HPV vaccination : a pilot study at the start of the national school-based vaccination program in Sweden
  • 2017
  • Ingår i: Journal of School Health. - : John Wiley & Sons. - 0022-4391 .- 1746-1561. ; 87:1, s. 62-70
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUNDParents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.METHODSThe sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.RESULTSDeclining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.CONCLUSIONParents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.
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43.
  • Granstam Björneklett, Helena, et al. (författare)
  • A randomised controlled trial of support group intervention after breast cancer treatment : Results on anxiety and depression
  • 2012
  • Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 51:2, s. 198-207
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPrevious studies have demonstrated that between 20 and 30% of women treated for breast cancer have measurable signs of anxiety and depression compared with 6% in a population of healthy women. Depression has been proposed as a predictive factor for recurrence and survival. The aim of the present study was to evaluate if psychosocial support intervention could influence anxiety and depression during the first year after diagnosis.Material and methodsNewly diagnosed breast cancer patients were randomised between April 2002 and November 2007 and stratified by adjuvant chemotherapy. Of 382 eligible patients, 191 + 191 patients were randomised to intervention group or control group, respectively. Control patients were subjected to standard follow-up routines. The Intervention group had support intervention at the Foundation Lustgarden Malardalen. The rehabilitation lasted one week on a residential basis followed by four days of follow-up two months later. We used the Swedish version of the HAD scale with a cut-off value greater than 10 for clinical symptoms of depression and anxiety.ResultsSupport group intervention lowered anxiety over time (p < 0.001) but depression was unaffected (p = 0.610).ConclusionThis prospective randomised trial of support group intervention in a large homogenous group of breast cancer women showed a statistically significant effect on lowering anxiety over time. No statistically significant effect of intervention could be seen on depression.
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44.
  • Granstam Björneklett, Helena, 1962-, et al. (författare)
  • A randomized controlled trial of support group intervention after breast cancer treatment : Results on sick leave, health care utilization and health economy
  • 2013
  • Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 52:1, s. 38-47
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundMore than 50% of breast cancer patients are diagnosed before the age of 65.  Returning to work after treatment is, therefore, of interest for both the individual and society. The aim was to study the effect of support group intervention on sick leave and health care utilization in economic terms.Material and MethodsOf 382 patients with newly diagnosed breast cancer, 191 + 191 patients were randomized to an intervention group or to a routine control group respectively. The intervention group received support intervention on a residential basis for one week, followed by four days of follow-up two months later. The support intervention included informative-educational sections, relaxation training, mental visualization and non-verbal communication. Patients answered a questionnaire at baseline, 2, 6 and 12 months about sick leave and health care utilization.ResultThere was a trend towards longer sick leave and more health care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036).Conclusion Costs to society were not reduced with intervention in its present form.
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45.
  • Granstam Björneklett, Helena, et al. (författare)
  • Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer
  • 2013
  • Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 74:4, s. 346-353
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:Despite a fairly good prognosis, many breast-cancer patients suffer from symptoms such as anxiety, depression and fatigue, which may affect health-related quality of life and may persist for several years. The aim of the present study was to perform a long-term follow-up of a randomized study of support group intervention in women after primary breast cancer treatment.Materials and methods:Three hundred and eighty two women with primary breast cancer were randomized to support group intervention or control group, 181 in each group. Women in the intervention group participated in 1 week of intervention followed by 4 days of follow-up 2 months later. This is a long-term follow-up undertaken, in average, 6.5. years after randomization. Patients answered the questionnaires the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC QLQ-C30) and the Breast Cancer Module questionnaire (BR23), the Hospital Anxiety and Depression Scale (HAD) and the Norwegian version of the fatigue scale (FQ).Results: After adjusting for treatment with chemotherapy, age, marriage, education and children at home, there was a significant improvement in physical, mental and total fatigue (FQ), cognitive function, body image and future perspective (EORTC QLQ C30 and BR23) in the intervention group compared with controls. The proportion of women affected by high anxiety and depression scores were not significantly different between the groups.Conclusion:Support intervention significantly improved cognitive function, body image, future perspective and fatigue, compared with to the findings in the control group.
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46.
  • Granstam, Elisabet, 1963-, et al. (författare)
  • Long‐term follow‐up of antivascular endothelial growth factor treatment for diabetic macular oedema : a four‐year real‐world study
  • 2020
  • Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 98:4, s. 360-367
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeTo evaluate visual acuity (VA) and central retinal thickness (CRT) on optical coherence tomography during a 4‐year period in patients treated for sight‐threatening diabetic macular oedema (DMO) at two Swedish county hospitals. Additionally, to compare health‐related quality of life and subjective visual functioning before and after 4 years of treatment.MethodsFifty‐eight patients with DMO were evaluated after 4 years of antivascular endothelial growth factor (VEGF) treatment. VA, CRT and clinical data were retrospectively reviewed. Health‐related quality of life and subjective visual functioning were evaluated with Short Form Health Survey (SF‐36) and National Eye Institute Vision Functioning Questionnaire 25 (VFQ‐25). Comparisons between independent groups were performed using Pearson's χ2 test, Fisher's exact test or Mann–Whitney U test. Spearman's ρ was used for correlation analyses. Wilcoxon signed‐rank test was used for comparison between dependent groups. Logistic regression analysis was applied for analysis of VA and CRT over 4 years.ResultsFollow‐up data were obtained from 37 of 58 (63.8%) patients. Baseline characteristics were similar, regardless of follow‐up. VA improvement at 1 year (mean + 4.4, SD 7.5; ETDRS letter score) was maintained over 3 years, then declined. CRT was reduced throughout the study. In the first treatment year, eyes received 5.1 (1.4) anti‐VEGF injections, followed by approximately two injections yearly. Additional treatment included laser and dexamethasone implants. SF‐36 showed no change at 4 years, compared with baseline. VFQ‐25 demonstrated improvement in near vision activities (p = 0.036).ConclusionSignificant long‐term improvement in visual function was present in patients with anti‐VEGF‐treated DMO.
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47.
  • Hedberg Nyqvist, Kerstin, 1945-, et al. (författare)
  • Early skin-to-skin contact between healthy late preterm infants and their parents : an observational cohort study
  • 2017
  • Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundSkin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants’ SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables.MethodsThis was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers.ResultsThe mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4–12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4–3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1–3.2) hours longer for boys (p = 0.033), 3.2 (1.2–5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1–3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6–5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5–3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4–4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3–3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother’s age, gestational age, or induction of labor were significantly associated with infants’ SSC with mothers or fathers during any of the first two days after birth.ConclusionFuture studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.
  •  
48.
  • Husdal, Rebecka, et al. (författare)
  • Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.
  • 2019
  • Ingår i: Primary care diabetes. - : Elsevier BV. - 1878-0210 .- 1751-9918. ; 13:2, s. 176-186
  • Tidskriftsartikel (refereegranskat)abstract
    • To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs' results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05).This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs' QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.
  •  
49.
  • Husdal, Rebecka (författare)
  • Key Features for Successful Swedish Primary Diabetes Care – Reality or Fiction? : Nationwide studies of longitudinal follow-up, HbA1c levels and all-cause mortality in an organizational context
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aims To extend knowledge about the changes in Swedish primary diabetes care from 2006 to 2013 and investigate associations of personnel resources, organizational features and quality-of-work conditions of primary health-care centres (PHCCs) with individual HbA1c levels and all-cause mortality in people with type 2 diabetes mellitus (T2DM).Methods Information about organizational features, personnel resources and quality-of-work conditions were collected from responses of PHCC managers to the Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary HealthCare (Swed-QOP) questionnaire. The longitudinal cross-sectional study included 74.3% and 76.4% of PHCCs in 2006 and 2013, respectively. Individual clinical data for 230,958 people with T2DM obtained from the Swedish National Diabetes Register were linked to the data from the Swed-QOP questionnaire. Individual data were linked to socio-economic and comorbidity data. All-cause mortality was followed up for a median of 4.2 years for 187,570 people with T2DM.Results The longitudinal follow-up study showed a decreased median PHCC list size but an increased median number of people with T2DM. The mean European Credit Transfer and Accumulation System (ECTS) credits in diabetes-specific education for registered nurses (RNs) increased. The number of PHCCs providing group education programs and involving the patient in goal setting remained low (I). PHCCs having diabetes teams and group education programs were associated with decreased HbA1c levels. Using call-recall system to general practitioners (GPs) was associated with increased HbA1c levels (II). Seven quality-of-work features were identified, of which Individualized treatment was associated with decreased HbA1c levels in people with controlled (≤ 52 mmol/mol), intermediate (53–69 mmol/mol) and uncontrolled (≥ 70 mmol/mol) HbA1c (III). GP staffing was associated with a decreased risk of early death and the mean ECTS credits in diabetes-specific and pedagogical education of RNs was associated with a decreased risk of early death in people aged ≥ 55 years and in men, respectively (IV).Conclusion This thesis adds to previous work on significant but less pronounced key features for successful organization of primary diabetes care, and indicates that the complexity of diabetes disease makes it difficult to identify success factors applicable to all people living with T2DM.
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50.
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