| 11. |
- Khan, Faisel, et al.
(author)
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Plaque characteristics and biomarkers predicting regression and progression of carotid atherosclerosis
- 2022
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In: Cell Reports Medicine. - : Elsevier BV. - 2666-3791. ; 3:7
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Journal article (peer-reviewed)abstract
- The factors that influence the atherosclerotic disease process in high-risk individuals remain poorly understood. Here, we used a combination of vascular imaging, risk factor assessment, and biomarkers to identify factors associated with 3-year change in carotid disease severity in a cohort of high-risk subjects treated with preventive therapy (n = 865). The results show that changes in intima-media thickness (IMT) are most pronounced in the carotid bulb. Progression of bulb IMT demonstrates independent associations with baseline bulb IMT, the plaque gray scale median (GSM), and the plasma level of platelet-derived growth factor (PDGF) (standardized β-coefficients and 95% confidence interval [CI] −0.14 [−0.06 to −0.02] p = 0.001, 0.15 [0.02–0.07] p = 0.001, and 0.20 [0.03–0.07] p < 0.001, respectively). Plasma PDGF correlates with the plaque GSM (0.23 [0.15–0.29] p < 0.001). These observations provide insight into the atherosclerotic process in high-risk subjects by showing that progression primarily occurs in fibrotic plaques and is associated with increased levels of PDGF.
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| 12. |
- Kozakova, Michaela, et al.
(author)
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Gamma-glutamyltransferase, arterial remodeling and prehypertension in a healthy population at low cardiometabolic risk
- 2020
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240.
-
Journal article (peer-reviewed)abstract
- Plasma gamma-glutamyltransferase (GGT) was suggested to reflect the level of systemic oxidative stress. Oxidative stress induces changes in arterial structure and function and contributes to the development of hypertension. Therefore, GGT may be associated with arterial remodeling and blood pressure (BP) increment, even in absence of disease. To test this hypothesis, we evaluated, in 825 healthy subjects at low cardiometabolic risk, the associations of plasma GGT with carotid artery intima-media thickness (IMT), luminal diameter and prehypertension; in 154 subjects was evaluated also the association with aortic stiffness (cfPWV). Associations were controlled for insulin sensitivity, C-reactive protein, and life-style habits. In the main population, BP was remeasured after 3 years. Carotid diameter and cfPWV, but not IMT, were directly and independently related to plasma GGT. Subjects with prehypertension (N = 330) had higher GGT as compared with subjects with normal BP (22 [14] vs 17 [11] IU/L; adjusted P = 0.001), and within prehypertensive subjects, those who developed hypertension during 3 years had higher GGT than those without incident hypertension (27 [16] vs 21 [14] IU/L; adjusted P < 0.05). Within subjects with arterial stiffness measurement, those with prehypertension (N = 79) had higher both GGT and arterial stiffness (25 [14] vs 16 [20] IU/L and 9.11 ± 1.24 vs 7.90 ± 0.94 m/s; adjusted P < 0.01 and <0.05). In the view of previous evidence linking plasma GGT concentration to the level of systemic oxidative stress, our findings suggest a role of oxidative stress in subclinical arterial damage and in prehypertension, even in healthy subjects free of cardiometabolic risk. Arterial organ damage may represent the link between GGT and hypertension.
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| 13. |
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| 14. |
- Persson, Helene Åvik, et al.
(author)
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Professionals’ expectations and preparedness to implement knowledge-based palliative care at nursing homes before an educational intervention : A focus group interview study
- 2021
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:17, s. 1-18
-
Journal article (peer-reviewed)abstract
- The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals’ expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation’s readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation’s readiness. This study contributes valuable knowledge about professionals’ expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations’ readiness.
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| 15. |
- Persson, Helene Åvik, et al.
(author)
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Professionals´ readiness for change to knowledge-based palliative care at nursing homes : a qualitative follow-up study after an educational intervention
- 2022
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In: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 21:1
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Journal article (peer-reviewed)abstract
- Background: There has been a global increase in the number of people who are dying of old age. This development implies a need for good palliative care among older persons at the end of life. Here nursing homes have an important role to play. However, the principles of palliative care have not been sufficiently applied in nursing homes, and there is a need to increase the implementation of palliative care in these settings. Therefore the project named Implementation of Knowledge-Based Palliative Care in Nursing Homes (the KUPA project, to use its Swedish acronym) was started as a contribution to filling this knowledge gap. The aim of the present study was to investigate the professionals’ experiences of readiness for change to knowledge-based palliative care at nursing homes after the educational intervention within the KUPA project. Methods: The focus group method was used to interview 39 health-care professionals with the aid of semistructured questions based on the Organizational Readiness for Change theoretical framework. Six focus groups were formed at six nursing homes in two counties in southern Sweden. The groups included different types of professionals: assistant nurses, nurses, occupational therapists, physiotherapists and social workers. The analysis was conducted with an abductive approach and included deductive and inductive content analysis. Results: The analysis revealed one overarching theme: hopeful readiness for change in palliative care despite remaining barriers. The main categories were increased knowledge facilitating development, enhanced team spirit, uncertainty about future plans connected with hopeful readiness and remaining organizational barriers. Conclusions: This study adds knowledge and understanding concerning professionals’ readiness for change palliative care in nursing homes and shows how ready nursing home settings undertake these changes in practice. The Organizational Readiness for Change theory proved suitable for application in nursing homes to assess the professionals’ experiences and to evaluate educational interventions regardless of the organization’s readiness for change. Trial registration: ClinicalTrials NCT02708498, first registration 15/03/2016.
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| 16. |
- Persson, Johanna, et al.
(author)
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Digitalization and mobile work in home care nursing – how does it work in everyday practice?
- 2021
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Conference paper (peer-reviewed)abstract
- In this study we explore what digitally supported, mobile work in home care nursing may look like in practice. The results show that there is a large degree of self-determination among the nurses when it comes to organizing their work and that the digital systems can lead to an increased complexity. The diverse environment encountered in home care (as compared to the more standardized hospital environment) accentuates that digitalization has many sides to it and cannot be treated as a generic homogeneous entity regardless of context and task.
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| 17. |
- Rydenfält, Christofer, et al.
(author)
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Covid-19 pandemins påverkan på arbetsmiljön för kommunal hemsjukvårds- och hemtjänstpersonal : lärande för framtiden och för ett mer mobilt arbetssätt: slutrapport
- 2023
-
Reports (other academic/artistic)abstract
- I projektet har vi studerat Covid-19-pandemins påverkan på arbetsmiljön för hemsjukvårds- och hemtjänstpersonal i fyra skånska kommuner, samt identifierat en rad lärdomar avseende arbetsmiljö och krishantering under pandemin. En serie delstudier bestående av intervjuer, fokusgrupper och observationer genomfördes för att följa pandemihanteringen och pandemins påverkan på arbetsmiljön över tid. Pandemin förde med sig en rad arbetsmiljörelaterade utmaningar. Arbetet blev tyngre och mer tidskrävande till följd av skyddsutrustningsanvändning, tidvis var personalbristen mycket hög vilket påverkade både verksamheten och arbetsmiljön. Både hemsjukvårdssköterskor, hemtjänstpersonal och deras chefer led av hög arbetsbelastning. För cheferna bestod arbetet också av en stor mängd nya arbetsuppgifter. Vi såg också indikationer på att både hemtjänstpersonal och chefer led av etisk stress till följd av motstridiga krav och behov i arbetet. Den omfattande skyddsutrustningsanvändning i patienternas hem förde dels med sig ergonomiska besvär, dels logistiska problem. Olika typer av digital teknik användes i pandemihanteringen, gemensamt för användningen var att syftet med den var relaterat till kommunikation. En god arbetsmiljö är viktig för uthålligheten under kris. Det största hotet mot hemsjukvården och hemtjänstens arbetsmiljö var personalbristen. En viktig lärdom är därför att det behövs bättre planering för hur personalförsörjningen skall säkerställas. Det var också tydligt att skyddsutrustningsanvändning handlade om mer än själva utrustningen och handhavandet. För hemsjukvården och hemtjänsten var logistiken runt skyddsutrustningen ett stort problem som behöver tas hänsyn till vid både utformning av rutiner för användning och av själva utrustningen. Chefernas situation var utsatt och därför är det viktigt att vidta åtgärder som möjliggör för cheferna att få tid för att stötta sin personal även under en kris. Ett sätt att göra detta på kan vara att ha en förberedd stödorganisation till chefen. Hemtjänstpersonalen led av att de tvingades ha en större distans till sina brukare och det är tydligt att de behövde mer stöd för att hantera detta. Även om pandemin minskat tröskeln för att använda digital teknik, är det tydligt att det var den upplevda nyttan som avgjorde vad som av som användes i slutändan.
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| 18. |
- Rydenfält, Christofer, et al.
(author)
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Home care nurses' and managers' work environment during the Covid-19 pandemic : increased workload, competing demands, and unsustainable trade-offs
- 2023
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In: Applied Ergonomics. - 1872-9126. ; 111
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Journal article (peer-reviewed)abstract
- Little research exists on how home care nursing personnel have experienced the Covid-19 pandemic. This qualitative study explores the work environment related challenges nurses and managers in home care faced during the pandemic. We discuss these challenges in relation to the Demand-Control-Support Model and reflect on how the organizational dynamics associated with them can be understood using the competing pressures model. During the pandemic, home care nurses and managers experienced both an increased workload and psychosocial strain. For managers, the increased complexity of work was a major problem. We identify three key takeaways related to sustainable crisis management: 1) to support managers' ability to provide social support to their personnel, 2) to increase crisis communication preparedness, and 3) to apply a holistic perspective on protective gear use. We also conclude that the competing pressures model is useful when exploring the dynamics of the work environment in complex organizational contexts.
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| 19. |
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| 20. |
- Rydenfält, Christofer, et al.
(author)
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Mobila tvärprofessionella hemsjukvårdsteam : påverkan på arbetsmiljön för hemsjukvårds- och hemtjänstpersonal och utformning av digitalt stöd : slutrapport
- 2022
-
Reports (other academic/artistic)abstract
- I detta projekt har vi studerat organisationsformer och behov av digitalt stöd för mobila tvärprofessionella hemsjukvårdsteam vid vård av multisjuka äldre. Projektet är en direkt fortsättning på AFA-projektet ”Hur kan arbetsmiljön för personer inom hemsjukvården förbättras genom att e-hälsolösningar skapar kompetensstöd vid ensamarbete?”Projektets syfte är att undersöka hur organisering i mobila tvärprofessionella hemsjukvårdsteam påverkar arbetsmiljön för hemsjukvårds- och hemtjänstpersonalen. Vi avser också ta fram konceptuella förslag på digitala och organisatoriska lösningar som dels tillfredsställer de kommunikations- och stödkompetensbehov som finns i och med det tvärprofessionella arbetssättet, dels, skapar förutsättningar för en förbättrad arbetsmiljö.
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