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- Andersson, Jenny, et al.
(författare)
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Decision‐Making in Seeking Emergency Care for Stroke Symptoms
- 2022
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Ingår i: Stroke: Vascular and Interventional Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 2694-5746. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision‐making processes after the onset of stroke symptoms in patients experiencing a first‐time stroke.MethodsWe included 36 patients aged 18 and older, all of whom were hospitalized with a first‐time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology.ResultsIn total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision‐making processes were described by the core category of “Acting on fear.” The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) “seeking care”–recognized stroke symptoms and acted immediately; (2) “pending and reluctance”–suspected stroke but awaited to seek care; and (3) “seeking an explanation”–confused by symptoms.ConclusionWe found that decision‐making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.
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- Andersson, Jenny, et al.
(författare)
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Symptoms at stroke onset as described by patients: a qualitative study
- 2024
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Ingår i: BMC Neurology. - : Springer Nature. - 1471-2377. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke.Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level.Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another.Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this.
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- Bergsten, Lisa, 1990-
(författare)
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Housing tenures in Sweden; from rental to ownership and intermediate tenures
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of housing tenures for a well-functioning housing market is repeatedly emphasized. Such suggestions include the need for balance between tenures, various tenures, mixed tenures in neighborhoods, et cetera. The development of new types of housing tenures has also been noticed as a tool or vehicle to make the housing market accessible to more people, either through creating more affordable housing or supporting homeownership. Since these tenures often combine attributes from both ownership and rental - and place somewhere in between rental and ownership on a continuum, they are often described as intermediate housing tenures. Intermediate tenures and concepts have been developed in Sweden as more people encounter difficulties accessing the housing market.As these new tenures and schemes develop, so does the need to increase the understanding of them, for example, in terms of the legal framework, rights, obligations, as well as risk exposure. This thesis examines the content of various tenures (established and new ones) and explores how and why intermediate tenures and concepts have been developed. This thesis includes two appended papers. The first paper is a comparative case study examining the design and content of the primary tenures in four Nordic countries. The second paper is a case study of four intermediate concepts in Sweden. As methods for data collection, document and literature studies were used for both papers, and paper 2 was supplemented with expert interviews with representatives from the concept developers.The findings imply significant similarities between the tenures in the four Nordic countries based on their design and content. Based on the literature, some attributes for overall tenures, such as ownership and rental, can be pointed out (although major differences still exist between tenure forms). In summary, attributes associated with ownership include far-reaching rights and responsibilities as well as risk-taking. In comparison, these rights are much more restricted for rentals, which do not include risk- taking. This also corresponds with the findings, showing that tenures within ownership have the most far- reaching rights, particularly regarding the right to transfer or let out the housing unit and the value therefrom. Furthermore, the rights are most restricted for rentals, while the tenures between ownership and rental also have bundles of rights in between. The studied intermediate tenures and concepts in Sweden were described to have evolved from the difficulties many faces in accessing the housing market (or the poor housing conditions that prevailed when they were created), like intermediate tenures in countries worldwide. Most of the studied concepts are new and, thus, still in the establishment phase. However, the developers see potential to scale up the concepts. Challenges identified in order to establish and scale up such concepts are to reach out with information to various actors and to achieve a certain degree of recognition, getting access to buildable land, and financial issues. The financial issues both concern the financial ability to initiate this type of project and to consider the current members' interest while scaling up the concepts.This thesis has contributed to the literature on intermediate housing tenures by providing examples of four cases of intermediate tenures from a Swedish context. This contribution can provide insights into the development of such tenures and concepts as well as some of the challenges the developers have met. These insights can also be a valuable practical contribution for actors, such as municipalities, policymakers, housing developers, and so forth, to understand some of the difficulties developers of new concepts meet.
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- Björnfot, Cecilia, et al.
(författare)
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Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults : a 4D flow MRI study
- 2024
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Ingår i: Journal of Cerebral Blood Flow and Metabolism. - : Sage Publications. - 0271-678X .- 1559-7016.
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Tidskriftsartikel (refereegranskat)abstract
- White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66–85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV’s stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.
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| 7. |
- Dahlström, Örjan, 1973-, et al.
(författare)
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Efficacy of pre-participation cardiac evaluation recommendations among athletes participating in World Athletics Championships
- 2020
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Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 27:14, s. 1480-1490
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Tidskriftsartikel (refereegranskat)abstract
- Background Athletes competing in athletics (track and field) at international level may be participating with underlying undiagnosed life-threatening cardiovascular conditions. Our objective was to analyse variations in pre-participation cardiac evaluation prevalence among athletes participating in two International Association of Athletics Federations (IAAF) World Athletics Championships, with regard to the human developmental level and global region of their home countries, as well as athletes’ age category, gender, event group and medical insurance type.Design Cross-sectional web-based survey.MethodsA total of 1785 athletes competing in the IAAF World Under 18 Championships Nairobi 2017 and World Championships London 2017 were invited to complete a pre-participation health questionnaire investigating the experience of a pre-participation cardiac examination.Results A total of 704 (39%) of the athletes participated. Among these, 59% (60% of women; 58% of men) reported that they had been provided at least one type of pre-participation cardiac evaluation. Athletes from very high income countries, Europe and Asia, showed a higher prevalence of at least one pre-participation cardiac evaluation.Conclusions The prevalence of pre-participation cardiac evaluation in low to middle income countries, and the African continent in particular, needs urgent attention. Furthermore, increases in evaluation prevalence should be accompanied by the development of cost-effective methods that can be adopted in all global regions.
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| 8. |
- Danielsbacka, Jenny S, et al.
(författare)
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Physical activity and respiratory symptoms after pulmonary embolism. A longitudinal observational study
- 2020
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848. ; 189, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Acute pulmonary embolism (PE) is a major cause of hospitalization and morbidity. Common symptoms are dyspnea and respiratory pain. Physical activity (PA) and respiratory symptoms during the first year after PE are not previously studied. The aim of the study was to describe PA and respiratory symptoms, to have as base for recommendations on PA after PE. Materials and methods: Sixty-four consecutive patients with first time PE were investigated during hospitalization and at 3, 6 and 12 months after discharge. The investigations included spirometry, six-minute walk test as well as ratings of PA, dyspnea and respiratory pain. Results: Median PA per week increased from 4 (0-27) hours to 7 (0-29) hours, while ratings of dyspnea and respiratory pain decreased during the year. Lung function, measured as forced expiratory volume in one second, increased between discharge and 3 months. Functional capacity, measured as six-minute walk distance, increased during the whole year. Reasons for change in amount of physical activity after pulmonary embolism were identified. To keep healthy and avoid recurrence of PE were two of the reasons to increase PA, and fear of respiratory pain, dyspnea at exertion and fear of recurrence of PE, among the reasons to decrease it. Conclusions: Median PA increased during the year. Respiratory symptoms and lung function improved during the first 3 months, whereas functional capacity improved during the whole year after. These results indicate that PA after PE is safe and can be recommended to patients, at least if no severe cardiovascular co-morbidity is present.
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| 9. |
- Ekström, Ulf, et al.
(författare)
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Insufficient mixing of thawed serum samples leading to erroneous results - experience from a field study and use of a correction procedure
- 2020
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 80:2, s. 99-105
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Tidskriftsartikel (refereegranskat)abstract
- Incorrect analysis results that are close to expected might not be recognized in scientific studies or routine patient care. In two field studies we obtained unexpected results in a large number of samples. The present study aimed to identify the source of error in the samples from these studies and to validate a method to obtain correct results. Pre-analytical procedures were scrutinized, giving no indications of inappropriate pre-analytical sample handling in the field or during transport in a tropical climate. Using a new set of samples from volunteers in simulation experiments, we observed the known concentration gradient of analytes sampled in gel as well as plain tubes after freezer storage and thawing. Experiments demonstrated that mixing of samples by vortexing alone was not sufficient to disrupt the gradient formed by freezing and thawing, which appeared to cause the problem encountered when we in field studies analyzed and biobanked large sample sets by robot pipetting. A correction procedure was introduced, in which the obtained value of an analyte was multiplied by a correction factor calculated for each sample using the expected sodium level (140 mmol/L) divided by the measured sodium value. When it was validated on results from the simulation experiments, we repeatedly found that the correction lead to results very close to true values for analytes of different size and charge. Usefulness of the procedure was demonstrated when applied to a large set of field study results.
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| 10. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundContinuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.MethodsEleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.ResultsWe identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.ConclusionsThe results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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