| 1. |
- Brorsson, Anna Lena, 1964-, et al.
(författare)
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A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol
- 2013
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Ingår i: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment.Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment.Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family.Trial registration: Current controlled trials: ISRCTN22444034
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| 2. |
- Jammer, Ib, et al.
(författare)
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Medical services of a mulicultural summer camp event: experiences from the 22nd World Scout Jamboree, Sweden 2011
- 2013
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prevention and treatment of medical issues are the main task of a health service at a youth camp. However, only few reports about organisation and implementation of camp health care are available. This makes it difficult for future camp directors to plan and estimate the health care needed for a certain camp size. We summarize the experience in planning and running health care for the 22nd World Scout Jamboree (WSJ) 2011 in Sweden. Methods: During the WSJ, 40,061 participants from 146 nations were gathered in southern Sweden to a 12 day summer camp. Another 31,645 people were visitors. Members for the medical service were 153 volunteering medical professionals with different language and cultural backgrounds from 18 different countries. Results: Of 40,061 participants 2,893 (7.3%) needed medical assistance. We found an equal distribution of cases to approximately one third surgical, one third medical and one third unspecified cases. Much energy was spent on health prevention, hygiene measures and organizing of psychological support. Conclusions: A youth camp with a multicultural population and a size of a small city demands flexible staff with high communication skills. Special attention should be paid in prevention of contagious diseases and taking care of psychological issues.
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| 3. |
- Johansson, Unn-Britt, et al.
(författare)
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Insulinpumpar vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Vid typ 1-diabetes och en del fall av typ 2-diabetes krävs så kallad intensiv insulinbehandling med flera injektioner per dag. Den vanligaste komplikationen vid denna behandling är lågt blodglukos (hypoglykemi) vilket kan få allvarliga följder [1,2]. Ett alternativ till intensiv insulinbehandling med injektioner är kontinuerlig insulintillförsel med pump, så kallad kontinuerlig subkutan insulininfusion (CSII).
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| 4. |
- Johansson, Unn-Britt, et al.
(författare)
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Kontinuerlig subkutan glukosmätning vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Blodglukos kan mätas av patienten själv med teststickor (self monitoring of blood glucose, SMBG) eller via en subkutan sensor (kontinuerlig subkutan glukosmätning, CGM). Vid typ 1-diabetes behövs rutinmässigt upprepade blodglukosmätningar varje dygn för att uppnå god glukoskontroll.SBU har utvärderat nytta och risk av behandling med kontinuerlig glukosmätning utan eller med insulinpump (SAP) vid diabetes hos barn, ungdomar och vuxna. I utvärderingen ingår också en hälsoekonomisk och etisk analys, samt en stor praxisundersökning som omfattade samtliga diabeteskliniker i Sverige
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| 5. |
- Lindholm Olinder, Anna, 1960-
(författare)
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Self-management of diabetes in adolescents using insulin pumps
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Insulin pump treatment (CSII) is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. However, despite the use of CSII, achieving the recommended disease control is difficult for adolescents. The aim of this thesis was to explore aspects of self-management of diabetes in adolescents using insulin pumps in order to describe conditions contributing to the recommended disease control. Three methods of bolusing (normal, dual-wave and square-wave) in connection with pasta meals were tested in a crossover study among 15 adolescents with diabetes to assess whether one method was superior in managing glucose levels. A cross-sectional study among 90 adolescents being treated with CSII was conducted to investigate the management of CSII, including the administration of bolus doses. Two qualitative interview studies, based on the grounded theory method, were performed to gain insight into the processes involved in taking bolus doses and to investigate reasons for missed bolus doses and strategies for avoiding missing them. Twelve adolescents, four parents and one diabetes specialist nurse were interviewed. No method of bolusing was found to be superior in managing the glucose levels after these meals. The post-prandial glucose peaks were <10 mmol/L, in 48% of the cases, regardless of bolus methods. This indicates that adolescents can be encouraged to individually test which bolus method gives them the most normal post-prandial glucose levels. The cross-sectional study showed that adolescents were satisfied with CSII, but that 38% had missed more than 15% of the bolus doses the day under study. The frequency of bolus doses correlated with the disease control. Findings from the interview study revealed the need to clarify the responsibility for diabetes self-management in continuous negotiation between adolescents and parents to avoid insulin omission. The main reason for missed boluses was lost focus, and the strategies for remembering them were agreements involving reminders. The thesis describes that individual dose testing, clarification of responsibility and agreements involving reminders are conditions contributing to the recommended disease control. The thesis also describes that lost focus and a lack of responsibility can lead to insulin omission and be a hindrance to achieving disease control.
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| 6. |
- Saarinen, Tuula, et al.
(författare)
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Insulin pump therapy is perceived as liberating, but to many it can imply a sense of the diabetes made visible
- 2014
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Ingår i: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 11:2, s. 38-42
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Tidskriftsartikel (refereegranskat)abstract
- This study describes how adults with type 1 diabetes experience the transition from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII or ‘insulin pump’). The study is based on interviews in focus groups, with 11 persons with type 1 diabetes who had had CSII for at least one year, which were analysed using qualitative content analysis. The analysis resulted in three categories: life and health; involvement of others; and technology dependence. Participants' experiences are summarised in the theme ‘CSII is perceived as liberating, but also implies a sense of the diabetes made visible’. The transition resulted in changed life and health with greater freedom and flexibility, particularly in meal situations. The participants felt that their blood glucose was easier to control. Those around them reacted with curiosity, but some participants felt compelled to tell others that they had diabetes since the pump could be seen or heard. The participants found that coping with CSII in daily life was easier and more comfortable than they had expected. However, having to constantly be prepared for technical failure was experienced as cumbersome. All participants indicated that they were satisfied with their treatment and recommended it to others. Transition to CSII may be experienced as liberating, but might also imply a sense of the diabetes made visible. The results can be used in clinical practice, when advising about CSII. Being aware of both positive and negative experiences with CSII can contribute to better care for those already being treated with CSII.
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| 7. |
- Forsner, Maria, 1954-, et al.
(författare)
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Parents' experiences of caring for a child younger than two years of age treated with continuous subcutaneous insulin infusion
- 2014
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Ingår i: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 11:1, s. 7-12
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Tidskriftsartikel (refereegranskat)abstract
- Diabetes during infancy is uncommon and continuous subcutaneous insulin infusion (CSII) is the recommended treatment with such young children. However, this form of treatment has not been investigated previously from the perspective of the parents.The aim of this study was to determine parents' experiences of caring for a child less than two years old who had diabetes mellitus and was being treated with CSII therapy.Three pairs of parents were interviewed twice to elucidate their views on the initial period and on daily living. Data were submitted to qualitative content analysis and resulted in seven categories and one theme, the latter being: ‘The diabetes disease was threatening our baby's life, but then the insulin pump came as a rescuing, though challenging, angel’. Parents initially felt life had been turned upside down, but later they felt in control nearly all the time.It was concluded that parents of infants with diabetes are in great need of support in order to manage the disease and CSII technology. The fear of losing control and the lack of relief lead to social isolation. Educating someone close to the family could be a valuable intervention.
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| 8. |
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| 9. |
- Lindholm Olinder, Anna, 1960-, et al.
(författare)
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Clarifying responsibility for self-management in adolescents with diabetes using insulin pumps : a qualitative study
- 2011
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses. Background: Insulin pump treatment is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. Despite insulin pump-treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses to meals. Method: In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (5 males and 7 females, mean age 14.4 years, range 12-19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009. Findings: Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarifying of responsibility. The distribution of responsibility was clear among those who took most of their doses; they had high personal responsibility or shared it with their parents. The optimal transfer of responsibility is when it gradually moves from the parents to the adolescent. The findings revealed a need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed bolus doses. Conclusion: Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams may facilitate and encourage these negotiations.
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| 10. |
- Lindholm Olinder, Anna, et al.
(författare)
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Clarifying responsibility for self-management of diabetes in adolescents using insulin pumps - a qualitative study
- 2011
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses.Background. Insulin pump treatment is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. Despite insulin pump treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses with meals.Method. In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (five boys and seven girls, mean age: 14.4 years, range: 12–19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009. Two adolescents and two parents were re-interviewed after approximately 10 months. Data from clinical visits and diabetes camps were used to verify emerging categories.Findings. Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarification of responsibility. The findings describe the need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed doses.Conclusion. Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams can facilitate and encourage these negotiations.
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