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- Bäckman, Carl G
(författare)
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The photo-diary and follow-up appointment on the ICU: Giving back the time to patients and relatives. : A descriptive and interventional study
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients on the ICU often spend a great deal of their time either unconscious or heavily sedated. When they return from the zone between life and death they are often in a state of confusion where dreams and delusions are intertwined with reality and it is not always easy to distinguish them apart. These experiences could lead to psychological problems and post-traumatic stress disorder (PTSD). Recovery may be improved by filling in the significant memory gaps and explaining what really happened during the “chaotic” time on the ICU. The provision of a diary describing the patients’ stay in ICU on a day to day basis and a follow-up meeting (together named the ICU-diary concept), may help the whole family to understand.Aim: The principal aim of this thesis was to see if the ICU-diary concept was of help to patients and relatives in the recovery after critical illness. A further aim was to look for precipitants in the ICU of PTSD.Material and Methods: ICU patients in a handful of European countries and their relatives have been studied. The studies have been single and multi-centred and we have used descriptive observational, randomised controlled and cohort study designs, including matched case-control designs. Quantitative methods have been used with questionnaires and structured interviews using established instruments (i.e Post-traumatic stress syndrome screening-14, Post-traumatic diagnostic scale, ICU memory tool, Short Form-36, Pearlin-Schooler Mastery Scale, Hopelessness scale) as the principal means of data collection.Results: The ICU-diary concept was seen to be a positive and useful aid in helping patients and their relatives understand the events that took place during the time on the ICU. It also decreased the risk for PTSD among patients and relatives. Patients that were supported with the ICU-diary concept perceived a better health-related quality of life even 3 years after the ICU stay. We did not find any definite improvement by the ICU-diary concept in mastery and hope. Variations in how the patients were cared for in the ICU had a significant effect on the development of PTSD. The implementation of an ICU diary, for instance, was associated with a lower frequency of PTSD.Conclusions: The ICU-diary concept was found helpful by patients and their relatives. It was associated with a reduction in new onset PTSD and improved health-related quality of life. The results are encouraging and suggest that an ICU diary may represent an important first step to help patients and relatives come to terms with their experiences during critical illness.ISBN 978-
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| 2. |
- Kahlmeter, Anna, 1981-
(författare)
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Stressful life events and risks for social exclusion in the youth-to-adulthood transition : Findings from Swedish longitudinal data
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Family background and childhood conditions have long held a special position in the academic literature as an explanation for young people’s life chances. Less attention has been paid to circumstances and events on the cusp of adulthood. This thesis aims to improve the understanding of how stressful life events are associated with future trajectories of education and labour market attachment. The thesis comprises three empirical studies, all of which draw on longitudinal micro data from Swedish administrative registers.Study I examines different types of housing instability events, among students in upper secondary school still in the parental nest, focusing on non-forced moves as well as eviction threats and forced relocations. It assesses the association between housing instability and educational attainment, operationalized as graduation from upper secondary school. The results suggest that the instability and stress following forced relocations, repeated relocations and long-distance relocations are of particular significance for understanding the link between housing instability and educational outcomes. Single short-distance relocations seem to have little impact on educational success. Findings also indicate that eviction threats, where a forced relocation was arrested, still may have implications for educational attainment. However, sensitivity tests showed that these estimates were not robust to confounding. Averting an eviction, even at this late stage of housing instability, may thus protect against early school leaving. Further research is however needed.Study II follows young individuals from the time of their residential emancipation and maps their labour market establishment trajectories until their mid-thirties, by means of sequence analysis. It then investigates to what extent the experience of economic hardship, measured as different degrees of social assistance receipt, is associated with adverse labour market trajectories. The results indicate that, for a majority of social assistance recipients, the system works as intended, and they transition to education or work rather swiftly, particularly if economic hardship is brief. Extensive hardship, however, is associated with elevated risks of long-term labour market exclusion that persists well into adulthood.Study III draws on register data for 12 complete successive cohorts and examines the link between severe violent victimization in young adulthood and labour market exclusion at ages 25 and 30. It puts particular emphasis on the moderating role of offending and gender. The findings suggest that victimized women are a particularly disadvantaged group, having faced a range of social and financial strain. Female victims of violent crime also face elevated risks of labour market exclusion, both in the short- and the long-term, and regardless of criminal offending. For men, however, violent offending moderates the association. While violent victimization adds to the risk of labour market exclusion for male violent offenders, male non-offenders display no elevated risks.Taken together, the thesis demonstrates that the experience of these life events in the transition from youth to adulthood place young individuals at heightened risk of educational shortfall and exclusion from the labour market, both in the immediate aftermath and later in life. Implications of the findings are that a long-term perspective is warranted in considerations of both preventive and reactive measures.
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