| 1. |
- Johansson, Anna, 1965-
(författare)
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Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep. Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.
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| 2. |
- Anderbro, Therese
(författare)
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Behavior change intervention and fear of hypoglycemia in type 1 diabetes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions
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| 3. |
- Andersson, Gunnel, 1958-
(författare)
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Urinary incontinence : prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews. Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI. Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems. In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.
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| 4. |
- Andrén, Ove, 1963-
(författare)
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Natural history and prognostic factors in localized prostate cancer
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The natural history of localized prostate cancer is not fully understood. In most patients the tumor will never progress to a lethal disease, while a subset of patients will ultimately die of the disease. Efficient tools to separate indolent from lethal disease is currently lacking which means that many patients will be offered treatment without any benefit, but still be at risk of experiencing treatment related side effects. The aims of these studies were to get more insight into the natural history of untreated localized prostate cancer, to assess the prognostic value of established clinical parameters such as Gleason score, nuclear grade and tumor volume and, moreover, some new prognostic markers Ki-67, AMACR and MUC-1. We also aimed to study time trends in the detection of incidental tumors in Sweden. Patients with localized disease (n=223) and no initial treatment were followed for 21 years. Most patients had a favorable outcome. However, a subset of patients developed lethal disease even beyond 15 years of follow-up and these patients define the group that may benefit most from treatment with curative intent. Patients with poorly differentiated tumors experienced a 9 time higher risk of dying in prostate cancer. The studies on prognostic markers are based on a cohort of patients (n=253) with incidental prostate cancer detected by transurethral resection for presumed benign hyperplasia. All patients were left without initial treatment. Gleason grade, nuclear grade and tumor volume turned all out to be independent prognostic factors. MUC-1, AMACR and Ki-67 also carried prognostic information. However, after adjustment for Gleason grade, nuclear grade and tumor volume only MUC-1 and AMACR remained as statistically significant prognostic factors. When tested for sensitivity and specificity they all failed and, consequently, they seem to be of less value in daily practice for cancelling an individual patient regarding the choice of treatment. Time trends in incidental prostate tumors in Sweden were analyzed in a cohort of patients with prostate tumors detected by transurethral resection (TUR-P). Through linkage of the national registration number (NRN) with several registers, e.g. the Swedish Cancer Registry, the National Inpatient registry and the Cause of Death Registry we identified, during the period 1970 through 2003, in total 23288 patients with incidental prostate cancer, who constituted the study group. As comparison group we choose all patients diagnosed with prostate cancer between 1970-2003 excluding those with incidental cancer, in total 112204 patients. Our result confirms earlier findings that there has been a dramatic change over time in incidence of incidental prostate cancers in Sweden, which parallels the introduction of prostate specific antigen. We also found that the cumulative incidence of prostate cancer death is high in the incidental group, opposing earlier findings that incidental tumours are a non-lethal disease.
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| 5. |
- Berntson, Erik, 1975-
(författare)
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Employability perceptions : Nature, determinants, and implications for health and well-being
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis is to increase our understanding of perceived employability. Employability perceptions refer to individuals’ beliefs about their possibilities of finding new, equal, or better employment. How people perceive their possibilities of getting employment is important in a labour market characterised by flexibility and uncertainty, and the present thesis sets out to investigate the nature, determinants, and implications of employability perceptions, using two population-based samples. In Study I, the aim was to study if employability and self-efficacy are two distinct but related constructs and, along with this, to investigate the nature of their association. The results from this study indicated that employability was distinct from self-efficacy and, furthermore, that employability predicted subsequent self-efficacy. In Study II, the aim was to identify predictors of perceived employability. The combination of situational and individual factors was identified as important for employability perceptions. National economic prosperity, living/working in metropolitan areas, poor physical and good psychological work environments, formal education, and competency development were found to be positively associated with perceived employability. The aim of Study III was to investigate if employability could predict subsequent health and well-being. The results from this study implied that individuals who reported higher levels of employability also reported better global health and mental well-being, but not physical complaints, one year later, after controlling for work environment variables and previous health status. In conclusion, the present thesis has implications for theory as well as practice when it concludes that employability is not primarily a self-evaluation, that it is dependent on individual as well as situational factors, and that it has implications for health and well-being.
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| 6. |
- Franzén, Karin, 1958-
(författare)
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Interventions for urinary incontinence in women : survey and effects on population and patient level
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urinary Incontinence is a common health problem that can cause both severe medical and social problems, resulting in negative impact on different aspects of Quality of Life. In 2000, the Swedish Council on Health Technology Assessment (SBU) published a systematic review, “Treatment of Urinary Incontinence” where multiple knowledge gaps in the field of UI, all of considerable clinical importance, were pointed out.Several of these knowledge gaps have been the starting points for the projects in this thesis. The overall aim has been to study the impact of different interventions for urinary incontinence in women on the population level but also on the patient group level, for assessessing the significance of UI on general living conditions and to validate instruments to measure quality of life to be used as part of the evaluation of treatment effectiveness.Paper I: A population-based study where UI amongst women was found to be commonly associated with different psychosocial problems and an expressed feeling of vulnerability.Paper II: A population-based study where informative material on UI to the general public in order to increase knowledge and encourage self management was found promising for meeting increasing demands and optimizing healthcare resources.Paper III: A randomized controlled trial where both electrical stimulation and drug therapy reduced the number of micturitions and improved QoL in women with urge or urge incontinence, but electrical stimulation was not found to be superior to drug therapy.Paper IV: A prospective cohort study where the international questionnaires UDI-6 and IIQ-7 after translation and validation, showed good responsiveness and were easy to administer and to fill out. The UDI-6 scale did not accomplish the same solid result in the psychometrical analysis as the IIQ-7 scale but both scales showed good responsiveness and can thereby be recommended for clinical use.
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| 7. |
- Hälleberg-Nyman, Maria, 1968-
(författare)
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Urinary catheter policies for short-term bladder drainage in hip surgery patients
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
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| 8. |
- Ivarsson, Pia-Maria, 1957-
(författare)
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Barns gemenskap i förskolan
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is about children’s communities. It is also about children’s everyday interaction in a pre-school setting and how they utilise interactional and institutional resources to construct peer communities and to group themselves within them. The peer communities discussed in this study are embedded in an institutional context, namely the pre-school setting.To capture this phenomenon an ethnographic approach was used. Included in the benefits of choosing this approach are the opportunities to study everyday practices and children’s activities in a pre-school setting. Participant observations, child interviews and video recordings were used when the data were subsequently constructed and analysed.One feature underlying the pre-school setting as a social context is the organisation of time and space. Time and space structure children’s activities and their material and immaterial resources and social relations. This is shown in an example related to a little boy’s (Mattias) story of everyday practices in pre-school. Another illustrative example of how time and space form the structure for routines and social relations is when the children play a game called ‘the ting-a-ling train’. Still another example of an interesting finding was discovered when the children swung together in the pre-school playground.The preschool conditions allow children to construct their own strategies to gain access to the interactive space, where their negotiations and the organisation of time and space are of vital importance. Another important finding is that activity and talk about activity are functions that are inter-related and that children use as interactional resources.When the children become members of a pre-school group they are at the same time constructed as pre-schoolers. They are ‘doing-being’ pre-schoolers and at a same time constructing the everyday practice called pre-school. Interaction and social context are entwined, which means that a study of children’s peer communities in a pre-school setting offers valuable knowledge about the world of children and about the pre-school as a social context.
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| 9. |
- Johansson, Fredrik Leffe, 1988-
(författare)
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Rosetta Observations of Plasma and Dust at Comet 67P
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In-situ observations of cometary plasma are not made because they are easy. The historic ESA Rosetta mission was launched in 2004 and traversed space for ten years before arriving at comet 67P/Churyumov-Gerasimenko, which it studied in unprecedented detail for two years. For the Rosetta Dual Langmuir Probe Experiment (LAP), the challenge was increased by the sensors being situated on short booms near a significantly negatively charged spacecraft, which deflects low-energy charged particles away from our instrument. To disentangle the cometary plasma signature in our signal, we create a charging model for the particular design of the Rosetta spacecraft through 3D Particle-in-Cell/hybrid spacecraft-plasma interaction simulations, which also can be applicable to similarly designed spacecraft in cold plasma environments. By virtue of this model, we find a way to cross-calibrate (with the Mutual Impedance probe, MIP) the LAP spacecraft potential to a plasma density estimate with increased temporal resolution and dynamic range than any single plasma instrument alone.To characterise and disentangle the Sun-driven photoelectric current from the positive cometary ion current signal, using three different methods (where we believe one is novel), we find a signature of an attenuation of the Extreme Ultraviolet (EUV) radiation from the Sun that follows the cometary out-gassing activity. We discuss possible reasons for this, where the scattering and absorption of radiation by ~20 nm sized dust grains created by the disintegration of far larger cometary dust grains far from the nucleus appears most likely.By cross-calibrating also our current measurements to MIP, we find a cometary ion speed estimate, which, when applied to a simple comet ionosphere model using the LAP photoemission as a photoionisation proxy, predicts the measured comet plasma densities near perihelion, when comet activity was highest. This demonstrates that the LAP cross-calibration estimates are self-consistent, but also strongly suggests that the EUV attenuation we reported is apparent also in the comet ionosphere, as less plasma is ionised by EUV radiation. The ion speed estimates from LAP are consistent with recent results of cometary water ion velocities from the Ion Composition Analyser (ICA), and much elevated above the comet neutral speed, often by a factor of 5. This verifies that the cometary ions are not collisionally coupled to the neutrals, and instead rapidly accelerated by some electric field, such as an ambipolar electric field or from plasma wave activity.
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| 10. |
- Johansson, Jan-Erik, 1963
(författare)
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Gastro-intestinal toxicity related to haemopoietic stem cell transplantation with a special focus on the intestinal barrier function
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The myeloablative, cytotoxic therapy (conditioning treatment) prior to haemopoietic stem cell transplantation (HSCT) has the combined purpose of eliminating leukaemic or cancer cells located in the bone marrow or elsewhere in the body and, in the allogeneic setting, of suppressing the immune response of the recipient to prevent marrow rejection. The unwanted effect is the inevitable elimination of normal, haemopoietic stem cells, a lethal effect which is circumvented by the following administration of haemopoietic stem cells from the patient (autologous HSCT) or from a related or an unrelated donor (allogeneic HSCT). However, normal tissues with a high cell-turnover rate, primarily the gastro-intestinal (GI) tract, will likewise be affected. Besides causing significant GI symptoms, this injury includes a disruption of the intestinal barrier, facilitating the permeation of bacteria and endotoxin through the bowel wall, with subsequent septicaemia and release of cytokines, known to be important mediators of graft-versus-host disease (GVHD), the primary complication of allogeneic HSCT. Accordingly, murine HSCT-models have suggested that after intensification of the conditioning treatment, GVHD has been amplified as a result of aggravated GI toxicity.Using a 51Cr-EDTA resorption test, the present study investigates the intestinal-barrier function in HSCT patients receiving myeloablative or reduced intensity conditioning (RIC). It also investigates whether the strengthening of the GI immune system by the oral administration of an immunoglobulin preparation would modify intestinal barrier integrity during autologous HSCT. Finally, on the basis of the observation that the impairment of intestinal barrier integrity by non-steroidal anti-inflammatory drugs (NSAID) is due to an early disturbance of energy metabolism in enterocytes, the existence of a similar mechanism in chemotherapy was searched for. Using high-performance liquid chromatography (HPLC) technique and 51Cr-EDTA resorption, the purine-nucleotide content in enterocytes and intestinal permeability was determined in rats after chemotherapy.It was found that the intestinal barrier was disrupted preceding clinical symptoms with myeloablative conditioning, but preserved with RIC. The oral administration of an immunoglobulin preparation revealed ameliorated intestinal barrier integrity during autologous HSCT. In rats, an early-detectable disruption of the intestinal barrier was found which parallels a decrease in purine-nucleotide content in enterocytes, reflecting a metabolic disturbance.A hypothesis may be formed containing an early intestinal-barrier disruption with chemotherapy, initiated by a metabolic disturbance in enterocytes. Since murine data revealed aggravated GVHD with increased intestinal injury, the preserved intestinal integrity with RIC should have the potential of reducing GVHD severity. These observations suggest that the intestinal barrier function has a central role to play in the intestinal damage induced by cytotoxic therapy as well as in GVHD.
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