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Att studera funktionshinder och åldrande : en bok om metoderfarenheter
- 2015
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Editorial collection (other academic/artistic)abstract
- Syftet med den här boken är att presentera och reflektera över metoder som tillämpades inom ett forskningsprogram där funktionshinder och åldrande studerades1 och som var förlagt till Nationella institutet för forskning om äldre och åldrande (NISAL) vid Linköpings universitet. Inom programmet tillämpades ett antal olika kvalitativa ansatser och metoder, inom ramen för varierande betingelser. Det är mot bakgrund av dessa metoderfarenheter som vi skrivit denna bok. Fokus är inte i första hand på vad vi kommit fram till genom våra studier utan hur vi gjort det och på de erfarenheter, möjligheter och utmaningar som olika metoder varit förknippade med. Våra diskussioner handlar också om vilka praktiska och metodologiska slutsatser som kan dras av våra erfarenheter och iakttagelser. Vi reflekterar över kvalitativa metoder, med exempel från frågor om urval, intervjumetoder, forskarrollen och teoriskapande.Vad innebär det att leva ett långt liv och åldras med en fysisk eller intellektuell funktionsnedsättning som man haft i många år? Det var den övergripande frågan som studerades inom olika delstudier i det forskningsprogram inom vilket vi gjort våra erfarenheter och som belyses i bokens kapitel. Programmet tillämpade ett livsloppsperspektiv, vilket betyder att innebörden i funktionshinder och åldrande förstås och tolkas utifrån hela livets dynamik, och där åldrandet ses som en livslång process. Tidsbegreppet är centralt i denna ansats och det är ett mångdimensionellt begrepp där både individens tid och den historiska tiden tas i beaktande (Jeppsson Grassman 2008a; Jeppsson Grassman & Whitaker 2013). Det betyder också att vi i boken diskuterar livsloppet som metodologiskt verktyg, både dess möjligheter och svårigheter, med utgångspunkt från våra erfarenheter.Idag finns det stort antal metodböcker som behandlar kvalitativa metoder (se till exempel Gubrium & Holstein 2002; Denzin & Lincoln 2011; Silverman 2011). Det kan vara fråga om allmänt inriktade handböcker, men numera inte så sällan också böcker som fokuserar på speciella discipliner inom samhällsvetenskap eller omvårdnadsforskning, etc. Det kan också handla om metodböcker, kapitel eller artiklar, som knyter an till speciella grupper och de metodfrågor som därigenom kan aktualiseras (se till exempel Nind 2008; Wenger 2002 ). Det har hittills inte funnits någon speciell metodbok inom just vårt studerade område. De perspektiv vi har tillämpat har hittills också varit ganska outforskade. Men ett lika viktigt argument är att de flesta metodböcker beskriver hur man gör och inte, som i vårt fall, betingelserna kring – möjligheterna och utmaningarna – och konsekvenserna av att använda olika metoder. För att ta del av forskning om de sistnämnda frågorna får man som regel gå till metodkapitel i avhandlingar, vilka ibland, men inte alltid, belyser de här frågorna. Det finns naturligtvis också vetenskapliga artiklar som tar upp metodologiska erfarenheter på olika sätt. Men här saknas ofta en mer övergripande bild.Krävs det egentligen några speciella metoder för att studera funktionshinder och åldrande? Nej, det kan vara svårt att hävda. Men vårt område är förknippat med speciella betingelser, vilka får betydelse för den forskning man vill genomföra. Det handlar om ett etiskt känsligt område. Frågor som berör funktionshinder och livet för människor med funktionsnedsättningar är också påtagligt ”normativt impregnerat” när det gäller vilka perspektiv som anses vara politiskt korrekta för forskningen och beträffande vem som ”har rätt” att forska inom området överhuvudtaget. I flera av bokens kapitel reflekterar författarna över den här typen av frågor. Men ”det speciella” är inte vårt syfte i sig. Istället menar vi att vi, genom att belysa våra frågor och perspektiv mot bakgrund av vårt speciella område och dess betingelser och våra studerade grupper, illustrerar allmänna metodfrågor och deras praktiska implikationer. Det specifika kan ofta tydliggöra allmängiltiga mönster. Samtidigt – och det är viktigt att understryka – är de metodologiska frågor vi tar upp sådana som sällan diskuteras överhuvudtaget och de grupper som intervjuats kommer sällan till tals.Boken riktar sig främst till högskolestudenter inom samhälls- och beteendevetenskap, liksom till omsorgsutbildningar och vårdvetenskap, mer specifikt i samband med metodutbildning och uppsatsskrivande. Men även doktorander och mer etablerade forskare hoppas och tror vi kan ha användning av våra metodologiska reflektioner. Vår bedömning är också att de erfarenheter som redovisas kan vara av praktisk nytta för yrkesverksamma inom områden som socialt arbete, vård och omsorg.
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- Austeng, Dordi, et al.
(author)
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Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
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Journal article (peer-reviewed)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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- Blom, Johannes, et al.
(author)
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A 9-year follow-up study of participants and nonparticipants in sigmoidoscopy screening : importance of self-selection
- 2008
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In: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 17:5, s. 1163-1168
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Journal article (peer-reviewed)abstract
- BACKGROUND: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. METHODS: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. RESULTS: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and <1.0 among participants. Mortality from all causes (MRR, 2.4; 95% CI, 1.7-3.4), neoplastic diseases (MRR, 1.9; 95% CI, 1.1-3.5), gastrointestinal cancer (MRR, 4.7; 95% CI, 1.1-20.7), and circulatory diseases (MRR, 2.3; 95% CI, 1.2-4.2) was significantly higher among nonparticipants than among participants. Standardized mortality ratio for the studied outcomes tended to be increased among nonparticipants and was generally decreased among participants. CONCLUSION: Individuals who might benefit most from screening are overrepresented among nonparticipants. This self-selection may attenuate the cost-effectiveness of screening programs on a population level.
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- Blom, Johannes, et al.
(author)
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Toward understanding non participation in sigmoidoscopy screening for colorectal cancer
- 2008
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In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 122:7, s. 1618-1623
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Journal article (peer-reviewed)abstract
- Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR = 1.27, 95% CI = 1.03-1.57, relative to female), unmarried or divorced (OR = 1.69, 95% CI = 1.23-2.30 and OR = 1.49, 95% CI = 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR = 1.68, 95% CI = 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status.
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- Blomqvist, Lennart, 1947, et al.
(author)
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Arachidonic acid-induced platelet aggregation and acetylsalicylic acid treatment during pregnancy in women with recurrent miscarriage, a post hoc study
- 2022
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In: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 33:2, s. 278-284
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Journal article (peer-reviewed)abstract
- In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were -0.7 (95%CI; -7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; -4.6; 12.2) U during the late first trimester and 1.7 (95%CI; -6.7; 10.3) U and 4.1 (95%CI; -3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median -84.0% (Q1; Q3; -89.8; -76.3), -79.9% (-84.7; -69.2) and -75.7% (-83.5; -49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p < .0001). There were two (1.9%) complete non-responders to ASA and 32.1% with a partial response. The rate of subsequent miscarriage was not affected by ASA, which did not seem to influence the rate of early miscarriage if treatment was initiated when a viable pregnancy was detectable by ultrasound.
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- Claesson, Ing-Marie, et al.
(author)
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Consumer satisfaction with a weight-gain intervention programme for obese pregnant women
- 2008
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In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 24:2, s. 163-167
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Journal article (peer-reviewed)abstract
- Objective: to investigate women's attitudes and satisfaction with a weight-gain intervention programme during pregnancy.Design: exploratory, descriptive study. Data were collected via interviews.Setting: University hospital.Participants: 56 obese pregnant women who attended antenatal care at the University Hospital of Linkoping's obstetrical department and took part in an intervention programme aimed at reducing weight gain during pregnancy, between November 2003 and August 2004.Findings: the interviews comprised several questions concerning attitudes and opinions of the programme. Most of the women expressed positive experiences with the treatment and would attend the programme if they became pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of a maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. A total of 71.4% of the women participated in aqua aerobics classes. They stated that they were most satisfied with this form of exercise, and that it also was a good social experience.Key conclusions and implications for practice: a pregnant woman herself must be actively involved in setting her own goals to prevent excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.
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- Claesson, Ing-Marie, 1953-, et al.
(author)
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Weight after childbirth : A 2-year follow-up of obese women in a weight-gain restriction program
- 2011
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 103-110
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Journal article (other academic/artistic)abstract
- Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth. Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum. Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018). Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.
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- Claesson, Ing-Marie, et al.
(author)
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Weight gain restriction during pregnancy is safe for both the mother and neonate
- 2009
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 88:10, s. 1158-1162
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Journal article (peer-reviewed)abstract
- The objective of this study was to investigate whether pregnancy, delivery, and neonatal outcome among obese pregnant women who took part in an intervention study for weight restriction differed from a group of obese pregnant women attending regular antenatal care. The intervention group consisted of 155 obese pregnant women and 193 obese pregnant women who formed a control group. We found that a weight gain restriction of less than 7 kg during pregnancy is safe for both the mother and the neonate.
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