| 1. |
- Berghammer, Malin, et al.
(author)
-
The impact of anxiety in relation to COVID-19 on the life-situation of young people in Sweden
- 2021
-
In: Quality of Life Research. - : SPRINGER. - 0962-9343 .- 1573-2649. ; 30:SUPPL 1, s. S4-S4
-
Journal article (other academic/artistic)abstract
- Aims: In general, COVID-19 symptoms are milder in children than inadults, but the experience of the pandemic could increase anxiety andsignificantly affect the life situation of children and adolescents. Itcould also lead to a long-term negative effect on their health. To studyhow the corona pandemic affected the life situation of children andadolescents in Sweden. Methods: A self-reported online survey wasperformed July–November 2020. Cross-sectional data were collectedusing non-probability and convenience sampling methods. The sample consisted of children 6–14 years and their guardians, and adolescents 15–19 years. The questionnaire covered items regarding the life situation including demographics, school situation, social isolation, and an open-ended question to provide a subjective expression of the living situation. A standardized measurement of anxiety was collected using the Children’s Anxiety Questionnaire (CAQ) (scores range 4–12) and the Numeric Rating Scale (NRS)(scores range 0–10). Data were analyzed by descriptive statistics andwith qualitative manifest content analysis. Results: In total, 1487 participants, 768 children with guardians and 719 adolescents participated. Most of the participants, 754 children (97.2%) and 634 adolescents (89.2%) attended school where a mixture of physical attendance and distance learning was reported by 79 children (10.2%)and 261 adolescents (36.7%). Two children (0.3%) and 298 adolescents (41.9%) reported only having distance learning. A larger proportion of children (n = 339, 43.9%) and adolescents (n = 420,59.2%) reported abstaining from leisure activities, while a minority ofchildren (n = 103, 13%) and adolescent (n = 135, 19%) reportedexperiencing a feeling of ‘social isolation’. These experiences ofchanges in daily routine were prominent in the qualitative result. Social restrictions and loss of contact with older relatives led to fear and anxiety. However, for young children, their lives continued torevolve around the everyday things in life rather than the coronapandemic, for the adolescents; however, their life situation was negatively affected by isolation from peer groups and the loss ofschool routine. Conclusion: The experiences by children due toCOVID-19 in Sweden highlight the importance that children continue living their lives as unchanged as possible and that particularly adolescents need receiving greater support with the maintenance of an educational routine.
|
|
| 2. |
- Brorsson, Anna Lena, 1964-, et al.
(author)
-
A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol
- 2013
-
In: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 13
-
Journal article (peer-reviewed)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
|
|
| 3. |
- Brorsson, Anna Lena, 1964-, et al.
(author)
-
A person-centered education for adolescents with type 1 diabetes - a randomized controlled trial
- 2019
-
In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 20:7, s. 986-996
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Young people with type 1 diabetes and their parents need to receive person-centred education to be able to manage their diabetes. Guided Self-Determination-Young (GSD-Y) is a person-centred communication and reflection education model that can be used in educational programmes for young people with type 1 diabetes.OBJECTIVE: To evaluate whether GSD-Y leads to improved glycaemic control, increased self-perceived health and health-related quality of life, fewer diabetes-related family conflicts, and improved self-efficacy in a group-based intervention for adolescents starting continuous subcutaneous insulin infusion (CSII) and their parents.METHODS: This randomized controlled trial included 71 adolescents starting CSII. Participants were followed for twelve months. The intervention group (n=37) attended seven group training sessions over a period of five months, using the GSD-Y model, the control group received standard care. Variables evaluated were HbA1c, self-perceived health, health-related quality of life, family conflicts, self-efficacy, and usage of continuous glucose monitoring.RESULTS: When adjusted for sex and family conflicts, there was a difference in glycaemic control between the groups at twelve months, favouring the intervention group (62 vs. 70 mmol/mol, p=0.009). When analyses were performed on boys and girls separately and adjusted for family conflicts, the only difference detected was for boys after twelve months (p=0.019). The intervention showed no effect on self-perceived health, health-related related quality of life, family conflicts, or self-efficacy.CONCLUSIONS: An intervention with GSD-Y may have an effect on glycaemic control. The content of the GSD-Y groups may serve as a model for person-centred care in adolescents with type 1 diabetes. This article is protected by copyright. All rights reserved.
|
|
| 4. |
- Brorsson, Anna Lena, 1964-, et al.
(author)
-
Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method : a qualitative study
- 2017
-
In: BMJ Open Diabetes Research & Care. - : BMJ. - 2052-4897. ; 5:1
-
Journal article (peer-reviewed)abstract
- Objective Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.Research design and methods In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.Results Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.Conclusions GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.
|
|
| 5. |
- Brorsson, Anna Lena, 1964-, et al.
(author)
-
Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? : A retrospective case-control study
- 2015
-
In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 16:7, s. 546-553
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate long-term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores (BMI-SDS) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion (CSII) compared with children and adolescents treated with multiple daily injections (MDI).METHODS: This retrospective case-control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin (HbA1c), sex, and age during a 2-yr period. Variables collected were gender, age, HbA1c, insulin requirement, BMI, BMI-SDS, ketoacidosis, and serious hypoglycaemic events.RESULTS: In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person-yr). The incidences of severe hypoglycaemic episodes per 100 person-yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group.CONCLUSIONS: This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis.
|
|
| 6. |
- Brorsson, Anna Lena, 1964-, et al.
(author)
-
Parent's perception of their children's health, quality of life and burden of diabetes : testing reliability and validity of 'Check your Health' by proxy.
- 2017
-
In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:3, s. 497-504
-
Journal article (peer-reviewed)abstract
- AIM: To test the validity and reliability of the 'Check your Health by proxy' instrument in parents to children with diabetes aged 8-17 years.METHODS: One hundred and ninety-one caregivers and their children, aged 8-17 years, were included. All completed the 'Check your Health' questionnaire measuring quality of life and burden of diabetes, DISABKIDS self- or proxy version, and 45 completed the same questionnaires 2 weeks later.RESULTS: Test-retest reliability on the 'Check your Health' questionnaire by proxy was moderate to strong (r = 0.48-0.74), p < 0.002). Convergent validity was weak to moderate (r = 0.15-0.49, p < 0.05). The instrument showed acceptable discriminant validity. Parents reported lower scores than the children on emotional health and social relations and higher scores on physical and emotional burden and higher burden on quality of life. Poorer social relationships and quality of life were associated with higher reported disease severity. The diabetes burden domain of the questionnaire correlated to perceived severity of diabetes and to perceived health. Discriminant validity showed that poorer social relationships and quality of life were associated with higher severity of the disease. The diabetes burden domain of 'Check your Health' by proxy showed discriminant validity on perceived severity of diabetes.CONCLUSIONS: The instrument 'Check your Health' by proxy showed acceptable psychometric characteristics in parents to young people (8-17 years of age) with diabetes. We also concluded that parents reported that their children had lower health and higher burden of diabetes than the children did, and it correlated to reported disease severity.
|
|
| 7. |
- Forsner, Maria, et al.
(author)
-
Mitt i informationsflödet om Covid 19 pandemin, en internationell webbenkätstudie till föräldrar och barn 7-12 år
- 2020
-
In: State of Art- Covid 2019, Nationell digital konferens, Svenska läkarsällskpet.
-
Conference paper (other academic/artistic)abstract
- Bakgrund: Tidigt under våren 2020 drabbades Sverige av Covid 19 pandemin. Med pandemin följe en infodemi. Barn skolåldern och deras förälder hamnade mitt i detta informationsflöde. Syfte: Att undersöka hur barn får och tolkar information om Covid 19 pandemin. Metod: Anonymiserad webbenkät. 2 enkäter til barn, respektive föräldrar. Översatt till respektive språk. Deltagare 390 barn, 7-12 är (Sv 50) och 1234 föräldrar ( Sv 235). Insamling april – 1 juni ( Sv 22 maj-1 juni). Initierat av Lucy Bray med team, Edge Hills universitet Storbritannien. Omvårdnad forskare från Sverige, Kanada , Australien, Brasilien och Spanien. Resultat: Majoriteten av barn från andra länderna fick information från föräldrarna. Svaren från de svenska barnen speglade myndighetens rekommendationer. Utomhus skildrades som en positiv plats för de svenska barnen. Teckningar från Sverige visade i stor utsträckning munskydd på både människor och djur. Slutsats: De sveks barnen var medvetna om att coronaviruset kunde vara farligt, vikten av att hålla avstånd och tvätta händerna och skydda de äldre. Svaren från Sverige skiljde sig från de andra länderna med att skolan var främsta och önskade informationskällan. Utomhusaktiviteter uppskattades som önskvärt.
|
|
| 8. |
- Haas, Josephine, et al.
(author)
-
Guided self-determination-young versus standard care in the treatment of young females with type 1 diabetes : study protocol for a multicentre randomized controlled trial
- 2017
-
In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 18:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Female adolescents with type 1 diabetes mellitus (T1DM) have the most unsatisfactory glycaemic control of all age groups and report higher disease burden, poorer perceived health, and lower quality of life than their male counterparts. Females with T1DM face an excess risk of all-cause mortality compared with men with T1DM. New methods are needed to help and support young females with T1DM to manage their disease. A prerequisite for successful diabetes management is to offer individualized, person-centred care and support the patient's own motivation. Guided self-determination (GSD) is a person-centred reflection and problem-solving method intended to support the patient's own motivation in the daily care of her diabetes and help develop skills to manage difficulties in diabetes self-management. GSD has been shown to improve glycaemic control and decrease psychosocial stress in young women with T1DM. The method has been adapted for adolescents and their parents, termed GSD-young (GSD-Y). The aim of this study was to evaluate whether an intervention with GSD-Y in female adolescents with T1DM leads to improved glycaemic control, self-management, treatment satisfaction, perceived health and quality of life, fewer diabetes-related family conflicts, and improved psychosocial self-efficacy.METHODS/DESIGN: This is a parallel-group randomized controlled superiority trial with an allocation ratio of 1:1. One hundred female adolescents with T1DM, 15-20 years of age, and their parents (if < 18 years of age), will be included. The intervention group will receive seven individual GSD-Y education visits over 3 to 6 months. The control group will receive standard care including regular visits to the diabetes clinic. The primary outcome is level of glycaemic control, measured as glycosylated haemoglobin (HbA1c). Secondary outcomes include diabetes self-management, treatment satisfaction, perceived health and quality of life, diabetes-related family conflicts, and psychosocial self-efficacy. Data will be collected before randomization and at 6 and 12 months.DISCUSSION: Poor glycaemic control is common in female adolescents and young adults with T1DM. Long-standing hyperglycaemia increases the risks for severe complications and may also have an adverse impact on the outcome of future pregnancies. In this study, we want to evaluate if the GSD-Y method can be a useful tool in the treatment of female adolescents with T1DM.TRIAL REGISTRATION: Current controlled trials, ISRCTN57528404 . Registered on 18 February 2015.
|
|
| 9. |
- Haas, Josephine, et al.
(author)
-
Treatment satisfaction correlated with glycaemic control and burden of diabetes in Swedish adolescents with type 1 diabetes
- 2020
-
In: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 109:3, s. 573-580
-
Journal article (peer-reviewed)abstract
- Aim: To assess treatment satisfaction and perceived discomfort or pain from the treatment, and potential associations with glycaemic control, type of treatment, perceived burden of diabetes, sex and age, in adolescents with type 1 diabetes.Methods: A cross-sectional study was performed at one paediatric and at one adult diabetes clinic in Sweden, preceded by a translation of 'Diabetes Treatment Satisfaction Questionnaire (DTSQ) Teen'. Adolescents with type 1 diabetes (15-20 years) participated. The questionnaires 'DTSQ Teen' and 'Check your health' were used. Data on glycosylated haemoglobin (HbA1c), type of treatment, sex and age were collected.Results: One hundred and thirty-eight adolescents (70 females, mean age 17.3, mean HbA1c 64.0 mmol/mol) participated. Treatment satisfaction correlated inversely with HbA1c (r = -.352, P < .001) and with all types of burden of diabetes (r = -.342 to -0.467, P < .001), but did not differ with type of treatment, sex and age. Perceived pain correlated inversely with burden on physical health (r = -.265, P = .002), mental health (r = -.237, P = .006) and quality of life (r = -.246, P = .004) but not with HbA1c, age or burden on social relations. Females perceived more discomfort or pain.Conclusion: In Swedish adolescents with type 1 diabetes, treatment satisfaction correlated with both glycaemic control and perceived burden of diabetes.
|
|
| 10. |
- Jammer, Ib, et al.
(author)
-
Medical services of a mulicultural summer camp event: experiences from the 22nd World Scout Jamboree, Sweden 2011
- 2013
-
In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 13
-
Journal article (peer-reviewed)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.
|
|
| 11. |
- Johansson, Unn-Britt, et al.
(author)
-
Insulinpumpar vid diabetes
- 2013
-
Reports (other academic/artistic)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).
|
|
| 12. |
- Johansson, Unn-Britt, et al.
(author)
-
Kontinuerlig subkutan glukosmätning vid diabetes
- 2013
-
Reports (other academic/artistic)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
|
|
| 13. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
Continuous subcutaneous insulin infusion in young girls : a two-year follow-up study
- 2007
-
In: European Diabetes Nursing. - : John Wiley & Sons. - 1551-7853 .- 1551-7861. ; 4:1, s. 34-39
-
Journal article (peer-reviewed)abstract
- Aims:To investigate why young girls decided to start continuous subcutaneousinsulin infusion (CSII) therapy, and to examine their opinions and concerns withregard to using an insulin pump. In addition, the girls were evaluated for HbA1cvalues, insulin requirements and body mass index standard deviation score (BMISDS) over a period of two years after starting CSII compared with a group of girlsusing multiple daily injections (MDI).Methods:Twelve girls (mean age 10.8 years) starting CSII were followed over a period of two years. Why the girls started CSII and whether they preferred CSII orMDI were investigated. Their statements about CSII were analysed and categorisedby two paediatric diabetes nurses. On four occasions HbA1c values, insulin require-ment and BMI SDS were collected and compared with those of a control group of 12 girls using MDI for the same period of time.Results:The girls started CSII due to a desire to test pump therapy, and their experiences of unstable blood glucose. They preferred CSII to MDI. The main positive statements were categorised as ‘quality-of-life benefits’. The main negativecategory was ‘the pump gets in the way’. In the CSII group, HbA1c decreased from8.5 (7.4–9.5) to 7.5 (6.9–8.1) (p<0.05) over two years, and the insulin requirementdecreased by 30%. In the control group these values were unchanged. There wereno changes in the BMI SDS mean values for either group.Conclusion:CSII was well accepted by the young girls, facilitated a decrease inHbA1c values, and did not result in weight gain.
|
|
| 14. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
Post-prandial glucose levels following three methods of insulin bolusing : A study in adolescent girls and in comparison with girls without diabetes
- 2009
-
In: Practical diabetes international. - : Wiley. - 1357-8170. ; 26:3, s. 110-115
-
Journal article (peer-reviewed)abstract
- The aims of this study were to assess whether one method of insulin bolusing wassuperior to two others in managing two pasta meals, and to compare the glucose levelswith those of females without diabetes.Fifteen continuous subcutaneous insulin infusion (CSII)-treated adolescent femalesand 10 adolescent females without diabetes consumed two pasta meals with different fatcontents. The plasma glucose (p-glucose) values were followed using capillarymeasurement and continuous glucose monitoring (CGMS) until three hours after themeal. The CSII-treated females received the same insulin dose at every occasion as:(1) normal bolus; (2) dual-wave bolus – 60% of the dose as normal bolus and 40% overone hour; and (3) square-wave bolus – a prolonged dose over one hour.No differences were found in p-glucose peak or AUC between the bolus methodsafter either of the meals. There was a difference in p-glucose increase at one time pointafter the less fat meal; after 60 minutes the increase was greater with a square-wavebolus (Friedman’s test p<0.02). Forty-eight percent of the measurements among thediabetes adolescents showed post-prandial p-glucose levels ≤10mmol/L. Femaleswithout diabetes had earlier and lower p-glucose peak and smaller AUC.It was concluded that there were no overall differences in p-glucose excursionsbetween different methods of bolusing for these adolescent females after these meals. Asquare-wave bolus may be less favourable with a less fatty pasta meal, giving a higherp-glucose increase. It was possible to achieve normoglycaemic post-prandial p-glucoselevels among adolescents with diabetes.
|
|
| 15. |
- Lindholm Olinder, Anna, 1960-
(author)
-
Self-management of diabetes in adolescents using insulin pumps
- 2010
-
Doctoral thesis (other academic/artistic)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.
|
|
| 16. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
Treatment with CSII in two infants with neonatal diabetes mellitus
- 2006
-
In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 7:5, s. 284-288
-
Journal article (peer-reviewed)abstract
- This article reports the case studies of two children with neonatal onset of diabetes who were treated with continuous subcutaneous insulin infusion (CSII) from within 4 d to 3 wk of the diagnosis. The aim was to describe diabetes-related and insulin-pump-specific data in relation to growth and various feeding patterns when using CSII in infants with diabetes during their first year of life. The two children's medical records were scrutinized. The results showed that both children had good metabolic control [median hemoglobin A1c (HbA1c) 5.3 and 5.7%, high performance liquid chromatography (HPLC) method, reference: 3.4-5.0%. Compared with the Diabetes Control and Complications Trial (DCCT) HbA1c units, Swedish units give approximately 1% point lower results]. No episodes of severe hypoglycemia or diabetic ketoacidosis have been demonstrated. The children had normal growth patterns, as they followed a normal feeding regime for their age. The meal doses of insulin were given over 12 min to 3 h. The children had diluted Humalog((R)) insulin 10 U/mL (Eli Lilly & Co, Indianapolis, IN, USA) in their pumps. Different types of insulin pumps were used, namely, the Minimed 507C and 508 (Medtronic, Minneapolis, MN, USA), and a Disetronic H-tron V100 (Roche Diagnostics, Basel, Switzerland). The children used different types of infusion sets. Neither family reported any technical problems with their pump system. CSII was an effective and safe treatment for the two children suffering from neonatal diabetes. This offers an alternative for other infants with a similar diagnosis.
|
|
| 17. |
- Olinder, Anna Lindholm, 1960-, et al.
(author)
-
Missed bolus doses : devastating for metabolic control in CSII-treated adolescents with type 1 diabetes
- 2009
-
In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 10:2, s. 142-148
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the management of continuous subcutaneous insulin infusion (CSII) in adolescents with type 1 diabetes including their administration of bolus doses and to study relationships between insulin omission and metabolic control, body mass index, daily frequency of self-monitoring of blood glucose (SMBG) and bolus doses, health-related quality of life (HRQOL), the burden of diabetes and treatment satisfaction. METHODS: Ninety CSII-treated (> or =6 months) adolescents aged 12-18 yr, from four diabetes clinics in Sweden, participated in the study. The adolescents recorded their meal intake the previous day, which was compared with downloaded pump data, and the frequency of missed boluses was stated. Haemoglobin A1c (HbA1c) and diabetes-related data were recorded. HRQOL and treatment satisfaction were measured with questionnaires. RESULTS: Thirty-eight per cent of the adolescents had missed >15% of the doses the previous day, those had higher HbA1c (7.8 +/- 1.0 vs. 7.0 +/- 1.2%, p = 0.001), took fewer daily boluses (3.8 +/- 1.7 vs. 5.3 +/- 1.7, p < 0.001) and SMBG (2.4 +/- 1.8 vs. 3.6 +/- 1.8, p = 0.003), were less satisfied with their treatment (4.8 vs. 5.3, scale 0-6, p = 0.029) and perceived the medical treatment more negatively (72.1 vs. 79.7, scale 0-100, p = 0.029). Multiple linear regression analysis showed that the variations in HbA1c could be explained by the frequency of bolus doses (p = 0.013) and SMBG per day (p < 0.0001) adjusted for duration and age (r(2) = 0.339, p < 0.0001). CONCLUSION: Insulin omission was common. Those who missed doses were less satisfied and perceived more impact with the treatment. The frequencies of daily boluses and SMBG were associated with metabolic control. Diabetes teams need strategies to guide adolescents on how to avoid insulin omission.
|
|
| 18. |
- Rydstrom, Lise-Lott, et al.
(author)
-
How children in Sweden accessed and perceived information during the first phase of the Covid-19 pandemic
- 2022
-
In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 50:1, s. 144-151
-
Journal article (peer-reviewed)abstract
- Aim: To describe how children in Sweden accessed and perceived information about SARS-CoV2 and Covid-19 during the first phase of the outbreak. Methods: This study is a substudy of an international cross-sectional online mixed methods survey examining elements of children's health literacy in relation to Covid-19. The survey included multiple-choice questions, open-ended questions and drawings and collected information from 50 Swedish children (7-12 years). Data were analysed concurrently on a descriptive level using statistics and content analysis. Quantitative and qualitative data, including the drawings, were considered equally important and resulted in six categories, illuminating how children accessed and perceived information about the pandemic. Results: The survey showed that children accessed information mainly from school but also from TV. They preferred information from reliable sources. Children reported the information they accessed as easy to understand and it prompted them to ask new questions. They reported they knew a lot about the pandemic, for example, the potential danger to themselves and others and how to act to protect themselves and others. They perceived the pandemic as an intrusion on their lives. Conclusions: This study indicates that Swedish children between 7 and 12 years old were well informed about SARS-CoV2 and Covid-19 during the first phase of the pandemic. School was shown to be an important source of information. The children could explain how to act to protect themselves and others from becoming infected by the virus.
|
|
| 19. |
- Saarinen, Tuula, et al.
(author)
-
Insulin pump therapy is perceived as liberating, but to many it can imply a sense of the diabetes made visible
- 2014
-
In: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 11:2, s. 38-42
-
Journal article (peer-reviewed)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.
|
|
| 20. |
- Forsner, Maria, 1954-, et al.
(author)
-
Parents' experiences of caring for a child younger than two years of age treated with continuous subcutaneous insulin infusion
- 2014
-
In: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 11:1, s. 7-12
-
Journal article (peer-reviewed)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.
|
|
| 21. |
- Granstam, Elisabet, 1963-, et al.
(author)
-
Long‐term follow‐up of antivascular endothelial growth factor treatment for diabetic macular oedema : a four‐year real‐world study
- 2020
-
In: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 98:4, s. 360-367
-
Journal article (peer-reviewed)abstract
- PurposeTo evaluate visual acuity (VA) and central retinal thickness (CRT) on optical coherence tomography during a 4‐year period in patients treated for sight‐threatening diabetic macular oedema (DMO) at two Swedish county hospitals. Additionally, to compare health‐related quality of life and subjective visual functioning before and after 4 years of treatment.MethodsFifty‐eight patients with DMO were evaluated after 4 years of antivascular endothelial growth factor (VEGF) treatment. VA, CRT and clinical data were retrospectively reviewed. Health‐related quality of life and subjective visual functioning were evaluated with Short Form Health Survey (SF‐36) and National Eye Institute Vision Functioning Questionnaire 25 (VFQ‐25). Comparisons between independent groups were performed using Pearson's χ2 test, Fisher's exact test or Mann–Whitney U test. Spearman's ρ was used for correlation analyses. Wilcoxon signed‐rank test was used for comparison between dependent groups. Logistic regression analysis was applied for analysis of VA and CRT over 4 years.ResultsFollow‐up data were obtained from 37 of 58 (63.8%) patients. Baseline characteristics were similar, regardless of follow‐up. VA improvement at 1 year (mean + 4.4, SD 7.5; ETDRS letter score) was maintained over 3 years, then declined. CRT was reduced throughout the study. In the first treatment year, eyes received 5.1 (1.4) anti‐VEGF injections, followed by approximately two injections yearly. Additional treatment included laser and dexamethasone implants. SF‐36 showed no change at 4 years, compared with baseline. VFQ‐25 demonstrated improvement in near vision activities (p = 0.036).ConclusionSignificant long‐term improvement in visual function was present in patients with anti‐VEGF‐treated DMO.
|
|
| 22. |
|
|
| 23. |
- Granström, Therese, et al.
(author)
-
Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting
- 2016
-
In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 121, s. 157-165
-
Journal article (peer-reviewed)abstract
- Aims: To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting.Methods: In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used.Results: The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity.Conclusions: Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.
|
|
| 24. |
- Göthesson, Johanna, et al.
(author)
-
Children's and adolescent's narratives about pain and negative experiences in diabetes treatment
- 2023
-
In: Journal for Specialists in Pediatric Nursing. - : John Wiley & Sons. - 1539-0136 .- 1744-6155. ; 28:1
-
Journal article (peer-reviewed)abstract
- Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear.Aim: To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives. Methods: Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7–18 years, were subjected to inductive qualitative content analysis.Results: Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst.Conclusion: All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications. Clinical Implications: When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.
|
|
| 25. |
- Haas, Josephine, et al.
(author)
-
Time-trends in body mass index, and overweight and obesity as independent risk factors for diabetes angiopathy in young females with type 1 diabetes : A nationwide study in Sweden
- 2023
-
In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 204
-
Journal article (peer-reviewed)abstract
- Aims: To examine time-trends in BMI-distributions of young females with and without type 1 diabetes (T1D), with focus on the upper half of the distribution i.e., the median and above, and to explore if overweight and obesity independently increase risk of diabetes angiopathy.Methods: Population-based cohort study of 3,473 females with T1D, 16-35 years, identified in the Swedish National Diabetes Registers, January 2005 to October 2015, and 8,487 females from the background population. BMI-distributions were examined using kernel density estimates and quantile regression. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for angiopathy in overweight/obese subjects were estimated with adjusted Cox regression.Results: The BMI-distribution in females with T1D was right shifted to that of the background population (p < 0.001). The 90th percentile and median BMI increased equally overtime in both groups, but females with T1D started from a higher baseline. In T1D, HRs were significantly increased for any angiopathy in individuals with obesity (adj HR 1.37 (CI 1.14-1.64)), and for retinopathy; adj HRs (CIs): overweight; 1.15 (1.02-1.29), obesity; 1.30 (1.08-1.56).Conclusions: Females with T1D have increasing BMI overtime and are heavier than females without T1D. Overweight and obesity are by themselves risk factors for angiopathy.
|
|
| 26. |
- Hanberger, Lena, et al.
(author)
-
Needle-Related Pain, Affective Reactions, Fear, and Emotional Coping in Children and Adolescents With Type 1 Diabetes : A Cross-Sectional Study
- 2021
-
In: Pain Management Nursing. - : Elsevier. - 1524-9042 .- 1532-8635. ; 22:4, s. 516-521
-
Journal article (peer-reviewed)abstract
- Background: The self-care of type 1 diabetes (T1D) includes undergoing procedures with needles several times daily, which may cause pain and fear.Aims: The aim was to identify the degree of perceived pain, affective reactions, fear, and emotional coping among children and adolescents with T1D.Design: A cross-sectional survey was performed.Methods: Children and adolescents 7-18 years of age (n = 197) and their parents (n = 123) completed the Coloured Analogue Scale (CAS), the Facial Affective Scale (FAS), the Diabetes Fear of Injection Questionnaire (D-FISQ), and the Faces Emotional Coping Scale (FECS) in relation to needle procedures.Results: The higher the values of the CAS, FAS and D-FISQ scores, the lower values for coping were reported by children and adolescents regarding treatment with insulin pen or pump, blood glucose test, and venipuncture (p < .001). Patients reported strong negative affect regarding insulin injections (35%) and blood glucose tests (32%), as well as negative affect (48%, 69%) and substantial pain (27%, 50%) for inserting a pump needle and venipuncture, respectively. Parents reported significantly higher values than children on all scales and procedures except D-FISQ (blood glucose tests) and FECS (venipuncture).Conclusions: Children and adolescents who perceive greater pain during needle-related procedures have poorer coping ability. Pediatric diabetes teams need to identify those in need of extra support to develop pain coping strategies.
|
|
| 27. |
|
|
| 28. |
- Leksell, Janeth, 1955-, et al.
(author)
-
Virtual clinic for young people with type 1 diabetes : a randomised wait-list controlled study
- 2023
-
In: BMC Endocrine Disorders. - : BioMed Central (BMC). - 1472-6823. ; 23:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: The transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1.METHODS: 79 participants with type 1 diabetes aged 18-25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months.RESULTS: Baseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life.CONCLUSIONS: The implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management.TRIAL REGISTRATION: ISRCTN number: 73,435,627 (registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627 . The performance and results of this trial adhere to the guidelines outlined in the CONSORT 2010 (Consolidated Standards of Reporting Trials) recommendations.
|
|
| 29. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
A randomised wait-list controlled clinical trial of the effects of acceptance and commitment therapy in patients with type 1 diabetes : a study protocol
- 2015
-
In: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 14
-
Journal article (peer-reviewed)abstract
- BACKGROUNDIn order to manage the acute and long-term effects of living with a chronic disease such as diabetes, both medical treatment and good psychosocial support are needed. In this study, we wish to examine whether a psychological group intervention targeting people with poorly controlled type 1 diabetes can be helpful in augmenting quality of life while also lowering participants' HbA1c level. The group intervention will consist of a brief treatment developed from a branch of cognitive behavioural therapy called acceptance and commitment therapy, which is part of the so-called third wave of cognitive behavioural therapy. Common for these third-wave therapies, the focus is less on the content and restructuring of thoughts and more on the function of behaviour. Here, we describe the protocol and plans for study enrolment.METHODS/DESIGNThis on-going study is designed as a randomised wait-list controlled trial. Eighty patients aged 26-55 years and with an HbA1c level >70 mmol/mol at the time of enrolment will be included.DISCUSSIONIn this study, we will assess the effect of starting acceptance and commitment therapy group treatment for patients with type 1 diabetes and its effect on glycaemic control and well-being.TRIAL REGISTRATIONCurrent controlled trials: ISRCTN17006837, registered 12(th) January 2015.
|
|
| 30. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
Clarifying responsibility for self-management in adolescents with diabetes using insulin pumps : a qualitative study
- 2011
-
In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
-
Journal article (peer-reviewed)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.
|
|
| 31. |
- Lindholm Olinder, Anna, et al.
(author)
-
Clarifying responsibility for self-management of diabetes in adolescents using insulin pumps - a qualitative study
- 2011
-
In: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
-
Journal article (peer-reviewed)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.
|
|
| 32. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
-
Reasons for missed meal-time insulin boluses, from the perspective of adolescents using insulin pumps – “lost focus”
- 2011
-
In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 12:4, s. 402-409
-
Journal article (peer-reviewed)abstract
- Objective: To investigate the reasons for missed bolus doses and strategies for avoiding this among adolescents using insulin pumps. Methods: The grounded theory method was chosen as a model for the collection and analysis of data. Data were collected through interviews with 12 adolescents treated with an insulin pump (5 males and 7 females, mean age 14.4 yr) from different Swedish pediatric diabetes clinics. All interviews were tape-recorded and immediately transcribed. Results: The core category 'lost focus' emerged as representing the main reason for missed bolus doses. Identified subcategories were delayed lost focus, directly lost focus, and totally lost focus. There was a risk of delayed lost focus when the adolescent used postprandial bolusing. Focus could also be lost directly in connection with the start of the meal. Totally lost focus could occur when the adolescent perceived the impact of diabetes as too high or tried to neglect that he or she had it. The category 'agreements about reminders' appeared to be the main strategy for avoiding missed bolus doses; subcategories were personal reminders and technical reminders. The adolescent needed to be involved in these agreements; otherwise, the reminding could be seen as nagging and did not work. Conclusion: The results may help diabetes care teams understand the circumstances in which adolescents miss their bolus doses. This understanding may make it easier to discuss missed doses and strategies for avoiding this with adolescents and support negotiations over agreements about reminders between them and their parents.
|
|
| 33. |
- Lindholm Olinder, Anna
(author)
-
Self monitoring of blood glucose in CSII-treated adolescents with type 1 diabetes
- 2008
-
In: Self monitoring of blood glucose in CSII-treated adolescents with type 1 diabetes.
-
Conference paper (other academic/artistic)abstract
- Many diabetic clinics in Sweden recommend four self monitoring of blood glucose (SMBG) per day for CSII treated adolescents, however it is common that CSII treated adolescents with type 1 diabetes perform fewer SMBG than recommended.Objectives: To compare age, diabetes duration, HbA1c value, frequency of daily bolus doses and health related quality of life (HRQOL) measured with the “Disabkids” questionnaire, between CSII treated adolescents who perform less than four SMBG per day and CSII treated adolescents who perform four or more.Methods: Data were obtained from 91 CSII treated adolescents (aged 12-18), who were regularly attending four different paediatric diabetes clinics in Sweden, all recommending four SMBG per day. Unpaired t-test was used to compare the group who took < 4 SMBG/day with the group who took > 4 SMBG/day. Nominal logistic regression analysis was used to compare the two groups.Results: The mean frequency of SMBG/day was 3.2. Forty-four % (40/91) of the adolescents performed four or more SMBG/day. The adolescents who performed the recommended frequency of SMBG were younger, had shorter diabetes duration, had lower HbA1c, took more daily bolus doses and perceived less impact of the medical treatment. There were no differences in general HRQOL between the two groups. Nominal logistic regression analysis showed that of these factors only HbA1c was independently associated to > 4 SMBG/day (p<0.001).Conclusion: Fifty-sex % of the adolescents performed fewer SMBG than recommended. The frequency of SMBG was associated with the metabolic control. The diabetes teams need new strategies to motivate adolescents to perform more SMBG.
|
|
| 34. |
- Nerpin, Elisabet, 1962-, et al.
(author)
-
A virtual clinic for the management of diabetes-type 1 : study protocol for a randomised wait-list controlled clinical trial
- 2020
-
In: BMC Endocrine Disorders. - : BMC. - 1472-6823. ; 20:1
-
Journal article (peer-reviewed)abstract
- Background Diabetes is a serious chronic disease. Medical treatment and good psychosocial support are needed to cope with acute and long-term effects of diabetes. Self-management is a large part of diabetes management, with healthcare providers playing a supportive role. Young adults with type 1 diabetes are of special interest as they tend to have higher mean glycosylated haemoglobin values than other patients with type 1 diabetes, and they often miss visits in traditional diabetes care. A well-designed virtual solution may improve a range of measures (e.g. glycaemic control and perceived health) and reduce hospitalisations. Method This randomised controlled trial with a control group using a wait list design will recruit 100 young adults from a hospital in Sweden. All participants will receive usual diabetes care besides the virtual clinic. The primary objective is to evaluate the effect of a virtual diabetes clinic on glycaemic control, treatment satisfaction and quality of life in young adults (aged 18-25 years) with type-1 diabetes. The secondary objective is to determine the effects of virtual care on the patient experience. Discussion Virtual tools are becoming increasingly common in healthcare; however, it remains unclear if these tools improve diabetes self-management. The results of this study will build understanding of how healthcare providers can use a virtual clinic to improve diabetes self-management.
|
|
| 35. |
- Nilsson, Stefan, 1972, et al.
(author)
-
The Faces Emotional Coping Scale as a self-reporting instrument for coping with needle-related procedures : An initial validation study with children treated for type 1 diabetes
- 2017
-
In: Journal of Child Health Care. - : SAGE Publications. - 1367-4935 .- 1741-2889. ; 21:4, s. 392-403
-
Journal article (peer-reviewed)abstract
- The aim of this study was to determine the concurrent and content validity, sensitivity and inter-rater reliability of the Faces Emotional Coping Scale (FECS) to evaluate the children's anticipation of the level of emotional coping in conjunction with a venepuncture. A total of 153 children with type 1 diabetes and 86 of their parents participated in the study. The age of the children, 76 of whom were boys, ranged from 7 to 18 years. The child and his or her parent reported the child's coping ability, and the child reported the pain intensity and unpleasantness of a venepuncture. The child also wrote a short narrative about his or her experience of the needle procedure. The FECS correlated negatively with the Coloured Analogue Scale and the Facial Affective Scale and positively with the FECS by proxy. The narratives of 90 children correlated negatively with the FECS. Younger children reported significantly lower scores than older children did regarding their ability to cope with a venepuncture. The children's scores on the FECS showed good agreement with the parents' scores. In this study, the FECS was deemed valid for measuring children's ability to cope with their emotions when undergoing needle-related procedures like venepuncture.
|
|
| 36. |
- Nilsson, Stefan, 1972, et al.
(author)
-
To be or not to be vaccinated against COVID-19 - The adolescents' perspective - A mixed-methods study in Sweden.
- 2021
-
In: Vaccine: X. - : Elsevier BV. - 2590-1362. ; 9
-
Journal article (peer-reviewed)abstract
- Vaccination of the population seems to be an important strategy in halting the COVID-19 pandemic in both local and global society. The aim of this study was to explore Swedish adolescents' willingness to be vaccinated against COVID-19 and its association with sociodemographic and other possible factors. A survey was distributed in Sweden between 7 July and 8 November 2020. The main qualitative question concerned adolescents' thoughts on vaccination against COVID-19 and evaluated whether the adolescents would like to be vaccinated when a COVID-19 vaccine is made available. In total, 702 adolescents aged between 15 and 19 responded to the questionnaire. A convergent parallel mixed-methods design was used. The results showed that nearly one in three adolescents had not decided if they wanted to get a COVID-19 vaccine, i.e. 30.5%: n = 214. Of the participants 54.3% (n = 381) were willing to be vaccinated. Girls had higher levels of anxiety about the vaccine compared to boys. In addition, high levels of anxiety impacted on the participants' willingness to be vaccinated. One reason for being undecided about the vaccine was that participants felt they did not know enough about it. Practising social distancing increased willingness to be vaccinated, as reflected in the qualitative results which showed participants wanted to be vaccinated to protect others. The results impart important knowledge to healthcare professionals and contribute to their communication with adolescents about vaccine hesitancy.
|
|
| 37. |
- Rooth, Esther, et al.
(author)
-
Nurses’ experiences of giving care to children with autism spectrum disorder within somatic emergency care
- 2016
-
In: Scientific Times Journal of Paediatrics. ; 1:1, s. 1-11
-
Journal article (peer-reviewed)abstract
- Aims: To describe nurses’ experiences of giving care to children with autism spectrum disorder in a paediatric emergency care unit and to explore how the nurses had obtained their knowledge of the subject.Background: Within somatic paediatric care, nurses frequently encounter children with autism spectrum disorder. Many parents of these children report a lack of knowledge about the diagnosis and difficulties in encounters with somatic care. According to Patricia Benner’s theory of learning, a skill is developed through education, tutoring and experience.Design: A qualitative interview study. Method: Semi-structured interviews were held with ten nurses during the spring of 2015. Data was analysed by content analysis to find categories and codes corresponding to the study’s aims.Findings: The findings present information regarding: 1) knowledge and experience; 2) the context in which the child finds itself, as well as an unsafe working environment for the nurses; 3) how the treatment and care of the child, among other things, is affected by information given by the parents about the diagnosis, and how the nurses feel in difficult situations; 4) interaction with the children, the parents and colleagues. The findings in this study mainly show the complexity in encounters with children with autism spectrum disorder and their parents and that nurses require further education. The nurses also give a number of suggestions for improvements that well concur with the literature.Conclusion: To be able to care well for children with autism spectrum disorder, a combination of knowledge and experience is necessary.
|
|
| 38. |
- Rosman, Jessica, et al.
(author)
-
Individual goal-based plan based on nursing theory for adults with type 2 diabetes and self-care deficits : a study protocol of a randomised controlled trial
- 2022
-
In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:3
-
Journal article (peer-reviewed)abstract
- Introduction The prevalence and costs of type 2 diabetes are increasing worldwide. A cornerstone in the treatment and care of diabetes is supporting each patient in self-management. In Sweden, most patients with type 2 diabetes are cared for in the primary care setting, which is heavily burdened. Because of implementation difficulties regarding evidenced-based diabetes self-management education and support in this setting, there is a need for an instrument that is easy to use and implement. We developed an individual care plan based on the self-care deficit nursing theory of Dorothea Orem as an instrument to facilitate more individualised self-care support for patients with type 2 diabetes. In this study, we aim to determine whether a written, theory-based, individual goal-based plan for patients with type 2 diabetes and self-management deficits can affect their glycaemic control and health-related quality of life, as well as their experiences of living with diabetes and of support from diabetes care. Methods and analysis The study design is a randomised controlled trial using a quantitative approach. A total of 110 patients will be included. Additionally, a qualitative interview study will be conducted 12 months after the intervention. The primary outcome will be glycosylated haemoglobin levels. Secondary outcomes will be health-related quality of life measured using the RAND-36, and the patient's experience of living with diabetes and of the support from diabetes care measured using the Diabetes Questionnaire. Quantitative data will be analysed using the paired t-test, unpaired t-test, and Mann-Whitney U test with IBM SPSS V.26.0 software. Qualitative content analysis will be used for qualitative data. Ethics and dissemination This study has been approved by the Ethical Review Authority in Uppsala, Sweden (Etikprovningsmyndigheten, Uppsala, Sverige) (Dnr: 2020-03421). The results will be disseminated in peer-reviewed publications.
|
|
