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  • 1.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    "A body in transformation"-An empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate-to-severe rheumatic pain2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To gain a better understanding of fear-avoidance beliefs towards physical activity and body awareness in people experiencing moderate-to-severe rheumatic pain.

    BACKGROUND: Rheumatoid arthritis and psoriatic arthritis are long-term conditions with pain as the prominent symptom. Health-promoting physical activity is recommended and can have an analgesic effect. High self-rated pain has previously been reported to be associated with increased fear-avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long-term diseases.

    DESIGN: Empirical phenomenological.

    METHODS: An empirical phenomenological psychological method was applied. The interviews took place between autumn 2016-spring 2017 with 11 informants (eight women and three men, age range 44-71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3-35 years. The mean visual analogue scale score in the study sample was 60 mm.

    RESULTS: Three typologies were identified: "My relatively fragile physical status", "I am an active creator" and "Part of something bigger than myself."

    CONCLUSIONS: The current findings indicated that pain anticipation and fear-avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long-term rheumatic pain syndromes. People experiencing moderate-to-severe rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance.

    RELEVANCE TO CLINICAL PRACTICE: The current findings are relevant for healthcare professionals engaged in health-promotion clinical practice.

  • 2.
    Amsberg, Susanne
    et al.
    Sophiahemmet University.
    Anderbro, Therese
    Sophiahemmet University.
    Wredling, Regina
    Sophiahemmet University.
    Lisspers, Jan
    Lins, Per-Eric
    Adamson, Ulf
    Johansson, Unn-Britt
    Sophiahemmet University.
    A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients: a randomized controlled trial2009In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 77, no 1, p. 72-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.

  • 3.
    Mattiasson, Anne-Cathrine
    et al.
    Sophiahemmet University College.
    Andersson, L
    Mullins, L C
    Moody, L
    A comparative empirical study of autonomy in nursing homes in Sweden and Florida, USA1997In: Journal of Cross-Cultural Gerontology, ISSN 0169-3816, E-ISSN 1573-0719, Vol. 12, no 4, p. 299-316Article in journal (Refereed)
    Abstract [en]

    This study seeks to comparatively examine how autonomy is evaluated by a sample of nursing staff in both Sweden and Florida, USA. In both cultures support for patient autonomy was generally greater from an individual point of view than from the anticipated institutional perspective. Comparisons between the cultures revealed that individual staff members in the Swedish nursing homes generally gave higher priority to patient preference than did their American counterparts. On the other hand, support for patient preference was generally greater in the American nursing homes in regard to institutionally anticipated decision. There were statistically significant mean value differences between Swedish nursing staff's personal opinion and anticipated institutional decisions in five of six case studies. Nursing staff's personal opinion showed a stronger support for patient's preferences. There was a statistically significant mean value difference between American nursing staffs' personal opinion and anticipated institutional decisions in only one of the six case studies. In spite of cultural differences the reported results to some degree reflect a common value-system regarding both the anticipated institutional perspective and nursing staffs' personal opinion.

  • 4. Svedbo Engström, Maria
    et al.
    Leksell, Janeth
    Johansson, Unn-Britt
    Sophiahemmet University.
    Eeg-Olofsson, Katarina
    Borg, Sixten
    Palaszewski, Bo
    Gudbjörnsdottir, Soffia
    A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability2018In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, no 1, p. 139-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the development and evaluation of the content and face validity and test-retest reliability of a disease-specific questionnaire that measures patient-reported outcomes and experiences for the Swedish National Diabetes Register for adult patients who have type 1 or type 2 diabetes.

    METHODS: In this methodological study, a questionnaire was developed over four phases using an iterative process. Expert reviews and cognitive interviews were conducted to evaluate content and face validity, and a postal survey was administered to evaluate test-retest reliability.

    RESULTS: The expert reviews and cognitive interviews found the disease-specific questionnaire to be understandable, with relevant content and value for diabetes care. An item-level content validity index ranged from 0.6-1.0 and a scale content validity/average ranged from 0.7-1.0. The fourth version, with 33 items, two main parts and seven dimensions, was answered by 972 adults with type 1 and type 2 diabetes (response rate 61%). Weighted Kappa values ranged from 0.31-0.78 for type 1 diabetes and 0.27-0.74 for type 2 diabetes.

    CONCLUSIONS: This study describes the initial development of a disease-specific questionnaire in conjunction with the NDR. Content and face validity were confirmed and test-retest reliability was satisfactory.

    PRACTICE IMPLICATIONS: With the development of this questionnaire, the NDR becomes a clinical tool that contributes to further understanding the perspectives of adult individuals with diabetes.

  • 5.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Rydell Karlsson, Monica
    Sophiahemmet University.
    Edner, Magnus
    Billing, Ewa
    Mattiasson, Anne-Cathrine
    A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 85, no 2, p. e162-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to investigate if family members of patients with chronic heart failure (CHF) increased knowledge about CHF through a group-based multi-professional educational programme and whether there was an effect on patients' health care utilization. METHODS: Family members (n=128) were randomly assigned to intervention-group (IG) who received CHF education programme or control-group (CG) who received information according to hospital routines. Programme effects were evaluated with CHF knowledge questionnaire, patient readmissions and number of days hospitalised during 18 months. RESULTS: Knowledge about CHF increased in both groups, significantly higher in IG at second assessment (IG 16±1.9 vs. CG 14.9±2.1, p=0.006), and knowledge maintained at third assessment. In IG 17 patients were re-admitted at least once and 28 patients in CG due to CHF (p=0.085). There were no differences in frequency of readmissions or number of days hospitalised. CONCLUSION: A group-based multi-professional education programme increased family members' knowledge about CHF. Despite this, effect on patient's health care utilization could not be seen during follow-up period. PRACTICAL IMPLICATIONS: We suggest that CHF education programmes for family members should be provided at clinics, with information preferably repeated 2-3 times during a period of six months to maintain knowledge level.

  • 6. Anderbro, Therese
    et al.
    Amsberg, Susanne
    Moberg, Erik
    Gonder-Frederick, Linda
    Adamson, Ulf
    Lins, Per-Eric
    Johansson, Unn-Britt
    Sophiahemmet University.
    A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes2018In: Endocrinology, Diabetes & Metabolism, ISSN 2057-3316Article in journal (Refereed)
    Abstract [en]

    Aims: To  investigate  fear  of  hypoglycaemia  (FoH)  longitudinally  in  a  cross-  sectional  study  of  adult  patients  with  type  1  diabetes.  Specifically,  we  investigated  two  sub-groups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.

    Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire  to  assess  hypoglycaemia  history  was  sent  by  mail  to  764  patients  in  2010. The responders in 2010 (n =   469) received another set of the same two ques-tionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥  75th percentile were included in   the    subgroup analyses. Statistical analyses included one- sample t tests, chi- square and McNemar’s test.

    Results: The absolute difference in the HFS total score (n =   347) between 2010 and 2014 was m =   ±7.6, SD ±   6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypogly-caemia in 2014 compared with the decreased FoH group. There were more subjects in the  increased  FoH  group  with  insulin  pumps  in  2014  and  in  2010.  In  the  decreased  FoH group, more patients had a high frequency of daily self- monitoring of blood glu-cose (SMBG) in 2010 and in 2014.

    Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking pa-tients about changes in hypoglycaemia experiences is of great importance.

  • 7.
    Andreassen, Sissel
    et al.
    Sophiahemmet University.
    Randers, Ingrid
    Sophiahemmet University.
    Ternulf Nyhlin, Kerstin
    Sophiahemmet University.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University.
    A meta-analysis of qualitative studies on living with oesophageal and clinically similar forms of cancer, seen from the perspective of patients and family members2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, Vol. 2, no 2, p. 114-27Article in journal (Refereed)
    Abstract [en]

    This study is part of a research programme of which the aim is to generate knowledge about patients' and family members' experiences of living with oesophageal cancer from their perspective. The aim of the present study was to extend this knowledge by adding other forms of cancer: other upper gastrointestinal cancer, and head and neck cancer. These cancer forms have clinical similarities with oesophageal cancer and the survival rates are similar. This study is a qualitative meta-analysis that examines the results reported in 13 qualitative original research reports, published in peer-reviewed nursing journals between April 1998 and June 2006. We used thematic analysis. Three themes were formulated: “running into an unpredictable enemy”, “enduring a fading body” and “entering social silence”. Patients and family members gave voice to a suffering that involved the whole person. Our findings show that the whole person must be given care, and this care must include the whole family

  • 8.
    Johansson, Unn-Britt
    et al.
    Sophiahemmet University.
    Wredling, Regina
    Sophiahemmet University.
    Adamson, Ulf
    Lins, Per-Eric
    A morning dose of insulin glargine prevents nocturnal ketosis after postprandial interruption of continuous subcutaneous insulin infusion with insulin lispro2007In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 33, no 6, p. 469-71Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this crossover trial was to evaluate the potential of partial substitution of basal insulin with glargine, administered once daily in the morning, to protect against nocturnal ketosis after postprandial interruption of continuous subcutaneous insulin infusion (CSII). METHODS: Seven patients with type 1 diabetes received 4 weeks of treatment with insulin lispro, administered by CSII, and 4 weeks of treatment with CSII and a partial basal replacement dose of insulin glargine administered in the morning. On day 28 of each treatment phase, patients were admitted to the research unit where dinner was served and their usual dinner insulin bolus dose given, after which CSII was discontinued at 7 pm. Plasma (p) beta-hydroxybutyrate and p glucose were measured every hour for 12 h thereafter. RESULTS: Plasma beta-hydroxybutyrate at 7 pm was 0.16+/-0.05 and 0.13+/-0.07 mmol/l with and without glargine, respectively, and increased to 0.17+/-0.10 and 0.60+/-0.3 mmol/l within 6 h (P=0.02). Plasma glucose increased without glargine, from 8.6+/-2.9 to 21.1+/-3.0 mmol/l (P=0.003), but did not rise significantly following glargine (13.6+/-4.7 vs. 12.6+/-5.6 mmol/l; P=0.65). CONCLUSIONS: Partial replacement with a morning dose of insulin glargine protects against the development of ketosis for as much as 12 h after postprandial interruption of CSII. This treatment strategy could, therefore, be useful for patients who are prone to ketosis but, for other reasons, are deemed suitable for CSII.

  • 9.
    Rydell Karlsson, Monica
    et al.
    Sophiahemmet University.
    Edner, Magnus
    Henriksson, Peter
    Mejhert, Märit
    Persson, Hans
    Grut, Mikaela
    Billing, Ewa
    A nurse-based management program in heart failure patients affects females and persons with cognitive dysfunction most2005In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 58, no 2, p. 146-53Article in journal (Refereed)
    Abstract [en]

    It is important that congestive heart failure (CHF) patients know how to monitor and manage disease-associated signs and symptoms. CHF patients were randomised to follow-up at a nurse-based outpatient clinic (intervention group (IG); n = 103), or to follow-up in primary healthcare (control group (CG); n = 105). Patient knowledge of CHF and self-care were assessed by a questionnaire and cognitive function by a Mini Mental State Examination (MMSE) at baseline and at six months. Men knew more about CHF as compared to females at baseline (p < 0.01). However, females in the IG increased their knowledge of self-care between baseline and six months as compared to CG females (p < 0.05). Patients with cognitive dysfunction (MMSE < 24) presented lower scores on knowledge as compared to those with a MMSE of >24 at baseline (p < 0.01). These differences disappeared after the intervention. Thus, females seemed to gain more than men from a nurse-based management program and patients with in-hospital signs of cognitive dysfunction should be encouraged to participate.

  • 10.
    Johansson, Unn-Britt
    et al.
    Sophiahemmet University.
    Eskils, J
    Adamson, Ulf
    Elwin, C E
    Wredling, Regina
    Sophiahemmet University.
    Lins, Per-Eric
    A paracetamol-pasta test for assessing gastric emptying in healthy and diabetic subjects2003In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 63, no 2, p. 159-66Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that the relationship between gastrointestinal symptoms and gastric emptying is weak. Therefore the quantitative assessment of gastric emptying with a relatively simple, non-invasive test would be of considerable clinical value in insulin-treated diabetic patients to identify those with disturbed gastric emptying. The aim of this investigation was to evaluate the inter- and intra-subject variability of a paracetamol-pasta test in healthy subjects and in IDDM patients. Eighteen healthy subjects (8 women) with a mean age of 37 years (range 19-68) and 19 IDDM patients (10 women) with a mean age of 48 years (range 25-62) and mean duration of diabetes of 28 years (range 6-52) were studied on two occasions with an interval of 1 to 4 weeks. After an overnight fast the subjects ingested a standardized pasta meal mixed with 2 g paracetamol in a period of 15 min. Blood samples were drawn at regular intervals after meal intake and analysed for paracetamol (P) and blood glucose. The serum levels of P were significantly lower at 15 min in diabetic patients. The intra-subject coefficients of variation (CV%) of the areas under the serum paracetamol concentration-time curve (AUC) were almost identical in healthy and diabetic subjects, while the intra-subject CV of the P-Tmax was considerably lower in diabetic patients as well as markedly lower than the corresponding inter-subject CV. The inter-subject CVs of all parameters calculated were generally higher in diabetic patients. This study indicates that the assessment of paracetamol absorption kinetics during a paracetamol-pasta test is reproducible in healthy as well as in diabetic subjects. Diabetic patients with non-optimal glucose control and without a case history indicating gastroduodenal motor function disturbances achieve lower serum concentration of P at 15 min and generally display a higher inter-individual variability indicative of subclinical disturbances of gastric emptying in this group of patients.

  • 11. Alvariza, Anette
    et al.
    Holm, Maja
    Sophiahemmet University.
    Benkel, Inger
    Norinder, Maria
    Ewing, Gail
    Grande, Gunn
    Håkanson, Cecilia
    Sophiahemmet University.
    Öhlen, Joakim
    Årestedt, Kristofer
    A person-centred approach in nursing: Validity and reliability of the Carer Support Needs Assessment Tool2018In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 35, p. 1-8, article id S1462-3889(18)30058-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The Carer Support Needs Assessment Tool (CSNAT) was developed for use among family caregivers in palliative care for assessment of their support needs. The purpose of this study was to translate and evaluate the validity and reliability of the CSNAT in a sample of Swedish family caregivers and nurses in a palliative care context.

    METHODS: Data for this validation study was collected during 2016 in the context of palliative home care in two larger Swedish cities. The study was conducted in three stages to reach conceptual, semantic, operational and measurement equivalence between the original UK version and the Swedish version. Stage I consisted of translation to Swedish. In Stage II, cognitive interviews were performed with 8 family caregivers and 10 nurses. Data were analyzed based on relevance, clarity and sensitivity. In Stage III, the CSNAT and related self-rating measures (caregiver burden, preparedness for caregiving and quality of life) were completed by 118 family caregivers. Data quality, construct validity and test-retest reliability were evaluated.

    RESULTS: The CSNAT items were considered relevant and useful to identify areas of support needs. The Swedish CSNAT showed sound psychometric properties with satisfactory data quality and few problems with missing data across items (1.8%-6.1%). All items except one correlated as expected (rho>0.3) with caregiver burden, supporting construct validity. All items had satisfactory test-retest reliability (κw=0.45-0.75).

    CONCLUSIONS: This study further adds to the validity of the CSNAT and shows in addition that it is reliable and stable for use among family caregivers in palliative care.

  • 12. Butler, Eile
    et al.
    Oien, Rut F
    Lindholm, Christina
    Sophiahemmet University.
    Olofsson, Tobias C
    Nilson, Bo
    Vásquez, Alejandra
    A pilot study investigating lactic acid bacterial symbionts from the honeybee in inhibiting human chronic wound pathogens2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 5, p. 729-37Article in journal (Refereed)
    Abstract [en]

    Treatment and management of chronic wounds is a large burden on the health sector and causes substantial suffering for the patients. We believe that 13 lactic acid bacteria (LAB) symbionts isolated from the honey crop of the honeybee are important players in the antimicrobial action of honey, by producing antimicrobial substances and can be used in combination with heather honey as an effective treatment in wound management. A total of 22 patients with chronic ulcers were included; culture-dependent and molecular-based (MALDI-MS and 16S rRNA gene sequencing) techniques were used to identify bacteria from chronic wounds. These clinical isolates were used for in vitro antimicrobial testing with standardised viable LAB and sterilised heather honey mixture. Twenty of the patients' wounds were polymicrobial and 42 different species were isolated. Patient isolates that were tested in vitro were inhibited by the LAB and honey combination with inhibitory zones comparable with different antibiotics. LAB and heather honey in combination presents a new topical option in chronic wound management because of the healing properties of honey, antimicrobial metabolite production from the LAB and their bactericidal effect on common chronic wound pathogens. This new treatment may be a stepping stone towards an alternative solution to antibiotics.

  • 13.
    Westerbotn, Margareta
    et al.
    Sophiahemmet University.
    Agüero-Torres, Hedda
    Fastbom, Johan
    Hillerås, Pernilla
    Sophiahemmet University.
    A population-based study on well-being in the very old: the role of cardiovascular diseases and drugs2005In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 40, no 3, p. 287-97Article in journal (Refereed)
    Abstract [en]

    Cardiovascular diseases constitute the most common health problems in very old people. Consequently, cardiovascular drugs are the medicines that are most frequently used by elderly subjects. Although many studies have examined the physiological effect and adverse reactions of these drugs, knowledge on their effect on emotional well-being is missing. The present study aims to examine the association between cardiovascular diseases and their medical treatment on the emotional well-being of very old people. We investigated a representative group of elderly subjects gathered from a population-based study (n=235). Participants were 84 years or older and cognitively intact (mini-mental state examination (MMSE) > or =24 points). Well-being was assessed with the positive and negative affect schedule (PANAS), measuring different mood categories. Cardiovascular diseases were diagnosed following the International Classification of Diseases. In this population the prevalence of cardiovascular diseases was high (62%). Multivariate regression analysis showed that while being affected by a cardiovascular disease did not affect the emotional well-being of the subjects (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of some cardiovascular drugs showed an association. Cardiac glycosides (p=0.006) and nitrates (p=0.008) were associated with increased negative feelings. Due to high prevalence of cardiovascular diseases and use of cardiovascular medicines, this finding has relevance on the quality of life of elderly people. However, due to the nature of this study we cannot assess cause-effect relationship of this positive association. Therefore, the present findings suggest that there is a need for clinical studies in this increasing and limited studied age group.

  • 14. Nürnberg Damström, D
    et al.
    Saboonchi, Fredrik
    Sophiahemmet University College.
    Sackey, P V
    Björling, Gunilla
    Sophiahemmet University College.
    A preliminary validation of the Swedish version of the critical-care pain observation tool in adults2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 4, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT. Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT. Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32-0.45). Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.

  • 15. Sjöblom, Ingela
    et al.
    Idvall, Ewa
    Rådestad, Ingela
    Sophiahemmet University.
    Lindgren, Helena
    A provoking choice: Swedish women's experiences of reactions to their plans to give birth at home2012In: Women and birth : journal of the Australian College of Midwives, ISSN 1878-1799, Vol. 25, no 3, p. e11-e18Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The home birth rate in Sweden is less than 1 in 1000, and home birth is not included within the health care system. This study describes women's experiences concerning reactions to their decision to give birth at home. DESIGN AND SETTING: A nationwide survey (SHE - Swedish Homebirth Experience) in Sweden was conducted between 1992 and 2005 whereas 735 women had given birth to 1038 children. Of 1038 questionnaires 1025 were returned. MEASUREMENTS: In the questionnaires an open-ended question asked women to report their experience of reactions to their decision to give birth at home The question was answered by 594 women, and data were analysed using content analysis. FINDINGS: The analysis yielded one overarching theme; "To be faced with fear for life and death" including being exposed to reactions about risks. This describes attitudes of professionals and family towards life and death and suggests perceptions of risk and fear of unexpected events. Four main categories were identified; Seen as an irresponsible person, Met with emotional arguments, Exposed to persuasion and Alienation. CONCLUSION: Women who plan for a home birth were confronted with negative attitudes and persuasion to make them change their mind. This made them feel alienated, and they searched for support among like-minded. Negative attitudes from health care professionals may erode their confidence in conventional health services and turn them towards other options. IMPLICATION FOR PRACTICE: Women who want to give birth at home should be given evidence-based information about risks and benefits. Enhanced knowledge among public and professionals about home births would improve the options for respectful encounters.

  • 16. Sjödin, Marie
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Zwedberg, Sofia
    A qualitative study showing women's participation and empowerment in instrumental vaginal births2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, no 3, p. e185-e189, article id S1871-5192(17)30525-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An instrumental birth with a ventouse or forceps is a complicated birth, possibly resulting in fear of childbirth which could influence the entire birth experience negatively. Patients who are actively involved in their care have a stronger sense of satisfaction and a sense of participation can contribute to shorter hospital stays.

    AIM: To describe the experience of participation for women involved in an instrumental delivery with ventouse or forceps.

    METHOD: Qualitative semi-structured interviews with 16 women who gave birth aided by a ventouse or forceps. Their answers were analyzed through qualitative content analysis. In addition the women were asked to evaluate their experience during the delivery. Using a numerical scale (NRS) the birth experience was graded by choosing a number between 0 (worst possible experience) and 10 (best conceivable experience).

    FINDINGS: Two themes were extracted from the data: To be part of a team and To feel empowered. Five categories were identified from the women's descriptions of the experience of involvement during the instrumental delivery: to cooperate; to understand; to have contact; to participate, and to not be involved. Those women who rated their experience as low grade, described a lack of involvement in their childbirth compared to those women who rated their experience as high.

    CONCLUSION: This study shows how cooperation and empowerment of the woman are two key factors in order for the women to have a positive experience of their instrumental vaginal births. The study also shows that empowerment is created when the woman is actively engaged and participates in the birth process which gives her the feeling of being part of the team, creating an environment based on mutual understanding.

    The full text will be freely available from 2019-09-21 15:19
  • 17. Franzén-Dahlin, Åsa
    et al.
    Larson, Jenny
    Murray, Veronica
    Wredling, Regina
    Sophiahemmet University College.
    Billing, Ewa
    A randomized controlled trial evaluating the effect of a support and education programme for spouses of people affected by stroke2008In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 8, p. 722-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether a nurse-led support and education programme for spouses of patients affected by stroke improved the psychological health of the spouses. DESIGN: A longitudinal, open, randomized controlled trial. SAMPLE: One hundred spouses of stroke patients were randomly assigned to either an intervention or a control group. SETTING: The study was conducted in a hospital setting. INTERVENTION: The intervention consisted of six group meetings during six months, with a follow-up after further six months. Comparison between the intervention and the control groups was made at baseline, after six and 12 months using analysis with repeated measures. MAIN MEASURES: The Comprehensive Psychopathological Rating Scale--Self-Affective for psychological health. RESULTS: No significant difference was found between the intervention and control groups concerning overall psychological health. However, a subanalysis revealed that those who participated more frequently in the group meetings (five or six times) had significantly stronger psychological health (P<0.05). Knowledge about stroke increased over time in both groups, but participants in the intervention group learned more (P=0.041). CONCLUSION: Encouraging participation in the group meetings of a support programme might have a positive effect on psychological health.

  • 18. Knutsson, Johan
    et al.
    Priwin, Claudia
    Sophiahemmet University.
    Hessén-Söderman, Anne-Charlotte
    Rosenblad, Andreas
    von Unge, Magnus
    A randomized study of four different types of tympanostomy ventilation tubes - Full-term follow-up2018In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 107, p. 140-144, article id S0165-5876(18)30078-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.

    METHODS AND MATERIAL: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored postoperatively every third month by an otolaryngologist.

    RESULTS: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.

    CONCLUSIONS: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.

    LEVEL OF EVIDENCE: 1b.

  • 19.
    Björling, Gunilla
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Andersson, G
    Schedin, Ulla
    Markström, A
    Frostell, C
    A retrospective survey of outpatients with long-term tracheostomy2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 4, p. 399-406Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Respiratory Unit (RU) at Danderyd University Hospital opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The primary aim of this retrospective study in tracheostomized patients was to compare the need for hospital care in the 2-year period before and after the tracheostomy. METHODS: Data were collected from patient medical records at the RU, from the National Board of Health and Welfare, Sweden and from the Official Statistics of Sweden. The subjects were RU patients in 1982 (Group 1, n = 27) and in 1997 (Group 2, n = 106) with long-term tracheostomy surviving at least 4 years after the tracheostomy. RESULTS: Both groups had few and unchanged needs for hospital care after tracheostomy. They spent > or = 96% of their time out of hospital. In 1997, (group 2) the number of patients, diagnoses and need for home mechanical ventilation had increased. Life expectancy was assessed for patients in Group 1. Data showed that they lived as long as an age-matched and gender-adjusted control cohort. CONCLUSIONS: Long-term tracheostomy may not increase the need for hospital care and does not reduce life expectancy. These clinical observations were made in a setting where patients had regular access to a dedicated outpatient unit.

  • 20. Bondesson, Tina
    et al.
    Petersson, Lena-Marie
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Alexanderson, Kristina
    Kjeldgård, Linnea
    Nilsson, Marie I
    A study to examine the influence of health professionals' advice and support on work capacity and sick leave after breast cancer surgery2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 10, p. 4141-4148Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to investigate how women, shortly after breast cancer surgery, experienced encounters with, and information from, healthcare professionals regarding work and sick leave and if these experiences were associated with self-reported work capacity and sick leave.

    METHODS: This is a cross-sectional study based on questionnaire data from 605 women who had had breast cancer surgery, aged 20-63 years. Exclusion criteria were known distant metastases, pre surgical therapy, and/or previous breast cancer. Data on age, type of surgery, global health, and work environment were included as covariates in multivariable logistic regression analysis.

    RESULTS: Five percent of the women had not received any advice concerning work or sick leave. Women reporting receiving useful advice or support related to paid work had lower risk of reporting reduced physical or psychological/social work capacity due to the cancer or treatment (OR 0.46 (95 % CI 0.26-0.81) respective OR 0.45 (95 % CI 0.26-0.77)). There were no associations between having received useful advice or support concerning work and being on sick leave. Women encouraged to take sick leave had an OR of 2.17 (95 % CI 1.39-3.37) of being sickness absent. They also to a higher extent had reduced physical and psychological/social work capacity. Women who reported to have been encouraged to work were sickness absent to a lower extent (OR 0.64; 95 % CI 0.41-0.98) and reported higher physical work capacity.

    CONCLUSIONS: Work and sick leave is being discussed during consultations with women with breast cancer and the advice given seems to be in line with the women's subjective work capacity.

  • 21.
    Swall, Anna
    et al.
    Sophiahemmet University.
    Fagerberg, Ingegerd
    Ebbeskog, Britt
    Lundh Hagelin, Carina
    Sophiahemmet University.
    A therapy dog's impact on daytime activity and night-time sleep for older persons with Alzheimer's disease: a case study2014In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 2, no 4, p. 80-93Article in journal (Refereed)
    Abstract [en]

    Background: Animal-Assisted Therapy using dogs have been described as having a calming effect, decrease sundowning and blood-pressure in persons with Alzheimer’s disease. The aim was to investigate how continuous and scheduled visits by a prescribed therapy dog affected daytime and night-time sleep for persons with Alzheimer’s disease.

    Methods: In this case study, registration of activity and sleep curves was conducted from five persons with moderate to severe Alzheimer’s disease living at a nursing home, over a period of 16 weeks using an Actiwatch. Data was analysed with descriptive statistics.

    Result: The study shows no clear pattern of effect on individual persons daytime activity and sleep when encounter with a therapy dog, but instead points to a great variety of possible different effects that brings an increased activity at different time points, for example during night-time sleep.

    Conclusions: Effects from the use of a Animal-Assisted Therapy with a dog in the care of persons with Alzheimer’s disease needs to be further investigated and analysed from a personcentred view including both daytime and nightime activities.

  • 22. Berglund, Britta
    et al.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    Nordström, Gun
    Acceptance of disability and sense of coherence in individuals with Ehlers-Danlos syndrome2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, p. 770-7Article in journal (Refereed)
    Abstract [en]

    Ehlers-Danlos syndrome (EDS) is a relatively rare, inherited connective tissue disorder and skin hyperextensibility, joint hypermobility, chronic joint and limb pain, blood vessel and tissue fragility are frequent symptoms. The aims of this study were to describe the degree to which individuals with EDS accept and cope with perceived limitations related to the syndrome, and to determine the relationships between acceptance of disability (AD), sense of coherence (SOC), functional health status and background data. Four questionnaires were mailed: the AD scale Modified (ADM), the SOC Scale, the Sickness Impact Profile (SIP) and a background form. The respondents with EDS were recruited through the EDS National Association in Sweden and the response rate was 74% (69 females and eight males). The Ethical Committee at Huddinge University Hospital (ref. no. 152/95) approved the study. This study has shown that the level of AD and SOC in individuals with EDS is similar to other patient groups, e.g. individuals with ostomy and with diabetes. Further, the SOC was in concordance with that of the general population. Those working full-time accepted their disability to a greater degree than those on sick leave or disability pension. A multiple regression analysis showed that a greater AD was associated with a higher level of SOC and a better functional health status. The SOC and SIP together accounted for 50% of the variance in the ADM. For health promotion in nursing practice it is important to have insight into the problem areas which may influence the overall life situation for an individual with EDS. A key issue for nurses is to identify individuals with low acceptance of their disease and/or low SOC in order to support these persons' adaptation process. Future research on EDS may be directed towards projects focusing on the development and implementation of models to strengthen the level of AD and SOC in this group.

  • 23.
    Hillerås, Pernilla K
    et al.
    Sophiahemmet University.
    Jorm, Anthony F
    Herlitz, Agneta
    Winblad, Bengt
    Activity patterns in very old people: a survey of cognitively intact subjects aged 90 years or older1999In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 28, no 2, p. 147-52Article in journal (Refereed)
    Abstract [en]

    AIM: to measure activity patterns in very old people, the factors related to this and the association of different types of activity with well-being.

    METHODS: a study of 105 people, aged 90 years or older, who were not cognitively impaired, living in Stockholm. The activities carried out during the previous day were recorded and each activity was rated.

    RESULTS AND CONCLUSIONS: the degrees of intellectual, social and physical activity are independent of each other. Very elderly people tended to have variable but relatively low activity levels over a day. Good health and not moving home were associated with greater intellectual activity. Extraversion and negative life events (such as death of close friend or family member) were associated with greater social activity, while relatively younger age and better health were associated with greater physical activity. There was positive association between physical activity and well-being.

  • 24. O'Sullivan, Anna
    et al.
    Öhlen, Joakim
    Alvariza, Anette
    Håkanson, Cecilia
    Sophiahemmet University.
    Adaptation and validation of the VOICES (SF) questionnaire - for evaluation of end-of-life care in Sweden2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Instruments for evaluating end-of-life care by voicing experiences of family members have previously been lacking in Sweden. The objective of this study was therefore to adapt and validate the VOICES (SF) questionnaire to evaluate quality of end-of-life care in Sweden. The VOICES (SF) [Views of Informal Carers - Evaluation of Services (Short form)] is a questionnaire about bereaved relatives' experiences of care in the last three months of life of a deceased family member.

    METHODS: This study was performed based on translation and back translation, cross-cultural adaptation and content validation through cognitive interviewing and feedback from professional experts. For the cognitive interviews, a purposeful sample of 35 bereaved family members was recruited from home care, hospital wards and nursing homes. The participants were 13 men and 22 women (age ranged between 20 and 90+, mean age 66), who were relatives of persons who died from life-limiting conditions. The bereaved family members' and the professional experts' concerns were summarised and analysed based on clarity, understanding, relevance, sensitivity and alternative response/wording.

    RESULTS: The main concerns emerging from the content validation related to the understanding and clarity of some of the questionnaire items', and a few concerns regarding the relevance of different response alternatives or items. Only two of the family members found it emotional to complete the questionnaire, and they still deemed completing it to be important and manageable.

    SIGNIFICANCE OF RESULTS: The VOICES (SF) can be considered as feasible in the Swedish context, provided that cultural adaptation has been achieved, that is translation alone is not enough. The Swedish version will be available for healthcare professionals to use for quality monitoring of the care provided over the last three months in life, and for research, it enables national and cross-national comparisons between different healthcare places and organisations.

  • 25. El Malla, Hanan
    et al.
    Ylitalo Helm, Nathalie
    Wilderäng, Ulrica
    El Sayed Elborai, Yasser
    Steineck, Gunnar
    Kreicbergs, Ulrika
    Sophiahemmet University.
    Adherence to medication: A nation-wide study from the Children's Cancer Hospital, Egypt2013In: World journal of psychiatry, ISSN 2220-3206, Vol. 3, no 2, p. 25-33Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt.

    METHODS: We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read the questions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child's medical journal. The study period consisted of 7 mo (February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher's exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, United States).

    RESULTS: Two hundred and eighty-one (90%) parents answered the second questionnaire, regarding their child's adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment (181/281, 64%). Sixty-eight percent (123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance (111/123, 90%) and inadequate information (100/123, 81%). In the adherent group, 20% of the parents (n = 12/58) reported trust in their child's doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123 (7%) for both their child's doctor and other health-care professionals. Almost all of the parents expressed a lack of optimism towards the treatment (116/121, 96%), yet they reported an intention to continue with the treatment for two main reasons, for the sake of their child's life (70%) (P = 0.005) and worry that their child would die if they discontinued the treatment (81%) (P < 0.0001).

    CONCLUSION: Non-adherence to medical regimen is common among children diagnosed with cancer in Egypt, the main reasons being child resistance and inadequate information.

  • 26. Theander, Kersti
    et al.
    Wilde-Larsson, Bodil
    Carlsson, Marianne
    Florin, Jan
    Gardulf, Ann
    Johansson, Eva
    Lindholm, Christina
    Sophiahemmet University.
    Nordström, Gun
    Nilsson, Jan
    Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence2015In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 178-183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported.

    OBJECTIVES: To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented.

    SETTING: A higher education nursing program at a Swedish university.

    PARTICIPANTS: In total, 119 (2011 n=69, 2014 n=50) nursing students responded.

    METHODS: Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale.

    RESULTS: There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students.

    CONCLUSIONS: Our findings indicate that newly graduated nursing students - both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing.

  • 27. Nilsson, Marie I
    et al.
    Petersson, Lena-Marie
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Olsson, Mariann
    Vaez, Marjan
    Alexanderson, Kristina
    Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 12, p. 2755-62Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work-related problems caused by treatments. Most previous studies have focused on individual and disease-related factors, whereas few have focused on work-related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery.

    METHOD: Inclusion criteria were as follows: women aged 20-63 years, living in Stockholm County, treated surgically for a first diagnosis of breast cancer, literate in Swedish, without pre-surgical chemotherapy or known distant metastases. Included in the study were 605 women who worked at diagnosis and that had answered a questionnaire within eight weeks of inclusion. Descriptive statistics, univariate, and multivariable logistic regression analyses were applied to estimate odds ratios (OR) with 95% confidence intervals (CI) for the likelihood of being sickness absent.

    RESULTS: Most women perceived and received social support and work adjustment after breast cancer surgery. Low adjustment (OR = 2.14; 95% CI, 1.45-3.18) and less social support (OR = 1.80; 95% CI, 1.16-2.78) were significantly associated with being sickness absent. Adjusting for sociodemographics, strenuous work posture, and treatment did not attenuate these associations.

    CONCLUSION: Adjustment at work and social support from employer are associated with sickness absence and needs to be explored in discussions on return to work after breast cancer surgery. Copyright © 2013 John Wiley & Sons, Ltd.

  • 28. Avelin, Pernilla
    et al.
    Gyllenswärd, Göran
    Erlandsson, Kerstin
    Rådestad, Ingela
    Sophiahemmet University.
    Adolescents' experiences of having a stillborn half-sibling2014In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 38, no 9, p. 557-562Article in journal (Refereed)
    Abstract [en]

    Although there is an increasing interest in siblings' experiences of loss and grief there is limited knowledge of adolescent's own perspectives, especially in a unique situation as after stillbirth in a reconstituted family. The authors interviewed 13 bereaved adolescents. They were sad that their family was not the same and expressed feelings of being inside family grief, yet outside, because they did not have full access in their reconstituted family. An implication of present findings is that it is important to include all the members of the family in the grieving process, even half-siblings of the deceased child.

  • 29.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Advertorial: International Diabetes Federation2015In: The Diabetes Communicator, ISSN 1912-8851, Vol. Summer, p. 1p. 22-Article in journal (Other (popular science, discussion, etc.))
  • 30. Winge, Charlotte
    et al.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    Shultz, Inkeri
    After axillary surgery for breast cancer: is it safe to take blood samples or give intravenous infusions?2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 9-10, p. 1270-4Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer.

    BACKGROUND: After axillary lymph node clearance in patients with breast cancer, some women experience lymphoedema and recurrent infections. To reduce the risk of these postoperative complications, most women are advised to not have intravenous infusions in, or blood samples taken from, the arm in the operated side. Very little published data are available regarding the incidence of lymphoedema after intravenous procedures under clean conditions in the hospital setting. This study set out to investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer is therefore important.

    DESIGN: Descriptive.

    METHODS: Self-reported questionnaire.

    RESULTS: Most of the reported complications were minor, including itching, bruises and vomiting at the time of the intravenous procedure. The most serious complication was infection in one patient needing antibiotic treatment and subsequent arm swelling.

    CONCLUSIONS: This study indicates that if a blood sample is taken or intravenous injection is given according to the current Swedish guidelines for health care professionals, there should be a very low risk of complications.

    RELEVANCE TO CLINICAL PRACTICE: If intravenous procedures are performed without any disadvantage in the arm of the operated side in women who have undergone axillary surgery, the clinical problem of finding a proper vein and the psychological concern of the women can be reduced.

  • 31. Mullins, L-C
    et al.
    Moody, L
    Colguitt, R
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    Andersson, L
    An examination of nursing home personnel's perceptions of residents' autonomy1998In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 17, no 84, p. 527-34Article in journal (Refereed)
  • 32. Warne, Tony
    et al.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Papastavrou, Evridiki
    Tichelaar, Erna
    Tomietto, Marco
    Van den Bossche, Koen
    Moreno, Maria Flores Vizcaya
    Saarikoski, Mikko
    An exploration of the clinical learning experience of nursing students in nine European countries2010In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, p. 809-815Article in journal (Refereed)
    Abstract [en]

    The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N = 1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007–2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship.

  • 33. Guldbrandsson, Karin
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena2009In: Health Promotion International, ISSN 1460-2245, Vol. 24, no 4, p. 434-44Article in journal (Refereed)
    Abstract [en]

    In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.

  • 34. Salih Joelsson, L
    et al.
    Tydén, T
    Wanggren, K
    Georgakis, M K
    Stern, Jenny
    Sophiahemmet University.
    Berglund, A
    Skalkidou, A
    Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 212-219, article id S0924-9338(17)32929-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

    METHODS: Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

    RESULTS: The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise<2h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09-1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04-1.49).

    CONCLUSIONS: Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

  • 35. Gravensteen, Ida Kathrine
    et al.
    Jacobsen, Eva-Marie
    Sandset, Per Morten
    Helgadottir, Linda Bjørk
    Rådestad, Ingela
    Sophiahemmet University.
    Sandvik, Leiv
    Ekeberg, Øivind
    Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women's relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth.

    METHODS: This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors.

    RESULTS: Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90-10.32 and aOR 1.91, 95% CI 1.11-3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68-9.24 and aOR 1.91, 95% CI 1.08-3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval <  12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups.

    CONCLUSION: Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.

  • 36. Fredricson, Adrian Salinas
    et al.
    Khodabandehlou, Farid
    Weiner, Carina Krüger
    Naimi-Akbar, Aron
    Adami, Johanna
    Sophiahemmet University.
    Rosén, Annika
    Are there early signs that predict development of temporomandibular joint disease?2017In: Journal of Oral Science, ISSN 1343-4934, E-ISSN 1880-4926Article in journal (Refereed)
    Abstract [en]

    Temporomandibular joint disorders (TMJD) involve orofacial pain and functional limitations that may limit important daily activities such as chewing and speaking. This observational case-control study attempted to identify factors associated with TMJD development, particularly inflammation. The study participants were patients treated at Karolinska University Hospital, Stockholm, Sweden. The cases were patients who received a diagnosis of TMJD, chronic closed lock, or painful clicking and were treated surgically during the period from 2007 through 2011. The control group was randomly selected from among patients who had undergone tooth extraction and was matched by age and sex. A total of 146 cases and 151 controls were included in the analyses. The response rate was 55.3% for the case group and 21.8% for the control group. The male:female ratio for patients with TMJD was 1:4.4. TMJD was significantly associated with pneumonia (odds ratio [OR], 2.1), asthma (OR, 2.1), allergies (OR, 1.8), headache (OR, 3.1), general joint hypermobility (OR, 3.8), orofacial trauma (OR, 3.9), rheumatism (OR, 2.5), and orthodontic treatment (OR, 2.4) (P < 0.05 for all outcomes). In conclusion, autoimmune diseases and inflammatory conditions are associated with increased risk of TMJD. Moreover, certain lung disorders may predict subsequent development of TMJD.

  • 37.
    Wennman-Larsen, Agneta
    et al.
    Div. of Insurance Medicine, Dpt of Clinical Neuroscience, Karolinska Institutet.
    Olsson, Mariann
    Alexanderson, Kristina
    Nilsson, Marie I
    Petersson, Lena-Marie
    Arm morbidity and sick leave among working women shortly after breast cancer surgery2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 1, p. 101-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is limited knowledge about the impact of arm morbidity on sick leave in the immediate period after breast cancer surgery.

    PURPOSE: To determine if arm morbidity was associated with sick leave shortly after breast cancer surgery and to investigate the association between arm morbidity and sick leave, adjusted for treatment, work characteristics, co-morbidity, time since surgery, and sociodemographic factors.

    SAMPLE AND METHODS: Included were 511 women who within 12 weeks had had breast cancer surgery, were aged 20-63 years, had no distant metastasis, pre-surgical chemotherapy, or previous breast cancer, and worked ≥75% before breast cancer diagnosis. Percentages and odds ratios (OR) for being on sick leave were calculated, using multivariable analyses.

    RESULTS: Of the women, 10% reported arm morbidity, 43% had had a total axillary clearance, and 60% were on sick leave. In multivariable analysis, those with planned chemotherapy had the highest OR (4.69; 95% CI 2.97-7.41) for being on sick leave. Nevertheless, those reporting arm morbidity had the second highest OR (2.71; 1.23-5.97) which was higher than if having strenuous work postures (2.49; 1.50-4.15) or having had an axillary clearance (1.64; 1.04-2.60).

    CONCLUSION: Arm morbidity is an important factor for whether being on sick leave or not shortly after breast cancer surgery, even more important than type of axillary surgery or work situation. However, planned chemotherapy had the greatest impact for being on sick leave already shortly after breast cancer surgery.

  • 38.
    Eulau, Louise
    et al.
    Sophiahemmet University.
    Sundman, Christina
    Scheja, Max
    Fossum, Bjöörn
    Assessing students' learning in student-dedicated treatment rooms during clinical nursing education2015In: Nursing and Health, ISSN 2332-2217, Vol. 3, no 1, p. 22-29Article in journal (Refereed)
  • 39. Gaber, Flora
    et al.
    James, Anna
    Delin, Ingrid
    Wetterholm, Anders
    Sampson, Anthony P
    Dahlén, Barbro
    Dahlén, Sven-Erik
    Kumlin, Maria
    Sophiahemmet University.
    Assessment of in vivo 5-lipoxygenase activity by analysis of leukotriene B4 in saliva: effects of treatment with zileuton2007In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 119, no 5, p. 1267-8Article in journal (Other academic)
  • 40. Rådestad, Monica
    et al.
    Lennquist Montán, Kristina
    Rüter, Anders
    Sophiahemmet University.
    Castrén, Maaret
    Svensson, Leif
    Gryth, Dan
    Fossum, Bjöörn
    Sophiahemmet University.
    Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 4, p. 376-85Article in journal (Refereed)
    Abstract [en]

    Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).

    METHODS: A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.

    RESULTS: The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.

    CONCLUSION: Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):1-10.

  • 41. Björklund, Ulla
    et al.
    Marsk, Anna
    Levin, Charlotta
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening: a randomized controlled trial2012In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 86, no 3, p. 390-395Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. METHODS: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). RESULTS: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. CONCLUSIONS: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. PRACTICE IMPLICATIONS: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women.

  • 42. Unbeck, Maria
    et al.
    Sterner, Eila
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    PukkHärenstam, Karin
    Authors' response (Unbeck and colleagues)2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 1, p. 484-5; discussion 485Article in journal (Other academic)
  • 43.
    Randers, Ingrid
    et al.
    Sophiahemmet University College.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    Autonomy and integrity: upholding older adult patients' dignity2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 45, no 1, p. 63-71Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations. METHOD: The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data. FINDINGS: The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously. CONCLUSION: The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.

  • 44.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Malm, Mari-Cristin
    Lindgren, Helena
    Pettersson, Karin
    Franklin Larsson, Lise-Lotte
    Sophiahemmet University.
    Being alone in silence - Mothers' experiences upon confirmation of their baby's death in utero2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 3, p. e91-e95Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore mothers' experiences of the confirmation of ultrasound examination results and how they were told that their baby had died in-utero.

    DESIGN: in-depth interviews.

    SETTING: Sweden.

    PARTICIPANTS: 26 mothers of stillborn babies.

    MEASUREMENT: narratives were analysed using a qualitative content analysis with an inductive approach.

    FINDINGS: the mothers experienced that silence prevailed during the entire process of confirming the ultrasound results. Typically all present in the ultrasound room were concentrating and focusing on what they observed on the screen, no one spoke to the mother. The mothers had an instinctive feeling that their baby might be dead based on what they observed on the ultrasound screen and on their interpretation of the body language of the clinicians and midwives. Some mothers reported a time delay in receiving information about their baby's death. Experiencing uncertainty about the information received was also noticed.

    CONCLUSION: mothers emphasised an awareness of silence and feelings of being completely alone while being told of the baby's death.

    IMPLICATION FOR PRACTICE: the prevalence of silence during an ultrasound examination may in certain cases cause further psychological trauma for the mother of a stillborn baby. One way to move forward given these results may be to provide obstetric personnel sufficient training on how difficult information might be more effectively and sensitively provided in the face of an adverse pregnancy outcome.

  • 45.
    Eilegård, Alexandra
    et al.
    Sophiahemmet University.
    Steineck, Gunnar
    Nyberg, Tommy
    Kreicbergs, Ulrika
    Sophiahemmet University.
    Bereaved siblings' perception of participating in research: a nationwide study2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 2, p. 411-416Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of the present study is to examine bereaved siblings' perception of research participation. METHODS: A Swedish nationwide study on avoidable and modifiable health care-related factors in paediatric oncology among bereaved siblings who lost a brother or sister to cancer between the years 2000 and 2007 was conducted. Data are presented as proportions, and the differences between groups were statistically tested at the 5% significant level using Fisher's exact test. RESULTS: Out of 240 eligible siblings, 174 responded (73 %). None of the siblings (0/168) thought their participation would affect them negatively in the long term. However, 13% (21/168) stated it was a negative experience to fill out the questionnaire, whereas 84% (142/169) found it to be a positive experience. Women were more likely to report their participation as positive in a long-term perspective compared with men (p = 0.018). CONCLUSIONS: None of the bereaved siblings in this Swedish nationwide study anticipated any long-term negative effect from their research participation. A majority reported it as positive to revisit their needs and experiences throughout their brother or sister's illness and death 2-9 years following the loss. We believe that the stepwise approach used in this study contributed to the high acceptance. Copyright © 2011 John Wiley & Sons, Ltd.

  • 46.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Pettersson, Karin
    Hagelberg, Linn
    Georgsson, Susanne
    Sophiahemmet University.
    "Better safe than sorry"-Reasons for consulting care due to decreased fetal movements2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 5, p. 376-381, article id S1871-5192(17)30074-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experience of reduced fetal movements is a common reason for consulting health care in late pregnancy. There is an association between reduced fetal movements and stillbirth.

    AIM: To explore why women decide to consult health care due to reduced fetal movements at a specific point in time and investigate reasons for delaying a consultation.

    METHODS: A questionnaire was distributed at all birth clinics in Stockholm during 2014, to women seeking care due to reduced fetal movements. In total, 3555 questionnaires were collected, 960 were included in this study. The open-ended question; "Why, specifically, do you come to the clinic today?" was analyzed using content analysis as well as the complementary question "Are there any reasons why you did not come to the clinic earlier?"

    RESULTS: Five categories were revealed: Reaching dead line, Receiving advice from health care professionals, Undergoing unmanageable worry, Contributing external factors and Not wanting to jeopardize the health of the baby. Many women stated that they decided to consult care when some time with reduced fetal movements had passed. The most common reason for not consulting care earlier was that it was a new experience. Some women stated that they did not want to feel that they were annoying, or be perceived as excessively worried. Not wanting to burden health care unnecessarily was a reason for prehospital delay.

    CONCLUSION: Worry about the baby is the crucial reason for consulting care as well as the time which has passed since the women first experienced decreased fetal movements.

  • 47.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Bullington, Jennifer
    Body awareness in persons diagnosed with rheumatoid arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl 2, p. 1327-Article in journal (Refereed)
  • 48.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Bullington, Jennifer
    Body awareness in persons diagnosed with rheumatoid arthritis2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, p. 24670-Article in journal (Refereed)
    Abstract [en]

    Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a person's health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patient's perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23–78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: “A reactive process on symptoms,” “A reactive process on emotional triggers,” “An active process of taking an inventory of abilities,” and “A shifting from BA to the outside world.” In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patient's general health.

  • 49.
    Saboonchi, Fredrik
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Body awareness, perfectionism and pain2009In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 24, no Supp 1, p. 347-347Article in journal (Refereed)
  • 50.
    Swall, Anna
    et al.
    Sophiahemmet University.
    Ebbeskog, Britt
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Fagerberg, Ingegerd
    'Bringing respite in the burden of illness': dog handlers experience of visiting older persons with dementia together with a therapy dog2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 15-16, p. 2223-31Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To illuminate meanings of the lived experiences of dog handlers' when visiting older persons with dementia with their therapy dog.

    BACKGROUND:

    Studies indicate that care of persons with dementia should focus on a person-centred approach with the person's interests in the centre. Animal-assisted therapy using a therapy dog in the care of persons with dementia has been shown to increase well-being and decrease problematic behaviours associated with the illness.

    DESIGN:

    A qualitative lifeworld approach was adopted for this study.

    METHODS:

    Data were collected from open-ended interviews with nine dog handlers, and the analysis conducted using the phenomenological hermeneutical method.

    RESULTS:

    The structural analysis resulted in one theme, 'Respite from the burden of illness for persons with dementia'.

    CONCLUSIONS:

    Visiting a person with dementia can be seen as an act of caring, providing temporary respite from their illness, and creating a special relationship between handler and patient. A therapy dog visit can represent a moment of communion between the handler and the person with dementia.

    IMPLICATION FOR CLINICAL PRACTICE:

    Dog handlers use their skills and knowledge to promote a situation that reduces symptoms of illness and encourages healthier behaviour. The results of this study may be of interest to researchers, clinical practitioners, caregivers and dog handlers who care for persons with dementia using therapy dog teams on prescription as an alternative method to minimise behavioural and psychological symptoms of dementia.

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