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  • 101.
    Philip, Ragnartz
    et al.
    Mälardalens högskola, Akademin för innovation, design och teknik.
    Staffanson, Axel
    Mälardalens högskola, Akademin för innovation, design och teknik.
    Produktutveckling av medicinteknisk produkt, Suture passer2016Independent thesis Basic level (university diploma), 10 poäng / 15 hpOppgave
    Abstract [en]

    The following report has been prepared based upon an assignment given by the company, Ortopedic Care Scandinavia AB. The paper is an exam on basic level, 15 credit points at higher level education within product development.

    Ortopedic Care Scandinavia AB is working with product development of medical technology products. What makes the corporate unique is the fact that the development is based upon problems encountered by surgeons in their daily work. Suggestions for improvement in technology are given directly by the end users. This paper is based upon such problems.

    Product development was made on the medical instrument called, suture passer. The instrument is used in endoscopic surgery of the rotator cuff. The cuff is a group of four muscles (and their respective tendons) that stabilize the shoulder. In case of an accident, mostly sport related, these muscles can loosen from the bone. In surgery a suture passer is then used to penetrate the injured tendon with a needle with an attached suture. The passer creates a loop of suture that can be used to attach the damaged tendon.

    The report is based upon the following problem formulations:

    • The needle has an inconvenient edge that can damage the muscle.
    • The strength of the suture thread is deteriorated by the design of the needle.
    • The suture thread has been known to snap when the surgeon apply to much pressure when tying.
    • If the patient is suffering from subacromial impingement the jaw of the instrument can appear to be clumsy and hard to open.
    • The jaw has sharp teeth which have been known to get stuck in the tendon. The surgeon must then perform an uncontrolled movement which might damage the tendon.
    • The jaw limits the surgeons’ choice of thickness of the suture thread.
    • The thickness of the needle used in the suture passer is limited to one size. 

    The purpose of the project is to develop a new concept that minimizes the risk for the patient and at the same time the concept should facilitate the work of the surgeon. The concept should meet the set requirements and be presented in the form of renderings of CAD-models and drawings.

    To achieve this process the instrument uses four different components. The needle, the jaw, the handle and an attachment between the needle and the handle.  Under heading 5, the generating process, each component presents to together with arguments of its design. The instrument consist of 25 components that are all developed from the ground up.

    The result should be viewed as a thorough concept that can be used for further development. It is recommended that the next step should be an investigation about material choice. When the material is specified a prototype should be manufacture and then used for testing. 

  • 102.
    Prenler, Johanna
    Mälardalens högskola, Akademin för innovation, design och teknik.
    Om astma för barn: Hur man förenklar komplex information med hjälp av bilder2016Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    This report presents the process of creating an information material for children

    around the age of seven that have just gotten the diagnosis asthma. With the help of

    literature, an interview with an expert in the field, and tests together with the target

    audience a material has been produced. A material that presents the information of

    how the everyday life with asthma will be like, in a simple and relaxed way. By

    explaining asthma with simple images, it makes the information more relaxed, and

    makes it easier for the children to process. This report accounts for the different

    theories, methods, and processes that has been utilised to create this material.

    Denna rapport syftar till att presentera den process jag genomfört för att skapa ett

    informationsmaterial för barn runt sju år som precis fått diagnosen astma. Med

    hjälp av litteratur, intervju med sakkunnig, samt tester ihop med målgruppen har ett

    material tagits fram. Ett material som presenterar information om hur vardagen

    med astma ser ut, på ett enkelt och avdramatiserat vis. Genom att förklara astma

    med enkla bilder gör det informationen avdramatiserad och gör den mer

    lättillgänglig för barnen att ta till sig. Denna rapport innehåller redogörelser för de

    olika teorier, metoder och processer som jag har använt för att skapa detta material.

  • 103.
    Ragnar, Inga
    et al.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Altman, D
    Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Tydén, T
    University of Uppsala, Uppsala, Sweden .
    Olsson, S-E
    Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Comparison of the maternal experience and duration of labour in two upright delivery positions - a randomised controlled trial.2006Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, Vol. 113, nr 2, s. 165-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience. Design: A randomised controlled trial. Setting: A county hospital delivery ward. Sample: Primiparous subjects (n = 271) were randomly allocated to a kneeling (n = 138) or a sitting (n = 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial. Methods: Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis. Main outcome measure: Duration of the second stage of labour. Results: A comparison of the duration of the second stage of labour (kneeling 48.5 minutes +/- 27.6 SD, sitting 41 minutes +/- 23.4 SD) revealed no significant difference between the groups. A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P = 0.002), less comfort for giving birth (P = 0.03) and more frequent feelings of vulnerability (P = 0.05) and exposure (P = 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) (Table 3). Conclusion: Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.

  • 104.
    Ragnar, Maria Ekstrand
    et al.
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Grandahl, Maria
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Stern, Jenny
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Mattebo, Magdalena
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health2018Inngår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, nr 4, s. 265-273Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group. Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis. Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given. Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

  • 105.
    Rahme, Hans
    et al.
    University Hospital, Uppsala, Sweden.
    Vikerfors, Ola
    Central Hospital, Västerås, Sweden.
    Ludvigsson, Lena
    Central Hospital, Västerås, Sweden.
    Elvén, Maria
    Central Hospital, Västerås, Sweden.
    Michaëlsson, K
    University Hospital, Uppsala, Sweden.
    Loss of external rotation after opern Bankart repair: an important prognostic factor for patient satisfaction2010Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, s. 404-408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0° of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10° of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

  • 106.
    Rasjö Wrååk, G.
    et al.
    Storvretens Primary Health Care Centre, Stockholm County, Sweden.
    Törnkvist, L.
    Karolinska Institutet, Stockholm, Sweden .
    Hasselström, J.
    Karolinska Institutet, Stockholm, Sweden .
    Wändell, P. E.
    Karolinska Institutet, Stockholm, Sweden .
    Josefsson, Karin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Nurse-led empowerment strategies for patients with hypertension: A questionnaire survey2015Inngår i: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 62, nr 2, s. 187-195Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim: This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods: A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results: Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations: Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion: Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. Implications for nursing and health policy: This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.

  • 107.
    Renbro, Gunnar
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Palpationsömhet i perifer nerv och känseltest med sporre på friska försökspersoner2010Independent thesis Basic level (university diploma), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Smärtor i ben är vanligt förekommande och neuropati (nervskada) är en orsak som troligen är underdiagnostiserad. Bimanuell (tvåhändig/tvåsidig) nervpalpation och känseltest med sporre har visat sig vara ganska tillförlitliga och enkla test för att hitta nervskada men har inte testats på friska individer.

    Syfte: Syftet var att undersöka om bimanuell nervpalpation i fossa poplitea framkallar smärta/obehag och om det finns skillnad mellan vänster och höger sida vid bimanuell undersökning med sporre på underben hos friska försökspersoner.

    Metod: Ett bimanuellt palpationstest av nervi tibialis och peroneus i fossa poplitea och även ett bimanuellt känseltest med sporre över dermatomen L4, L5 och S1 på underben genomfördes. Urvalet var ändamålsenligt och totalt deltog 37 försökspersoner. Åldersspannet var 20 till 57 och medianålder 23.

    Resultat: Vid palpationstestet hade intensiteten av smärta/obehag en median på 1 (variationsvidd 3) på den 11 gradiga skalan. En stor del skattade olika mellan sidorna i både palpationstestet (11 av 37) och känseltestet med sporre (25 av 37). Det var inte någon större skillnad mellan könen.

    Slutsats: När man utför dessa nervtester måste man ta hänsyn till att även friska individer ofta anger en liten sidoskillnad och inte alltid skattar noll vad gäller smärta/obehag. Det behövs dock fler studier för att bekräfta dessa resultat.

  • 108.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Lööf, Helena
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Yngve, Agneta
    Exploration of study participants experiences following Sophia Step Study: A two-year physical activity intervention2016Konferansepaper (Annet vitenskapelig)
  • 109.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Lööf, Helena
    Sophiahemmet Högskola.
    Yngve, Agneta
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Using pedometers for self-management of physical activity: Participants' experiences from Sophia Step Study: A physical activity promotion intervention in pre- and type 2 diabetes2017Konferansepaper (Annet vitenskapelig)
  • 110.
    Rubertsson, Christine
    et al.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Wickberg, B.
    University of Göteborg, Sweden.
    Gustafsson, P.
    Karolinska Institutet, Stockholm, Sweden.
    Rådestad, Ingela
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Depressive symptoms in early pregnancy two months and one year postpartum-prevalence and risk factors in a national Swedish sample2005Inngår i: Archives of Women’s Mental Health, ISSN 1434-1816, Vol. 8, nr 2, s. 97-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained. METHODS: All Swedish speaking women attending their first antenatal care visit during three predestined weeks were invited to participate. Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy, two months and one year postpartum. RESULTS: In all, 2430 women completed three questionnaires. A dose-effect relation was found between the numbers of stressful life events experienced in the year prior to pregnancy and mean EPDS score in pregnancy. The prevalence of recurrent or sustained depressive symptoms (EPDS> or =12 on all three evaluations) was 3% (79/2430). Three factors were associated with depressive symptoms, two or more stressful life events in the year prior to pregnancy, native language other than Swedish and unemployment. CONCLUSIONS: Apart from questions about psychiatric history, a psychosocial history in early pregnancy including stressful life events, native language and employment status could help the health professionals to identify women at risk for recurrent or sustained depression during pregnancy and the year after giving birth.

  • 111.
    Rådestad, Ingela
    et al.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Rubertsson, Christine
    Karolinska Institutet, Stockholm, Sweden .
    Ebeling, M.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Hildingsson, Ingegerd
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap. Karolinska Institutet, Stockholm, Sweden .
    What factors in early pregnancy indicate that the mother will be hit by her partner during the year after childbirth2004Inngår i: Birth, ISSN 0730-7659, Vol. 31, nr 2, s. 84-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To be hit by one's intimate partner during the first year after childbirth may affect a woman's health and ability to take care of her newborn. The purpose of this study was to document the prevalence and indicators in early pregnancy of a woman being hit by her partner during the year after childbirth. METHOD: Information was collected by a postal questionnaire in early pregnancy and 12 months after childbirth from the approximately 5,550 women in Sweden who visited an antenatal care clinic for the first time during one of three chosen weeks in 1999 and 2000. RESULTS: Of the 3,266 recruited women, 2,563 returned the follow-up questionnaire. Being hit during the first year after childbirth was reported by 52 of the 2,563 (2%) women: 32 (61%) had been hit by their partner once, 12 (23%) twice, and 8 (15%) three or more times. Risk increased in women who were age 24 years or younger (3.9% had been hit), unmarried (7.1%), born in countries outside Europe (6.8%), with a partner born outside Europe (5.4%), had a low level of education (8.9%), and were unemployed (5.0%). In early pregnancy, women with back pain (4.0%), a chronic illness (4.1%), coital pain (6.1%), frequent depression-related symptoms (8.1%), stomach pain (3.8%), or a urinary tract problem (6.3%) were hit more often than others after childbirth. CONCLUSIONS: At least 2 percent of Swedish women giving birth in 2000 were hit by their partner during the year after childbirth. Using identified predictors during antenatal care may increase the likelihood of finding women at risk, thereby enhancing the possibility of interventions to prevent this crime and health hazard.

  • 112.
    Sjöö, Emmalisa
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Att lämna intensivvården: En kvalitativ litteraturstudie2018Independent thesis Advanced level (professional degree), 5 poäng / 7,5 hpOppgave
    Abstract [sv]

    När en patient som varit kritiskt sjuk börjar återhämta sig är det aktuellt med förflyttning från intensivvårdsavdelning (IVA) till en lägre vårdnivå på vårdavdelning. Ett högt tryck på intensivvårdsplatser kan resultera i snabba förflyttningar, vilka riskerar en bristfällig planering och förberedelse. Detta kan få negativa konsekvenser för patienten genom ökad risk för återinläggning på IVA, förlängd vårdtid och ökad mortalitet. Det är intensivvårdssjuksköterskans ansvar att genomföra en trygg och sammanhållen patientförflyttning. Att genomgå transition innebär att patienten ställs inför en förändring, exempelvis från en miljö till en annan, vilket kräver anpassning. Studiens syfte var att beskriva patienters upplevelse av förflyttning från IVA till vårdavdelning. En kvalitativ litteraturstudie med beskrivande syntes valdes som metod. Resultatet visar att bristfällig information och förberedelse inför en förflyttning orsakar oro, ångest och nedstämdhet. Detta till skillnad från de patienter som fick ett bra stöd och som upplevde att förflyttningen var ett positivt steg i rätt riktning. Utifrån resultatet kan slutsatsen dras att patienter som skall förflyttas från IVA behöver individuellt anpassad information och förberedelse. Det finns ett behov av tydligare riktlinjer för att minska oron hos patienter, underlätta kommunikation och informationsöverföring samt garantera patientsäkerheten.

  • 113.
    Skoglund, Karin
    et al.
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Hillered, Lars
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Tsitsopoulos, Parmenion
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Engquist, Henrik
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Purins, Karlis
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Lewén, Anders
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Enblad, Per
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Marklund, Niklas
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    The Neurological Wake-up Test Does not Alter Cerebral Energy Metabolism and Oxygenation in Patients with Severe Traumatic Brain Injury2014Inngår i: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Neurocritical Care, ISSN 1541-6933, Vol. 2014, nr 20, s. 413-426, artikkel-id 3Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.Methods: Seventeen intubated TBI patients (age16–74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2and/or SjvO2 . Up to 10 days postinjury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were ompared. MD was evaluated at a flow rate of 1.0 µL/min (28 NWTs) or the routine 0.3 µL/min rate (21 NWTs). Results: The NWT increased ICPandCPP levels (p<0.05). Compared to baseline, nterstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the actate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2(<50 % or >71 % ;n=2 NWTs) and PbtiO2(<10 mmHg; n=3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen. Conclusions: The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oygenation in TBI patients.

  • 114.
    Stenvall, M.
    et al.
    Umeå University, Sweden.
    Elinge, E.
    Umeå University, Sweden.
    von Heideken Wågert, Petra
    Umeå University, Sweden.
    Lundström, M.
    Umeå University, Sweden.
    Gustafson, Y.
    Umeå University, Sweden.
    Nyberg, L.
    Umeå University, Sweden.
    Having had a hip fracture – association with dependency among the oldest old2005Inngår i: Age and ageing, ISSN 0002-0729, Vol. 34, nr 3, s. 294-297Artikkel i tidsskrift (Fagfellevurdert)
  • 115.
    Strömsöe, Anneli
    Högskolan Dalarna.
    .: .2010Inngår i: Nationella kvalitetsregister och nationellt kvalitetsregister för hjärtstopp utanför sjukhus: Befolkningstäthet och dess karakteristik och utfall vid hjärtstopp utanför sjukhus, 2010Konferansepaper (Annet vitenskapelig)
  • 116.
    Strömsöe, Anneli
    Högskolan Dalarna.
    .: .2010Inngår i: Befolkningstäthet och dess karakteristik och utfall vid hjärtstopp utanför sjukhus, 2010Konferansepaper (Annet vitenskapelig)
  • 117.
    Strömsöe, Anneli
    Högskolan Dalarna, Sweden.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2015Konferansepaper (Annet (populærvitenskap, debatt, mm))
  • 118.
    Strömsöe, Anneli
    Högskolan Dalarna.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2014Konferansepaper (Annet vitenskapelig)
  • 119.
    Strömsöe, Anneli
    Högskolan Dalarna.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2013Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In Sweden, the reported incidence and outcome of out-of-hospital cardiac arrest (OHCA) vary between counties. In the mid -1980s, a national programme in cardiopulmonary resuscitation (CPR) was developed and rescuers have been educated in CPR. Since 1990, Swedish OHCA data are to be reported to the Swedish Cardiac Arrest Register (SCAR). The aim of this thesis was to describe and analyse the incidence and outcome of OHCA and the amount of national training in CPR from data reported to the SCAR and to the CPR training register. The data on OHCAs were related to a variety of epidemiological and quality indicators. Methods: this thesis is based on register data from both the SCAR and the CPR training register. The inclusion criteria were treated OHCAs (I-IV), witnessed treated OHCAs (V) and rescuers educated in CPR (I).The number of participants were: I: CPR training register, 1983-2007, n=2 million rescuers, and SCAR, 1990-2007, n=45,775, II: SCAR, 2008-2009, n=6,457 registered manually or on the web and n=3,522 registered on the web, III: SCAR, 2008-2010, n=2,398 prospectively registered and n=800 retrospectively registered, IV: SCAR, 1992-2011, n=59,926, V: SCAR, 2008-2010, n=11,005. Results: since 1983, 5,000 instructor-trainers have trained more than 50,000 instructors who have trained almost two million of Sweden’s nine million inhabitants to perform adult CPR. The number of bystander CPR attempts for OHCA in Sweden increased from 31% (1992) to 55% (2007) (I). In 2008-2009, the number of reported OHCAs varied between 13 and 52 per 100,000 inhabitants and year. Bystander CPR, cardiac aetiology and longer emergency medical service (EMS) response times were more frequent in less populated areas, but survival was not associated with population density (II). A validation process showed that, there was a 25% missing rate between 2008 and 2010 of OHCAs reported to the SCAR. In the non-reported OHCAs, patients were older and had less frequently received bystander CPR, but, despite this, they also had a higher survival rate (III). From 1992 to 2011, the OHCAs reported to the SCAR increased from 27 to 52 per 100,000 inhabitants and year. Survival to one month increased from 4.8% (1992) to 10.7% (2011), particularly among patients found in a shockable rhythm. This increase in survival was associated with signs of improvement in all four links of the chain of survival (IV). Furthermore, estimates indicate that, if the delay from collapse to 1) calling for an ambulance, 2) the start of CPR, and 3) the time to defibrillation is reduced to <2 min, <2min and <8 min respectively, approximately 300-400 additional lives could be saved (V). Conclusions: there has been an impressive development in the preparedness for and treatment of patients suffering from OHCAs in Sweden during the last 30 years. Improvements in various links in the chain of survival have resulted in a marked increase in survival after OHCA. It suggests that this figure will increase further if the delay to the start of treatment can be reduced still further.

  • 120.
    Strömsöe, Anneli
    Högskolan Dalarna.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences.2010Inngår i: ResuscitationArtikkel i tidsskrift (Fagfellevurdert)
  • 121.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2009Inngår i: XXII Nordic-Baltic Congress of Cardiology, Reykjavik, 2009Konferansepaper (Annet vitenskapelig)
  • 122.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Förbättrade resultat för patienter som drabbats hjärtstopp utanför sjukhus – en uppföljning från 1992 till 20112013Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Syfte: Att beskriva patienter som drabbats av hjärtstopp utanför sjukhus och dess resultatsförändringar i behandling och överlevnad.

    Metod: Patienter (n=59 926) som drabbats av hjärtstopp utanför sjukhus i samtliga Sveriges län och som rapporterats till Svenska hjärt-lungräddningsregistret från 1992 till 2011.

    Resultat: Antalet rapporterade hjärtstopp utanför sjukhus ökade från 27 (1992) till 52 (2011) per 100 000 invånare och år. Vidare så ökade bevittnandegraden av hjärtstopp utanför sjukhus av ambulanspersonalen, en ökad förekomst av hjärtlungräddning innan ambulansen kom fram till patienten samt att tiden ökade från larm till dess att ambulansen kom fram till patienten.

    1-månads-överlevnad ökade från 4,8% (1992) till 10,7% (2011). De som framförallt överlevde 1 månad eller mer var de patienter som levde vid ankomst till sjukhus. Av de patienter som drabbats av hjärtstopp utanför sjukhus mellan 2008 till 2010, var det 41% som genomgick kylbehandling på sjukhus samt 28% som behandlades med ballongvidgning av hjärtats kranskärl. De patienter som överlevde (2008-2011), hade 94% en god eller relativ god hjärnfunktion.

    Sammanfattning: De patienter som drabbats av hjärtstopp utanför sjukhus 1992-2011, påvisar en fördubblad överlevnad. De patienter som framförallt överlever, är de som lever vid ankomst till sjukhus och som senare läggs in på vårdavdelning.   

  • 123.
    Strömsöe, Anneli
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Mälardalens högskola.
    Kvalitetsindikatorer i det svenska hjärt-lungräddningsregistret2015Konferansepaper (Annet vitenskapelig)
  • 124.
    Strömsöe, Anneli
    Högskolan Dalarna, Sweden.
    Långsiktigt förbättrade resultat hos patienter som drabbats av hjärtstopp utanför sjukhus2015Konferansepaper (Annet vitenskapelig)
  • 125.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Utbildning i HLR i Sverige och dess kliniska konsekvenser2008Inngår i: HLR kongressen, Stockholm, 2008Konferansepaper (Annet vitenskapelig)
  • 126.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden2012Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in 4 Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2398 and retrospective cases n=3198 which indicates a 30% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3198 cases of OHCA in 4 regions in Sweden 800 (30%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 127.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden: [HLR-registrets tillförlitlighet]2013Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: To describe differences between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in three Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2, 398 and retrospective cases n=3, 198 which indicates a 25% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3, 198 cases of OHCA in three regions in Sweden 800 (25%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 128.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    Afzelius, S.
    Axelsson, C.
    Kallestedt, M. L. Sodersved
    Enlund, M.
    Svensson, L.
    Herlitz, J.
    Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden2013Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 273, nr 6, s. 622-627Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. In a review based on estimations and assumptions, to report the estimated number of survivors after out-of-hospital cardiac arrest (OHCA) in whom cardiopulmonary resuscitation (CPR) was started and to speculate about possible future improvements in Sweden.

    Design. An observational study. Setting All ambulance organisations in Sweden. Subjects Patients included in the Swedish Cardiac Arrest Registry who suffered an OHCA between January 1, 2008 and December 31, 2010. Approximately 80% of OHCA cases in Sweden in which CPR was started are included. Interventions None

    Results. In 11005 patients, the 1-month survival rate was 9.4%. There are approximately 5000 OHCA cases annually in which CPR is started and 30-day survival is achieved in up to 500 patients yearly (6 per 100000 inhabitants). Based on findings on survival in relation to the time to calling for the Emergency Medical Service (EMS) and the start of CPR and defibrillation, it was estimated that, if the delay from collapse to (i) calling EMS, (ii) the start of CPR, and (iii) the time to defibrillation were reduced to <2min, <2min, and <8min, respectively, 300400 additional lives could be saved.

    Conclusion. Based on findings relating to the delay to calling for the EMS and the start of CPR and defibrillation, we speculate that 300400 additional OHCA patients yearly (4 per 100000 inhabitants) could be saved in Sweden.

  • 129.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    Svensson, L.
    Axelsson, A. B.
    Goransson, K.
    Todorova, L.
    Herlitz, J.
    Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden2013Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, nr 7, s. 952-956Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. 

    Methods: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. 

    Result: In 2008-2010, the number of prospectively (n = 2398) and retrospectively (n = 800) reported OHCA cases was n = 3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p = 0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p = 0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p = 0.035). 

    Conclusion: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias. 

  • 130.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    Svensson, L.
    Axelsson, Å.
    Göransson, K.
    Todorova, L.
    Herlitz, J.
    Kvalitetsbedömning - nationella hjärtstoppsregistret 2008-20102012Konferansepaper (Annet vitenskapelig)
  • 131.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    Svensson, L.
    Claesson, A.
    Lindkvist, J.
    Lundström, A.
    Herlitz, J.
    Association between population density and reported incidence, characteristics and outcome after out–of–hospital cardiac arrest in Sweden2011Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, nr 10, s. 1307-1313Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. To describe the reported incidence of out of hospital cardiac arrest (OHCA) and the characteristics and outcome after OHCA in relation to population density in Sweden. Methods All patients participating in the Swedish Cardiac Arrest Register between 2008 and 2009 in (a) 20 of 21 regions (n = 6457) and in (b) 165 of 292 municipalities (n = 3522) in Sweden, took part in the survey.

    Results. The regional population density varied between 3 and 310 inhabitants per km2 in 2009. In 2008–2009, the number of reported cardiac arrests varied between 13 and 52 per 100,000 inhabitants and year. Survival to 1 month varied between 2% and 14% during the same period in different regions. With regard to population density, based on municipalities, bystander CPR (p = 0.04) as well as cardiac etiology (p = 0.002) were more frequent in less populated areas. Ambulance response time was longer in less populated areas (p < 0.0001). There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA.

    Conclusion. There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA. However, bystander CPR, cardiac etiology and longer response times were more frequent in less populated areas.

  • 132.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Sweden.
    Svensson, Leif
    Södersjukhuset, Stockholm, Sweden.
    Axelsson, Åsa B.
    Sahlgrenska Academy at Gothenburg University, Sweden.
    Claesson, Andreas
    Prehospen University College of Borås, Borås; Sweden.
    Göransson, Katarina E.
    Karolinska University Hospital, Stockholm; Sweden.
    Nordberg, Per
    Södersjukhuset, Stockholm, Sweden.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden.
    Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival2015Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr 14, s. 863-871Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation.

    Methods and results: All cases of OHCA (n = 59 926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100 000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P< 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008–2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008–2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm.

    Conclusion: From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.

  • 133.
    Svanberg, Mikael
    et al.
    Region Västmanland, Sweden.
    Johansson, Ann-Christina
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Boersma, Katja
    Örebro Universitet, Sweden.
    Does validation and alliance during the multimodal investigation affect patients' acceptance of chronic pain? An experimental single case study.2019Inngår i: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 19, nr 1, s. 73-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients' experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process. Methods Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5-10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6-8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI. Results Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI. Conclusions The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.

  • 134.
    Svindseth, Marit F.
    et al.
    Department of Psychiatry, Sunnmore Hospital, 6026 Aalesund, Norway, and National University of Science and Technology, 7440 Trondheim, Norway.
    Nøttestad, Jim Aage
    Department of Forensic Psychiatry, Broset, St. Olav’s Hospital, National University of Science and Technology, 7440 Trondheim, Norway. .
    Wallin, Juliska
    Mälardalens högskola, Akademin för hållbar samhälls- och teknikutveckling.
    Roaldset, John Olav
    Department of Psychiatry, Sunnmore Hospital, 6026 Aalesund, Norway, and National University of Science and Technology, 7440 Trondheim, Norway. .
    Dahl, Alv A.
    The Cancer Clinic, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Montebello, 0310 Oslo, Norway..
    Narcissism in patience admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology2008Inngår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 8, nr 13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM).

    Methods

    This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM).

    Results

    Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales.

    Conclusion

    Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  • 135.
    Svindseth, Marit
    et al.
    National University of Science and Technology.
    Sørebø, Øystein
    Buskerud University College.
    Nøttestad, Jim Aage
    National University of Science and Technology.
    Roaldset, John Olav
    National University of Science and Technology.
    Wallin, Juliska
    Mälardalens högskola, Akademin för hållbar samhälls- och teknikutveckling.
    Dahl, Alv A.
    University of Oslo.
    Psychometric examination and normative data for the Narcissistic Personality Inventory 29 item version: Personality and Social Sciences2009Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 50, nr 2, s. 151-159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Narcissistic Personality Inventory (NPI) is commonly used in empirical studies of narcissism. Few population-based studies have been published. Our aim was to do a confirmatory factor analysis (CFA) of the NPI 29 item version with a four-factor structure, in two population-based samples and in a patient sample, and present normative population-based data. The NPI-29 was filled in by 324 respondents from the Norwegian population, 231 from the Swedish population and 167 Norwegian psychiatric patients. The four-factor structure of the NPI-29 with Leadership/Power, Exhibitionism/Self-admiration, Superiority/Arrogance and Uniqueness/Entitlement was reproduced in these samples. The CFA models showed good fit indices in all samples. Mean scores on the NPI-29 and four subscales hardly differed between the samples. For the NPI-29 total score and factors, few significant differences were observed. CFA of the samples supported the factor structure of the NPI-29 formerly identified by principal component analysis of the Swedish population sample.

  • 136. Söderbäck, Maja
    Encountering Parents: Professional Action Styles among Nurses in Pediatric care1999Doktoravhandling, monografi (Annet vitenskapelig)
  • 137.
    Söderbäck, Maja
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Nurses' empowering of Parents in Pediatric settings: A conceptual analysis1996Rapport (Fagfellevurdert)
  • 138.
    Söderbäck, Maja
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Christensson, Kyllike
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Care of hospitalized children in Mozambique: nurses' beliefs and practice regarding family involvement2007Inngår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 11, nr 1, s. 53-69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study aims to describe nurses' beliefs and practice regarding family involvement in the care of hospitalized children in Mozambique. Ethnographic fieldwork was used. The data production consisted of field descriptions from observations and interviews with 36 nurses. Through qualitative content analysis the findings show that nurses' practice of family involvement reflects a society that is poor, hierarchical, family-oriented but at the same time still adaptive. Four themes are identified: family members' presence in order to assist the nurses in care; nurses' support and education of family members to be involved in care; nurses' shielding of family members from family involvement; difficulties and conditional dilemmas in the nurses' involvement of families. It is concluded that emphasizing culturally congruent nursing care is necessary if families' way of life is to be accommodated. However, to empower family involvement in everyday practice, the Mozambican nurses themselves need to be empowered.

  • 139.
    Tham, Vibeke
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Christensson, Kyllike
    Karolinska Institutet, Stockholm, Sweden.
    Ryding, Elsa Lena
    Karolinska Institutet, Stockholm, Sweden.
    Sense of coherence and symptoms of post-traumatic stress after emergency caesarean section2007Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, nr 9, s. 1090-1096Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In this study of women who had undergone an emergency caesarean section (EmCS), the aim was to examine the associations between, on the one hand, the new mother's sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and on the other hand, post-traumatic stress symptoms 3 months' postpartum. METHODS: In a prospective study, 122 Swedish- or English-speaking new mothers completed 2 self-assessment questionnaires, at 2 days and 3 months after an EmCS. To measure SOC, we used the Sense of Coherence Scale (SOC-13), and to measure reactions to traumatic events, the Impact of Event Scale (IES-15). RESULTS: Independent risk factors associated with post-traumatic stress symptoms were: imminent fetal asphyxia as an indication for the operation, and low SOC in the woman. The group of women with low SOC were those with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women. CONCLUSIONS: Symptoms of post-traumatic stress following EmCS are associated both with the new mother's personal coping style and with the circumstances of the event. We recommend that women who belong to groups who more often report a low SOC or who had imminent asphyxia as an indication for the operation should be offered support and follow-up.

  • 140.
    Thirugnanam, Vasanthakumar
    Mälardalens högskola. Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hållbar samhälls- och teknikutveckling.
    Effect of combined treatment with R-(+)-methanandamide and chemotherapeutic drugs in mantle cell lymphoma and chronic lymphocytic leukemia: MCLIndependent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [en]

    Mantle cell lymphoma (MCL) is a non-Hodgkin B-cell lymphoma with very bad prognosis. The genetic hallmark of MCL, is the translocation t(11;14)(q13;q32) which leads to overexpression of cyclin D1, a D-type cyclin that is not usually expressed at high levels in normal B lymphocytes.

     

    Previous studies indicate that cannabinoid receptors are expressed in lymphoma and have shown that lymphoma cell death is induced as a result of exposure to cannabinoids (ligands).

     

    The aim of this diploma work was to combined cytostatics with the cannabinoid receptor ligand R (+)-Methanandmide (R-MA). Our data suggest that combination treatment with cytostatics and R-MA induces synergistic effects in most cases.

  • 141.
    Torres, Sandra
    et al.
    Linköping University, Sweden.
    Hammarström, Gunhild
    Uppsala University, Sweden.
    Speaking of 'limitations' while trying to disregard them:: A qualitative study of how diminished everyday competence and aging can be regarded2006Inngår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Journal of aging studies, Vol. 20, nr 4, s. 291-302Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Research shows that there is a difference between being old and feeling old. The way in which the experience of growing into advanced old age is regarded has also been found to play an important role for well-being in old age. One central aspect of this experience - i.e. diminished everyday competence - remains relatively under-researched. This article explores, through 21 qualitative interviews, how a group of elders regard declines in everyday competence. Three distinctive categories were found: (a) diminished everyday competence is regarded as a 'fact of life' that cannot be overcome and must therefore be accepted; (b) as something that could be overcome - in the long run - but must be 'temporarily' accepted and (c) as a matter of fact that can neither be overcome nor accepted. In addition, these categories were found to come hand in hand with specific ways of regarding limitations; being in need of assistance from others and how the process of growing into old age is regarded as a whole.

  • 142.
    Trobec, R.
    et al.
    Department of Communication Systems, Jožef Stefan Institute, Ljubljana, Slovenia.
    Jan, M.
    Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia.
    Lindén, Maria
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Tomasic, Ivan
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Detection and Treatment of Atrial Irregular Rhythm with Body Gadgets and 35-channel ECG2019Inngår i: 2019 42nd International Convention on Information and Communication Technology, Electronics and Microelectronics, MIPRO 2019 - Proceedings, Institute of Electrical and Electronics Engineers Inc. , 2019, s. 301-308Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The atrial irregular rhythm, often reflected in atrial fibrillation, undulation or flutter, is recognized as one of the major causes of brain stroke and entails an increased risk of thromboembolic events because it increases the likelihood of blood clots formation. Its early detection is becoming an increasingly important preventive measure. The paper presents a simple methodology for the detection of atrial irregular rhythm by ECG body gadget that can perform long-term measurements, e.g. several weeks or more. Multichannel ECG, on the body surface, gives a more detailed insight into the atrial activity in comparison to standard 12-lead ECG. The information from MECG is compared with single-channel patch ECG. The obtained results suggest that the proposed methodology could be useful in treatments of atrial irregular rhythm. One can obtain a reliable information about the time and duration of fibrillation events, or determine arrhythmic focuses and conductive pathways in heart atria, or study the effects of antiarrhythmic drugs on existing arrhythmias and on an eventual development of new types of arrhythmias. 

  • 143.
    Trulsson, O.
    et al.
    Ullevåls University Hospital, Oslo, Norway.
    Rådestad, Ingela
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    The silent child -: Mother´s experiences before, during and after stillbirth2004Inngår i: Birth, ISSN 0730-7659, Vol. 31, nr 3, s. 189-195Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The quality of care received by a woman who gives birth to a dead baby is crucial for her long-term well-being, and limiting the period between diagnosis of intrauterine death and induction of delivery decreases her anxiety risk. The primary objective of this study was to explore why induction of delivery for most women should not be delayed more than 24 hours from the diagnosis of intrauterine death. A secondary objective was to determine how the time between diagnosis and delivery should be spent. METHODS: Twelve women were interviewed about their experience before and during the diagnosis of their baby's death and the event of birth. Interviews took place 6 to 18 months after the delivery and were analyzed using a phenomenological methodology. RESULTS: Women experienced premonition, difficulty communicating their worry, cessation of verbal communication with staff, unreality and numbing, desire to get rid of the dead child immediately, going through childbirth, and total silence. Many women believed that they were not respected as a human being during the process of diagnosing the intrauterine death. Themes emerged indicating caregivers should not reduce to zero the time between diagnosis of intrauterine death and induction of delivery. Time may be needed to obtain medical information about the delivery and to prepare the woman for meeting with and saying goodbye to her long-awaited but now silent baby. CONCLUSION: The period between diagnosis of intrauterine death and induction of delivery may give health professionals a major opportunity to improve a woman's ability to cope with the event of stillbirth and prepare her to meet with her loved but now silent baby. Further clinical research can identify supportive mechanisms for parents, and sources of iatrogenic psychological trauma that should be eliminated.

  • 144.
    Tulviste, Tiia
    et al.
    University of Tartu, Estonia.
    Mizera, Luule
    University of Tartu, Estonia.
    De Geer, Boel
    Södertörn University College, Sweden .
    Tryggvason, Marja-Terttu
    Södertörn University College, Sweden .
    Child-rearing goals of Estonian, Finnish, and Swedish mothers2007Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, Vol. 48, nr 6, s. 487-497Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the present study, the child-rearing goals of mothers of 4- to 6-year-old children from Estonia, Finland, and Sweden were compared. The developedChild-Rearing Goals Questionnaire consisted of three different tasks: open-ended questions, item rating, and item ranking. All mothers were similar in valuing highly self-maximization, but differed in emphasis on traditional child-rearing goals (e.g., conformity, obedience, politeness, being hard-working, etc.). The Swedish mothers tended to stress the characteristics connected with self-maximization as well as self-confidence and children's happiness, but did not value the traditional child-rearing goals. The Estonian mothers attached a great significance both to the traditional characteristics and to self-maximization. The Finnish mothers also stressed both traditional and non-traditional values, but to a lesser extent than the Estonians. The Swedish andFinnish mothers' child-rearing goals were relatively homogeneous. In contrast, the Estonian mothers were generally less focused on any specific goal.Mothers with a lower level of education stressed traditional goals more than mothers with a higher level of education. The results are discussed in the light of the possible effect different cultural contexts have on maternal child-rearing goals: bringing up children in stable welfare societies (such as Sweden and Finland) in contrast to a rapidly changing society (such as Estonia).

  • 145.
    Tydén, Tanja
    et al.
    Uppsala universitet, Sweden.
    Aneblom, Gunilla
    Uppsala universitet, Sweden.
    von Essen, Louise
    Uppsala universitet, Sweden.
    Häggström-Nordin, Elisabet
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Uppsala universitet, Sweden.
    Larsson, Margareta
    Uppsala universitet, Sweden.
    Odlind, Viveca
    Uppsala universitet, Sweden.
    Trots lättillgängliga akut-p-piller sjunker inte antalet aborter. Studier av kvinnors kunskaper, attityder och erfarenheter av metoden.2002Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, nr 47, s. 4730-4735Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Despite the fact that emergency contraceptive pills (ECP) have become easily available across the country during recent years, abortion numbers continue to rise in Sweden, especially in the young age groups (< 25). In a series of studies, we have investigated knowledge, attitudes and experience of ECP among young women. Our results show that, whereas most women are aware of the method, many lack knowledge about the mechanism of action and time frames for best use, which could explain why ECPs are not used by more than a fraction of women who might have had benefit from their use. Since half of the women requesting a termination of pregnancy stated that they would have used ECP if they had had them available at home at the time of the unprotected intercourse which led to an unintended pregnancy, it seems reasonable to encourage women to keep ECPs at home, in case the need should arise. It is important that ECPs are available without prescription, but beyond that, much more information about ECP is necessary in order for the method to be widely accepted and used as a back-up after failure with other contraceptives.

  • 146.
    von Heideken Wågert, Petra
    et al.
    Institutionen för Samhällsmedicin och Rehbilitering, Umeå Universitet.
    Gustafson, Yngve
    Geriatrik, Institutionen för Samhällsmedicin och Rehbilitering, Umeå Universitet.
    Kallin, Kristina
    Geriatrik, Institutionen för Samhällsmedicin och Rehbilitering, Umeå Universitet.
    Jensen, Jane
    Sjukgymnastik, Institutionen för Samhällsmedicin och Rehbilitering, Umeå Universitet.
    Lundin-Olsson, Lillemor
    Sjukgymnastik, Institutionen för Samhällsmedicin och Rehbilitering, Umeå Universitet.
    Falls in very old people: The population-based Umeå 85+ Study in Sweden2009Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, nr 3, s. 390-396Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

     

     The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ≥95 (-103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

     

    The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ³ 95 (-103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for six months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within one year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

     

  • 147.
    von Heideken Wågert, Petra
    et al.
    Umeå University, Umeå, Sweden.
    Gustafson, Yngve
    Umeå University, Umeå, Sweden.
    Lundin-Olsson, Lillemor
    Umeå University, Umeå, Sweden.
    Large variations in walking, standing up from a chair, and balance in women and men over 85 years: An observational study2009Inngår i: Australian Journal of Physiotherapy, ISSN 0004-9514, Vol. 55, nr 1, s. 39-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Question: How do three different age groups of women and men >85 years perform in tests of gait speed, chair stands, and balance?

    Design: A population-based cross-sectional observational study.

    Participants: Half the 85-year-old population, and the total population aged 90 and ³95 (-103) in Umeå, Sweden were assessed in the Umeå 85+ Study (n=238).

    Outcome measures: Usual and fastest gait speed (m/s) over 2.4 meters (8 feet), three consecutive chair stands (s), the Berg Balance Scale and ability to perform the tests (yes/no).

    Results: The median (10th-90th percentile) usual gait speed was 0.49 m/s (0.23-0.75), time to perform the chair stands test 12.6 seconds (8.5-20.2), and median Berg Balance Scale scores 45 (0-54). An age-related decline in physical ability was seen in women, but not in men. Men had greater physical ability than women. The Berg Balance Scale showed no floor or ceiling effects, but the gait speed and chair stands tests resulted in a floor effect especially for women.

    Conclusion: There were large variations in physical ability in these very old people. These data provide valuable reference values for physical ability in the oldest age groups for commonly used clinical measurements.

  • 148.
    von Heideken Wågert, Petra
    et al.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap. Umeå University, Umeå, Sweden .
    Gustavsson, JM
    Umeå University, Umeå, Sweden .
    Kallin, K
    Umeå University, Umeå, Sweden .
    Nygren, B
    Umeå University, Umeå, Sweden .
    Lundman, B
    Umeå University, Umeå, Sweden .
    Norberg, A
    Umeå University, Umeå, Sweden .
    Gustafson, Y
    Umeå University, Umeå, Sweden .
    Health status in the oldest old. Age and sex differences in the Umeå 85+ Study.2006Inngår i: Aging Clinical and Experimental Research, ISSN 1670-2780, Vol. 18, nr 2, s. 116-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND AIMS: With an increasing population aged 85 years and over, the aim of this study was to describe health status and living conditions in the oldest old and to estimate age and sex differences in a Northern European population. METHODS: A population-based cross-sectional study, The Umeå 85+ Study, was carried out in the municipality of Umeå in northern Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and over, 253 participated. Structured interviews and assessments were conducted with the participants in their homes, and data were also collected from relatives, caregivers and medical charts. Cognition was screened with the Mini-Mental State Examination (MMSE), depressive symptoms with the Geriatric Depression Scale-15 (GDS-15) and nutritional status with the Mini Nutritional Assessment (MNA). Activities of daily living (ADL) were assessed applying the Staircase of ADL (including Katz' Index of ADL) and morale with the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health. RESULTS: Over half of the participants had hypertension, one out of four was depressed, and the same proportion had had a hip fracture; the mean number of drugs taken was 6.4+/-4.0. Younger participants had lower rates of diagnoses and prescribed drugs, and were less dependent in ADL and other functional variables; men had lower rates of diagnoses and reported symptoms. The majority of participants rated their general health and morale as good. CONCLUSIONS: There were large variations in social, medical and functional variables within and between age and sex groups. This northern population of the oldest old seems to have a very high prevalence of hypertension, depression, hip fractures, and many prescribed drugs.

  • 149.
    von Heideken Wågert, Petra
    et al.
    Umeå University, Sweden.
    Rönnmark, B.
    Umeå University, Sweden.
    Rosendahl, E.
    Umeå University, Sweden.
    Lundin-Olsson, L.
    Umeå University, Sweden.
    Gustavsson, J.M.C.
    Umeå University, Sweden.
    Nygren, B.
    Umeå University, Sweden.
    Lundman, B.
    Umeå University, Sweden.
    Norberg, A.
    Umeå University, Sweden.
    Gustafson, Y.
    Umeå University, Sweden.
    Morale in the oldest old: the Umeå 85+ Study2005Inngår i: Age and Ageing, ISSN 0002-0729, Vol. 34, nr 3, s. 249-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to describe morale among the oldest old, and to investigate which social, functional and medical factors are associated with morale in this population. Design: a cross-sectional study. Setting: a population-based study in the municipality of Umea, a city in Northern Sweden. Subjects: half of the 85-year-old population, and the total population of 90-year-olds and >= 95-year-olds (95-103) were asked to participate (n = 319) and 238 were interviewed. Methods: structured interviews and assessments during home visits, interviews with relatives and caregivers and review of medical charts. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Participants were assessed with the Barthel Activities of Daily Living (ADL) Index, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and a symptom questionnaire. Multiple regression analyses were conducted to find independent factors to explain the variation in the PGCMS score. Results: eighty-four per cent (n = 199) of those interviewed answered the PGCMS. Three-quarters had middle range or high morale. GDS score, type of housing, previous stroke, loneliness and number of symptoms, adjusted for age group and sex, explained 49.3% of the variance of total PGCMS score. Conclusions: a large proportion of the oldest old had high morale. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and low number of symptoms. The PGCMS seems applicable in the evaluation of morale among the oldest old.

  • 150.
    Waldenström, U.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Rubertsson, Christine
    Karolinska Institutet, Stockholm, Sweden.
    Rådestad, Ingela
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    A negative birth experience: prevalence and risk factors in a national sample2004Inngår i: Birth, ISSN 0730-7659, Vol. 31, nr 1, s. 17-27Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample. METHODS: A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Sweden during 3 weeks spread over 1 year was conducted. Data were collected by three questionnaires, which measured women's global experience of labor and birth 1 year after the birth, and obtained information on possible risk factors during pregnancy and 2 months after the birth. RESULTS: Seven percent of the women had a negative birth experience. The following risk factors were found: (1) factors related to unexpected medical problems, such as emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; (2) factors related to the woman's social life, such as unwanted pregnancy and lack of support from partner; (3) factors related to the woman's feelings during labor, such as pain and lack of control; and (4) factors that may be easier to influence by the caregivers, such as insufficient time allocated to the woman's own questions at antenatal checkups, lack of support during labor, and administration of obstetric analgesia. CONCLUSIONS: Many risk factors were related to unexpected medical problems and participants' social background. Of the established methods to improve women's birth experience, childbirth education and obstetric analgesia seemed to be less effective, whereas support in labor and listening to the woman's own issues may be underestimated

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