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  • 1.
    Aaby Orellana, Tanja
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Kirkegaard, Betina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sjuksköterskors upplevelser av att implementera personcentrerad omvårdnad i slutenvården: -         En Empirisk Studie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Person-centred care (PCC) is when the person seeking care get’s involved in their care and are seen as more then their illness or ailment. PCC as a concept began in dementia care, but is now the approach that most healthcare institutions strive after. To achieve the improved care that PCC can bring, there is need for a well- planned and clear implementation plan from the management.

    Aim: To describe the nursing staffs experience of implementing person-centred care as a work procedure in inpatient care.

    Method: An inductive qualitative study where eleven interviews was completed. Eight interviews were strategically chosen and a content analysis was carried out.

    Result: There is hope among the participants that implementation will bring a better and safer care, but also concerns about fear of change among the healthcare staff and increased workloads. Participants experience that PCC will place higher demans on the healthcare staff, especially nurses, regarding time, knowledge and communication skills.

    Conclusion: To provide the best care, there has to be dedicated and competent staff who also have the support and understanding from the management. Despite the obstacles that seem to exist, there is a positive spirit among the nurses in relation to the implementation of person-centred care.  There is hope that person-centred care, among other things, will increase participation that could lead to shorter hospital stays and risk of needing to seek care again short after being discharged from the hospital. Ultimately it provides a better care in the whole for the individual person seeking care.

  • 2.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Att ansvara för en annan människas liv2013Conference paper (Other (popular science, discussion, etc.))
  • 3.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Att bedöma patienter utsatta för trauma2013Conference paper (Other academic)
  • 4.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Att träna på en patient som går att starta om2015Conference paper (Other academic)
  • 5.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Den specialistutbildade ambulanssjuksköterskans uppfattning av att bedöma patienter utsatta för svårt trauma2013Conference paper (Other academic)
  • 6.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Developing ethical competence among students in nurse specialist programs2014Conference paper (Other academic)
  • 7.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Dom ser döda ut allihop: Att våga fatta svåra beslut2015In: Samverkan 112, ISSN 1650-7487, Vol. AprilArticle in journal (Other academic)
  • 8.
    Abelsson, Anna
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013).
    Full scale pre-hospital care scenario: Prehsopital workshop2015Conference paper (Refereed)
  • 9.
    Abelsson, Anna
    Department of Health Sciences, Karlstad University, Sweden.
    Learning through simulation2017In: Disaster and Emergency Medicine Journal, ISSN 2451–4691, Vol. 2, no 3, 125-128 p.Article in journal (Refereed)
    Abstract [en]

    With simulation, caregivers are given the opportunity to improve their knowledge and skills. With simulation, both theoretical and practical knowledge is taught. With the experiences that simulation creates, critical thinking and better care are developed. Learning through simulation complements the learning that takes place in everyday work and can have a positive effect of the advances of the care profession. The purpose of simulation may vary and different learning theories are used, both based on learning objectives and the purpose of the simulation. The experience gained from simulation prepares caregivers on how similar complex situations can be handled in the future.

  • 10.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Mapping the use of simulation in prehospital care2013Conference paper (Refereed)
  • 11.
    Abelsson, Anna
    Department of Health Sciences, Karlstad University, Sweden.
    Medical tattoos impact on CPR decisions2017In: Disaster and Emergency Medicine Journal, ISSN 2451-4691, Vol. 2, no 3, 140-141 p.Article in journal (Other academic)
  • 12.
    Abelsson, Anna
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013).
    Nästa gång du hör sirener vill jag att du skall tänka på mig2014In: Vård i fokus, ISSN 0781-495X, Vol. 1Article in journal (Other academic)
  • 13.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Prehospital simulation differs from others: Prehospital workshop2015Conference paper (Refereed)
  • 14.
    Abelsson, Anna
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013).
    Prehospital simulering2014Conference paper (Other academic)
  • 15.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Simulering i ambulanssjukvården2013Conference paper (Other academic)
  • 16.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Simulering som lärande inom prehospital akutsjukvård2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of the research was to deepen the understanding of learning through simulation in prehospital emergency care.

    Method: In this research, qualitative and quantitative methods are used as well as integrative literature studies (I, II). Qualitative data from the interview studies (III, V) were analyzed by phenomenographic methodology. Quantitative data from the intervention study (IV) were analyzed using descriptive and analytical statistics.

    Results: Research on simulation and learning within the prehospital trauma care context is relatively rare (I). Simulation of realistic scenarios where the caregivers are exposed to stress contributes to strengthen caregiver knowledge, skills and experience (II). Caregivers request simulation opportunities regarding critical and emergency situations (III). They describe that learning through regular simulation provides in-depth knowledge and skills in the care of a patient exposed to high-energy trauma (V). Interventions with repeated simulation opportunities related to the care of the patient exposed to high-energy trauma give some improvement in care provided at the site of the accident (IV).

    Conclusion: Through simulation, the caregivers develop knowledge and skills and receive enhanced confidence in the care of an injured and sick patient. The research suggests several areas with potential for improvement with regard to the care of patients exposed to high-energy trauma. A model has been developed for systematic trauma simulation.

     

  • 17.
    Abelsson, Anna
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013).
    Simulering som pedagogisk metod: ett sätt att träna olika patientsituationer2015Conference paper (Refereed)
  • 18.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Så räddar du liv2014Conference paper (Other (popular science, discussion, etc.))
  • 19.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    The simulation used in prehospital care2013Conference paper (Refereed)
  • 20.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    To optimize prehospital CPR- performed by fire fighters2015Conference paper (Refereed)
  • 21.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    What do we need to train the ambulance staff in and how can we train them?2014In: Workshop vid Society in Europe for Simulation Applied to Medicine, Pre-Hospital Special Interest Group Pre-Conference Course., 2014Conference paper (Refereed)
  • 22.
    Abelsson, Anna
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Öppet samtal mellan Sveriges prehospitala doktorander och representanter för nationell prehospital forskning2013Conference paper (Other (popular science, discussion, etc.))
  • 23.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Bisholt, Birgitta
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Nurse students learning acute care by simulation: Focus on observation and debriefing2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 24, 6-13 p.Article in journal (Refereed)
    Abstract [en]

    Introduction:

    Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings.

    Aim:

    To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing.

    Design:

    The study was designed as an observational study inspired by an ethnographic approach.

    Method:

    Data was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis.

    Results:

    Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity.

    Conclusion:

    High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety.

  • 24.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    What is dignity in prehospital emergency care?2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 3, 268-278 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.

    OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.

    RESEARCH DESIGN: The study had a qualitative approach.

    METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.

    ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.

    FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.

    DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.

    CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

  • 25.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Suserud, Björn-Ove
    Högskolan i Borås.
    Rystedt, Ingrid
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Effect of repeated simulation on the quality of trauma care2017In: Clinical Simulation in Nursing, ISSN 1876-1399, E-ISSN 1876-1402, Vol. 13, no 12, 601-608 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Simulation participants are not dependent on learning during an actual clinical situation. This allows for a learning environment that can be constructed to meet the knowledge and experience needs of the participant. Simulations in a prehospital emergency are an ideal way to address these needs without risking patient safety.

    Method

    Nurses in prehospital emergency care (n = 63) participated in simulation interventions. During the simulation, the performed trauma care was assessed in two groups of participants with different frequency of simulation.

    Results

    Several statistically significant differences and clinical improvements were found within and between the groups. Differences were noted in specific assessments, examinations, care actions, and time from assessment to action.

    Conclusion

    The result suggested that repeated simulation may contribute to a clinical improvement in trauma care, and more frequent simulation may led to even greater improvements.

  • 26.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Lundberg, Lars
    CPR performed in the military environment2016In: Society in Europe for Simulation Applied to Medicine Lisbon 16/6 2016., Lisabon, 2016Conference paper (Refereed)
  • 27.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Rystedt, Ingrid
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Suserud, Björn-Ove
    Högskolan i Borås.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Experiences of simulation in prehospital emergency care settings, the paramedic and ambulance nurses` point of view2014Conference paper (Refereed)
  • 28.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Rystedt, Ingrid
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Suserud, Björn-Ove
    Högskolan i Borås.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Learning by simulation in prehospital emergency care: an integrative literature review2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 2, 234-240 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

    METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

    RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

    CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

  • 29.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Rystedt, Ingrid
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Suserud, Björn-Ove
    Högskolan i Borås.
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Simulation of high-energy trauma makes knowledge readily available from memoryManuscript (preprint) (Other academic)
  • 30.
    Abelsson, Anna
    et al.
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Rystedt, Ingrid
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Suserud, Björ-Ove
    Lindwall, Lillemor
    Karlstads universitet, Institutionen för hälsovetenskaper.
    Mapping the use of simulation in prehospital care: a literature review.2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, no 22, 12- p.Article in journal (Refereed)
    Abstract [en]

    Background:

    High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice.

    Methods:

    An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context.

    Results:

    The volume of published research is distributed between 1984-2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.

    Conclusion:

    Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.

  • 31.
    Aboutouk, Rana
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Forsberg, Fredrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Erfarenheter av egenvård hos personer med diabetes typ 22017Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

    Bakgrund: Antalet personer med diabetes Mellitus typ 2 växer snabbt i världen. Egenvård krävs för att bromsa progressionen av DMT2 och förhindra eller fördröja komplikationer. Många personer med DMT2 sköter emellertid inte sin egenvård enligt rekommendationer.

    Syftet: Att beskriva erfarenheter av egenvård hos personer med DMT2.

    Metod: Med hjälp av Fribergs femstegsmodell gjordes en litteraturöversikt av elva kvalitativa studier om erfarenheter av egenvård hos personer med DMT2.

    Resultat: Att integrera egenvården i vardagen är en utmaning. Familjen och vårdpersonalen har en nyckelroll och kan utgöra såväl ett hinder som ett stöd för egenvården. Andra personer med diabetes upplevs som ett entydigt positivt stöd. Att acceptera sjukdomen är en förutsättning för att kunna bedriva egenvården. Brist på förståelse och okunskap kring DMT2 utgör ett hinder mot egenvård. Personliga mål och feedback är avgörande för motivationen.

    Slutsatser: Socialt stöd, acceptans av sjukdomen, positiv feedback och individualiserad information upplevs underlätta egenvård.

  • 32.
    Abrahamsson, Sara
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Palmberg, Hampus
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Children with Intellectual Disabilities and Their Perceived Participation in Everyday Life Activities: A descriptive study conducted in Addis Abeba, Ethiopia2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Children with intellectual disabilities living in developing countries are vulnerable to participation restrictions. Few studies have been made regarding their own perspectives. Aim: To describe how children in a low income country aged 13-17 with an intellectual disability perceive their participation in everyday life activities. Method: This bachelor thesis was conducted as a descriptive study and had a quantitative approach. Participants were collected through a non-probability, goal-oriented consecutive sampling. Data were collected by using “Picture my Participation”, an instrument designed as a structured interview with quantitative questions. The data were analyzed with IBM SPSS Statistics 21. Tables and diagrams were made in Microsoft Excel 2013. Result: The activity that the children participated in most frequently was “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. The activity that most children prioritized as most important, and they were most involved in was “Organised leisure activities”. “Services and policies” and “Social environment” were the factors seen as “Facilitators” to participation, whereas “Family attitudes” was seen as a “Barrier” to participation. Conclusion: The children perceived their participation in the prioritized activities as high and experienced few barriers in the context of participation.

  • 33.
    Abyan, Luul
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Gustavsson, Ellinor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Unga vuxnas upplevelser av att leva med diabetes typ-12016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Summary

    Background: Diabetes type-1 is an autoimmune disease and one of the most common chronic diseases in Sweden. Diabetes type-1 can be developed at any age, but usually appears during childhood and adolescence. Living with the disease implicates being responsible for their self-care.

    Aim: The aim of the study was to describe the young adult’s experiences of living with diabetes type-1, based on Orem’s self-care deficit nursing theory.

    Method: This study is a qualitative study with deductive approach. The study is based on three blogs. Orem’s self-care deficit nursing theory was used in this study.

    Results: The relationship with family and other diabetics are perceived to be a great support and can serve as an aid in self-care. Self-care can be difficult to achieve and sometimes they can experience that planning and structure be in vain. According to the individuals, it is important not to let the disease limit the social life. There is a major ignorance of diabetes type-1 in the society which leads to insecurity and lack of trust. Despite an environment of supportive people, individuals with diabetes type-1 can experience loneliness.

    Conclusion: An insight of young adult’s experiences of living with diabetes type-1 is important for the nurse because of the ability to reduce conflicts between nurse and patient and thereby improve conditions for a successful self-care.

  • 34.
    Adolfsson, P.
    et al.
    Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Lindstedt, H.
    Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Pettersson, I.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hermansson, L. N.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Janeslätt, G.
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities2016In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, no 6, 493-500 p.Article in journal (Refereed)
    Abstract [en]

    Background: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs.

    Objective: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs.

    Methods: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses.

    Results: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken.

    Conclusions: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons.

    Implications for Rehabilitation: The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

  • 35.
    Agahi, Neda
    et al.
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Kelfve, Susanne
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden; Department of Sociology, Stockholm University, Stockholm, Sweden.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Alcohol consumption in very old age and its association with survival: a matter of health and physical function2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 159, 240-245 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old.

    Methods

    Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n = 863) collected in 2010/2011 were used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5–30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed.

    Results

    Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant.

    Conclusions

    The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to-moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

    Graphical abstract

  • 36. Agahi, Neda
    et al.
    Shaw, Ben
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Lennartsson, Carin
    Trajectories of social activities and mobility problems from middle to old age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012, 207- p.Conference paper (Refereed)
    Abstract [en]

    Objectives: To investigate how trajectories of social activities, suchas spending time with family and friends, observed during a34-year period (from middle age to old age) were associated withtrajectories of mobility problems during the same time periodamong men and women.Methods: Nationally representative data from the Swedish Levelof Living Survey (LNU) and the Swedish Panel Study of the OldestOld (SWEOLD) were used. LNU data from 1968, 1981, 1991 and2000 were merged with SWEOLD data from 1992 and 2002 tocreate a longitudinal dataset with four observation periodscovering the period 1968-2002. The sample consisted of thoseaged 40-60 years at baseline who survived through the period,and participated in at least three observation periods (n=698).Trajectories of social activity were identified through clusteranalysis, and then used as predictors of mobility trajectories inmultilevel regression models.Results: Most people had a socially active life as they moved frommiddle age into old age. Five trajectories of social activity wereidentified: continuously very active, continuously active,increasing social activity, decreasing social activity, and continuouslyinactive. Upholding a very active social life was morecommon among women than men.Mobility problems increased significantly over time for bothwomen and men. Among men, decreasing activity levels overtime were associated with a faster increase in mobility problems.Among women, those who were continuously inactive or whodecreased their activity levels had higher levels of mobilityproblems, but the increase in mobility problems with age wassimilar across trajectories of social activity.Conclusions: Most men and women had high levels of socialactivity in midlife, and continued their high activity levels into latelife. Decreasing social activity was related to worse mobility inboth men and women. The nature and direction of theseassociations need to be explored further.

  • 37.
    Agren, Susanna
    et al.
    Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden and Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden.
    Ivarsson, Bodil
    Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, 221 85 Lund, Sweden and Department of Cardiothoracic Surgery/THAI, Sk˚ane University Hospital and Medical Services, 221 85 Lund, Sweden.
    Rönning, Helén
    Jönköping University, School of Health Science, HHJ. ADULT. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    The Unsteady Mainstay of the Family: Now Adult Children's Retrospective View on Social Support in Relation to Their Parent's Heart Transplantation.2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437Article in journal (Refereed)
    Abstract [en]

    The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).

  • 38.
    Ahacic, Kozma
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Kennison, Robert F.
    Department of Psychology, California State University, Los Angeles, California.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 874, 1-13 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade.

    METHOD:

    Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up.

    RESULTS:

    Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population--and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population.

    CONCLUSIONS:

    Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.

  • 39. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 4, 748-755 p.Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to examine age, cohort and period trends in alcohol abstinence.

    Design: Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

    Setting: The samples were representative of the Swedish population.

    Participants: Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

    Measurements: Alcohol abstinence was determined by asking 'Do you ever drink wine, beer, or spirits?', where a 'no' response indicated abstinence.

    Findings: Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

    Conclusion: Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

  • 40. Ahacic, Kozma
    et al.
    Trygged, Sven
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Income and education as predictors of stroke mortality after the survival of a first stroke2012In: Stroke Research and Treatment, ISSN 2042-0056Article in journal (Refereed)
    Abstract [en]

    Background: It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke.

    Question: Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival?

    Methods: All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type.

    Results: Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients.

    Conclusions: Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

  • 41.
    Ahlgren, Jennie
    et al.
    Jönköping University, School of Education and Communication, HLK, Disciplinary Research.
    Görman, Ulf
    Jönköping University, School of Education and Communication, HLK, Disciplinary Research.
    Nordström, Karin
    Jönköping University, School of Education and Communication, HLK, Disciplinary Research.
    Ethical considerations in relation to personalised nutrition: An overview of Work Package 5, with respect to ethics2015Report (Other academic)
    Abstract [en]

    The objectives of Food4Me work package 5 included a baseline assessment of the ethical and legal aspects of personalised nutrition at the start of the project in 2011, as well as a final assessment at the end of the project (2015), taking into account results achieved in other work packages. The initial assessment made a number of ethical issues visible, most of them relating to the consumer of personalised nutrition service. The results depicted in this publication indicate that many of the questions raised in relation to these issues remain unsolved, and in some cases they seem to be neglected in relation to the services offered by internet companies.

  • 42.
    Ahlgren Kvist, Cia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Karlsson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Hundens betydelse inom arbetsterapin: - Hur hundar kan främja och motivera till meningsfulla aktiviteter2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet var att beskriva hur arbetsterapeuter arbetar i aktivitet med vård- och terapihund och upplevd nytta med detta. Metoden som valdes var en kvalitativ induktiv ansats med semistrukturerade intervjuer. Elva arbetsterapeuter rekryterades genom ett bekvämlighetsurval via grupper på Facebook. Telefonintervjuer och intervjuer via personligt möte spelades in och transkriberades för att slutligen analyseras med hjälp av en kvalitativ innehållsanalys. Resultatet mynnade ut i ett övergripande tema som var: Arbetsterapeuten och hunden som ett stöd till meningsfulla aktiviteter, vilket resulterade i tre huvudkategorier som var: nytta, aktivitet och kommunikation, samt 14 underkategorier. Slutsatsen av examensarbetet var att hunden kunde vara användbar i att motivera patienter till aktivitet samt att aktiviteter tillsammans med och för hunden kändes mer meningsfulla.

  • 43.
    Ahlstrand, Inger
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pain and its relation to participation in valued activities in rheumatoid arthritis2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There has been a dramatic change over the past two decades for persons with rheumatoid arthritis (RA) not only due to early diagnosis, structured treatment, and aggressive medication but also due to an increased demand of participation in work life and society. Despite these treatment changes, RA continues to impact these individuals’ participation in valued daily activities. Participation in valued daily activities provides wellbeing and the opportunity for engagement and participation. By persons with RA pain has been highlighted as one of the most restrictive symptoms. This thesis uses the International Classification of Functioning, Disability, and Health (ICF) as a conceptual framework to describe disability and how participation is related to pain.

    Aims: The overall aim of this thesis was to explore and describe the relationship between pain and participation in valued activities, in RA. Paper I compared pain and activity limitations in women and men with contemporary treated early RA with persons who were diagnosed ten years earlier. Paper II described experiences of pain and pain’s relationship with daily activities. Paper III examined difficulties performing valued life activities in relation to pain intensity. Paper IV described personal factors, including self-efficacy and pain acceptance, and studied whether personal factors are mediators of the relationbetween pain and performance of valued life activities.

    Methods: Different methodological approaches were used to provide a comprehensive understanding of pain and participation in valued activities in persons with RA. A prospective longitudinal cohort study was used to compare women and men treated with contemporary treated RA (n=276) with their counterparts ten years earlier (n=373) (Paper I). This study was followed by a focus group study where 33 persons with RA participated in seven focus groups (Paper II). Subsequently, Papers III and IV were conducted based on data from The Swedish Rheumatology Quality Registry (SRQ) and data from a postal questionnaire that gathered data on demographics, pain, personal factors, and participation in valued life activities (n=737). In addition, these studies used descriptive and analytical statistics with multiple regression and structural equation modelling (SEM).

    Results: Pain and activity limitations were still pronounced in women and men with RA despite recent treatment advances (Paper I). The relationship between participation and pain was dynamic and is related to fatigue, stress, and mood, factors that generated difficulties finding a suitable level of activity, resulting in difficulties balancing daily activities (Paper II). Both women and men reported restrictions in participation in valued life activities. Pain was identified as having an important relationship to difficulties performing valued life activities (Paper III). Personal factors were found important as mediators for pain in relation to participation (Paper IV).

    Conclusions: This thesis found a continued need for multidisciplinary interventions despite current treatments. Pain was identified as related to participation restrictions and had an important relationship to difficulties performing valued life activities. Pain and participation in valued activities needs to be comprehensively analysed and treated in the context of the person’s perspective and needs and demands of persons with RA. The subjective experience of participation, the engagement, must be highlighted. Personal factors mediated the relationship between pain and participation and this finding supports the value of self-management interventions to enable participation in valued activities

  • 44.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. ADULT.
    Björk, Mathilda
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Linköping university.
    Thyberg, Ingrid
    Linköping university.
    Low levels of pain impact on valued life activities in women and men with Rheumatoid Arthritis2013Conference paper (Refereed)
  • 45.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Björk, Mathilda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Thyberg, Ingrid
    AIR/Rheumatology Unit, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Börsbo, Björn
    Rehabilitation Medicine, IKE, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Occupational Therapy, La Trobe University, Melbourne, VIC, Australia.
    Pain and Daily Activities in Rheumatoid Arthritis2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 15, 1245-1253 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method. Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results. Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it.Conclusion. The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

  • 46.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. ADULT.
    Björk, Mathilda
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. ADULT.
    Thyberg, Ingrid
    Linköping University.
    Börsbo, Björn
    Linköping university.
    Falkmer, Torbjörn
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Smärta och dagliga aktiviteter vid Reumatoid artrit ur ett patientperspektiv2011Conference paper (Other academic)
    Abstract [sv]

    Bakgrund: Smärta vid Reumatoid artrit (RA) ärett välkänt symtom som orsakar lidande ochaktivitetsbegränsning. Traditionellt mäts smärtainom reumatologin som smärtintensitet på enVisuell Analog Skala (VAS). Kunskapen kring hurpatienter med RA upplever smärta och dess konsekvenser är begränsad. Patientens egenbeskrivning behövs som underlag för behandlingsplanering och för att utveckla nya metoderför att beskriva problematiken.Syfte: Syftet med studien är att beskriva smärtavid RA ur ett patientperspektiv med fokus på hursmärtan påverkar dagliga aktiviteter.Metod: Patienter med diagnostiserad RA i syd-östra Sverige identifierades via Svenska Reumatologiregistret. Urvalet baserades på minst 5 årssjukdomsduration och minst 40 mm smärtintensitet på VAS vid de två senaste besöken på reumatologklinik. Sammanlagt 33 patienter, 7 män och26 kvinnor, deltog i sju fokusgrupper. Gruppernaformades utifrån kön och ålder. Intervjuguideninnehöll frågor som: Hur beskriver patienter medRA sin smärta? Vad påverkar smärtan? Vilkakonsekvenser har smärtan för aktivitetsutförande,aktivitetsbalans och undvikande av aktivitet? Enkvalitativ innehållsanalys görs.Resultat/förväntat resultat: Analyser hittills visar patienternas frustration över att inteklara det man vill eller behöver göra, beroendeav andra, minskade möjligheter till delaktigheti sociala sammanhang. Och närståendes betydelse. Analyserna visar att smärtan är relaterad till Göteborg6-8 april 201134trötthet, stress och sinnesstämning och att arbeteeller andra aktiviteter medverkar till att glömmabort smärtan och uppehålla förmåga. Analysenslutförs under hösten.Konklusion: Denna studie förväntas genererany angelägen kunskap om och förståelse försmärta.

  • 47.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Björk, Mathilda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Thyberg, Ingrid
    Linköping University.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis2015In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 8, 1353-1362 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (>40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

  • 48.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Thyberg, Ingrid
    Linköping University.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Dahlström, Ö
    Linköping University.
    Björk, Mathilda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project2015In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, 259-264 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier.

    METHOD: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years.

    RESULTS: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2.

    CONCLUSIONS: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

  • 49.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. ADULT.
    Thyberg, Ingrid
    Linköping University.
    Falkmer, Torbjörn
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Dahlström, Örjan
    Linköping University.
    Björk, Mathilda
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Less pain and activity limitations in today's early RA patients compared with patients diagnosed 10 years earlier (the swedish TIRA-project)2014In: EULAR 2014: Scientific Abstracts, 2014, 141-142 p.Conference paper (Refereed)
    Abstract [en]

    Background: Over the last decades the RA-treatment strategies have changed considerably. Routines for early RA diagnosis and instituted disease modifying anti rheumatic drugs (DMARDs) have been established. In the early 2000s biologic agents also became available for treatment purposes. Despite these altered and improved strategies RA patients continue to report pain and activity limitations; women more so than men.

    Objectives: To study differences regarding pain and activity limitations during the first three years after diagnosis of RA in today's patients compared with patients diagnosed 10 years earlier from a gender perspective.

    Methods: This study was based on patients recruited to the project “early interventions in RA” (TIRA). In the first cohort (TIRA-1) 320 patients were included during 1996-1998. In the second cohort (TIRA-2) 463 patients were included during 2006-2008. Disease activity score 28 joint count (DAS-28) and medication were registered. Pain intensity (VAS), bodily pain (BP) in Short Form36 (SF-36) and activity limitation (Health Assessment Questionnaire, HAQ) were reported at inclusion and at follow-ups after one, two and three years.

    Results: Disease activity did not differ between cohorts at inclusion, but was significant lower at the follow ups in the TIRA-2 cohort compared with the TIRA-1 cohort. Patients in TIRA2 were prescribed traditional DMARD:s and biologic agents more frequent than in TIRA-1. The TIRA-2 patients reported significantly higher pain intensity and activity limitations at inclusion but lower pain intensity and activity limitations at all follow-ups than TIRA-1 patients. There were no significant differences between cohorts regarding bodily pain at inclusion, but thereafter the TIRA-2 patients showed significant lower bodily pain than the TIRA-1 patients. Men reported lower activity limitation than women in TIRA-1; otherwise there were no gender differences in TIRA-1. In TIRA-2, there were no significant gender differences regarding pain at inclusion. However, men reported lower pain than women at all follow-ups. Women, in turn, reported significantly higher activity limitations at all time points in TIRA-2. Pain and activity limitations were significantly reduced from inclusion to the one year follow-up but remained stable thereafter.

    Conclusions: Both women and men in today's early RA patient cohort report lower pain and less activity limitations at the follow ups after diagnosis of RA compared to 10 years earlier. However, both activity limitations and bodily pain are still pronounced.

  • 50.
    Ahlstrand, Inger
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Vaz, Sharmila
    School of Occupational Therapy & Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Thyberg, Ingrid
    Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Björk, Mathilda
    Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 6, 824-834 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

    METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

    RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

    CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

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