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  • 1.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Univ Hosp Linkoping, Dept Clin Neurophysiol, Linkoping, Sweden..
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jonkoping Univ, Sch Hlth & Welf, ADULT, Jonkoping, Sweden..
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karlstad Univ, Dept Hlth Sci, Karlstad, Sweden..
    Oral health-related situations among patients with experience of continuous positive airway pressure treatment: a critical incident analysis of experiences and actions2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no Suppl 1, article id P085Article in journal (Refereed)
  • 2.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    “The terrible dryness woke me up, I had some trouble breathing”- critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13670Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

  • 3.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Kvarnvik, Christine
    Folktandvården Region Jönköpings län.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Avdelningen för Klinisk Neurofysiologi, Linköpings Universitetssjukhus, Linköping.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Inspektionen för Socialförsäkringen, Göteborg.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Stensson, Malin
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Oral hälsa och obstruktiv sömnapné- protokoll för en longitudinell studie2019Conference paper (Refereed)
  • 4.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Kvarnvik, Christine
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Stensson, Malin
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Norderyd, Ola
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics.
    Ulander, Martin
    Sunnergren, Ola
    Jansson, Henrik
    Sayardoust, Shariel
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    “No one seems to know”: Studieprotokoll för utvärdering av ett teoretiskt ramverk för oral hälsa avseende reliabilitet och validitet i en obstruktiv sömnapné population2019Conference paper (Other academic)
  • 5.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Kvarnvik, Christine
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. The Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden; Department of Endodontics, Periodontology and Prosthetics, Public Dental Health, Jönköping County Council, Jönköping, Sweden.
    Norderyd, Ola
    The Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden; Department of Endodontics, Periodontology and Prosthetics, Public Dental Health, Jönköping County Council, Jönköping, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Clinical and self-reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health2021In: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 71, no 1, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Introduction

    Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs.

    Objectives

    To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI's theoretical framework of oral health.

    Materials and methods

    A psychometric study was performed, using cross-sectional data from Sweden (= 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach's Alpha.

    Results

    The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach's Alpha indicated good to sufficient internal consistency for each component in the constructs (a = 0.88, 0.68, 0.61, respectively).

    Conclusion

    In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI's theoretical framework.

  • 6.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Views about oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnea: A qualitative studyManuscript (preprint) (Other academic)
  • 7.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department of Odontology and Oral Health Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Neher, Margit
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Views on oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnoea: a qualitative study2023In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 23, no 1, article id 407Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health.

    METHODS: Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation's [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework's component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories.

    FINDINGS: The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI's theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants.

    CONCLUSION: The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment.

  • 8.
    Ahonen, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science.
    Norderyd, Ola
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Applying World Dental Federation Theoretical Framework for Oral Health in a General Population2022In: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 72, no 4, p. 536-544Article in journal (Refereed)
    Abstract [en]

    Introduction: The World Dental Federation (FDI) has recently proposed a new definition and theoretical framework of oral health. The theoretical framework includes 4 main components and describes the relationships amongst them. In 2020, an international work group proposed the minimum Adult Oral Health Standard Set (AOHSS) of variables to measure oral health, which was mapped onto the FDI's theoretical framework. By using an empirical data set, the proposed variables in the AOHSS and the potential interactions amongst the components of the FDI's theoretical framework can be tested. The purpose of this research was to investigate structural relations of the components of the FDI's theoretical framework of oral health based on data from a general adult population.

    Methods: Data from a previously conducted Swedish cross-sectional study focusing on oral health were utilised (N = 630; women, 55.2%; mean age, 49.7 years [SD, 19.2]). Variable selection was guided by the AOHSS. Structural equation modeling was used to analyse relationships amongst the components of the FDI's theoretical model (core elements of oral health, driving determinants, moderating factors, and overall health and well-being).

    Results: The Oral Health Impact Profile (OHIP)-14, xerostomia, and aesthetic satisfaction had statistically significant direct effects on overall health and well-being (p < .05). Driving determinants and moderating factors had statistically significant direct effects on all core elements of oral health (p < .05) except aesthetic satisfaction (p = .616). The predictors explained 24.1% of the variance of the latent variable overall health and well-being. Based on several indices, the proposed model showed acceptable model fit.

    Conclusions: The FDI's theoretical framework can be used to describe different components of oral health and the relationship amongst them in an adult general population. Further research based on the FDI's theoretical framework in other populations and settings is needed to explore complex interactions and possible relationships that form oral health and to investigate other or additional important social determinants.

  • 9.
    Ahorsu, D. K.
    et al.
    Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Lin, C. -Y
    Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Imani, V.
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Carlbring, P.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Hamilton, K.
    School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Testing an app-based intervention to improve insomnia in patients with epilepsy: A randomized controlled trial2020In: Epilepsy & Behavior, ISSN 1525-5050, E-ISSN 1525-5069, Vol. 112, article id 107371Article in journal (Refereed)
    Abstract [en]

    Purpose: Insomnia has adverse effects on people with epilepsy. We aimed to test a novel cognitive behavioral therapy for insomnia (CBT-I) app-based intervention on insomnia symptoms and social psychological factors in people with epilepsy and to examine the possible mechanisms among the factors.

    Methods: Participants were recruited from neurology clinics in Iran and comprised individuals diagnosed with epilepsy and having moderate to severe insomnia. A two-arm randomized controlled trial design was used, consisting of a treatment group (CBT-I; n = 160) and control group (patient education; n = 160). Primary outcomes were self-reported sleep quality, insomnia severity, and sleep hygiene behavior and objective sleep characteristics measured by actigraphy. Secondary outcomes were attitude, perceived behavioral control, intention, action planning, coping planning, behavioral automaticity, self-monitoring, anxiety, depression, and quality of life (QoL). All outcomes were measured at baseline, and at one, three, and six months postintervention, except objective sleep, which was assessed at baseline, and one and six months postintervention. Data were analyzed using linear mixed models.

    Results: Current findings showed that sleep quality, insomnia severity, sleep hygiene behavior, and sleep onset latency were significantly improved in the CBT-I group compared with the patient education group at all measurement points. Also, the CBT-I group had significantly improved anxiety, depression, and QoL compared with the patient education group. Mediation analyses showed that attitude, intention, coping planning, self-monitoring, and behavioral automaticity significantly mediated the effect of the intervention on sleep outcomes.

    Conclusion: Results support the use of the CBT-I app to improve sleep outcomes among people with epilepsy.

  • 10.
    Ahorsu, Daniel Kwasi
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Timpka, Toomas
    Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Updegraff, John A.
    Department of Psychological Sciences, Kent State University, Kent, OH, United States.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Griffiths, Mark D.
    Psychology Department, International Gaming Research Unit, Nottingham Trent University, Nottingham, United Kingdom.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands: An Actor-Partner Interdependence Modelling2022In: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882, Vol. 20, p. 68-82Article in journal (Refereed)
    Abstract [en]

    The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives’ actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

  • 11.
    Ahorsu, Daniel Kwasi
    et al.
    Hong Kong Polytech Univ, Dept Rehabil Sci, Hung Hom, Hong Kong 999077, Peoples R China..
    Lin, Chung-Ying
    Natl Cheng Kung Univ, Coll Med, Inst Allied Hlth Sci, Tainan 701, Taiwan..
    Alimoradi, Zainab
    Qazvin Univ Med Sci, Res Inst Prevent Noncommunicable Dis, Social Determinants Hlth Res Ctr, Qazvin 3419759811, Iran..
    Griffiths, Mark D.
    Nottingham Trent Univ, Psychol Dept, Nottingham NG1 4FQ, England..
    Chen, Hsin-Pao
    E DA Hosp, Dept Surg, Div Colon & Rectal Surg, Kaohsiung 824, Taiwan.;I Shou Univ, Coll Med, Sch Med, Kaohsiung 824, Taiwan..
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jonkoping Univ, Sch Hlth & Welf, Dept Nursing, S-55333 Jonkoping, Sweden..
    Timpka, Toomas
    Linkoping Univ, Dept Hlth Med & Caring Sci, S-58183 Linkoping, Sweden..
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Qazvin Univ Med Sci, Res Inst Prevent Noncommunicable Dis, Social Determinants Hlth Res Ctr, Qazvin 3419759811, Iran.;Jonkoping Univ, Sch Hlth & Welf, Dept Nursing, S-55333 Jonkoping, Sweden..
    Cyberchondria, Fear of COVID-19, and Risk Perception Mediate the Association between Problematic Social Media Use and Intention to Get a COVID-19 Vaccine2022In: Vaccines, E-ISSN 2076-393X, Vol. 10, no 1, article id 122Article in journal (Refereed)
    Abstract [en]

    Vaccination is the most effective way to control the COVID-19 pandemic, but vaccination hesitancy threatens this effort worldwide. Consequently, there is a need to understand what influences individuals' intention to get a COVID-19 vaccine. Restriction of information gathering on societal developments to social media may influence attitudes towards COVID-19 vaccination through exposure to disinformation and imbalanced arguments. The present study examined the association between problematic social media use and intention to get the COVID-19 vaccine, taking into account the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception. In a cross-sectional survey study, a total of 10,843 residents of Qazvin City, Iran completed measures on problematic social media use, fear of COVID-19, cyberchondria, COVID-19 risk perception, and intention to get a COVID-19 vaccine. The data were analyzed using structural equation modeling (SEM). The results showed that there was no direct association between problematic social media use and intention to get a COVID-19 vaccine. Nonetheless, cyberchondria, fear of COVID-19, and COVID-19 risk perception (each or serially) mediated associations between problematic social media use and intention to get a COVID-19 vaccine. These results add to the understanding of the role of problematic social media use in COVID-19 vaccine hesitancy, i.e., it is not the quantity of social media use per se that matters. This knowledge of the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception can be used by public health experts and policymakers when planning educational interventions and other initiatives in COVID-19 vaccination programs.

  • 12.
    Ahorsu, Daniel Kwasi
    et al.
    Hong Kong Polytech Univ, Fac Hlth & Social Sci, Dept Rehabil Sci, Hung Hom, Hong Kong, Peoples R China..
    Lin, Chung-Ying
    Natl Cheng Kung Univ, Coll Med, Inst Allied Hlth Sci, Tainan, Taiwan..
    Yahaghai, Rafat
    Qazvin Univ Med Sci, Social Determinants Hlth Res Ctr, Res Inst Prevent Noncommunicable Dis, Qazvin, Iran.
    Alimoradi, Zainab
    Qazvin Univ Med Sci, Social Determinants Hlth Res Ctr, Res Inst Prevent Noncommunicable Dis, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Griffiths, Mark D.
    Nottingham Trent Univ, Psychol Dept, Nottingham, England.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Qazvin Univ Med Sci, Social Determinants Hlth Res Ctr, Res Inst Prevent Noncommunicable Dis, Qazvin, Iran.
    The mediational role of trust in the healthcare system in the association between generalized trust and willingness to get COVID-19 vaccination in Iran2022In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 18, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    For some individuals, there appears to be some level of unwillingness in getting a COVID-19 vaccine which may be due to trust issues. The present study used a mediation model to investigate how trust is associated with an individual's willingness to get COVID-19 vaccination among Iranians. A total of 10,843 Iranian adults were recruited in Qazvin province using a multistage stratified cluster sampling method. The survey was completed between February 19 and April 9, 2021. The findings showed that generalized trust was positively associated with trust in the healthcare system, trust in the healthcare system was positively associated with willingness to get COVID-19 vaccination, and generalized trust was positively associated with willingness to get COVID-19 vaccination. Also, trust in the healthcare system mediated the association between generalized trust and willingness to get COVID-19 vaccination. There were some significant demographic differences in COVID-19 vaccination willingness. The findings suggest that generalized trust plays a significant role in directly or indirectly influencing individuals' willingness to get COVID-19 vaccine. Therefore, government bodies and health officials may utilize these findings to appeal in a more transparent and professional manner in encouraging individuals to get a COVID-19 vaccine. However, for those with lower trust levels (in general and in the healthcare system), the focus may be to re-build and/or regain the individuals' trust through carefully planned transparent communication, information dissemination, and ethical education to help increase the uptake of COVID-19 vaccination.

  • 13.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ohayon, M. M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, United States.
    Lin, C. -Y
    Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Griffiths, M. D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Jernelöv, S.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Huddinge Hospital, Region Stockholm, M58, Stockholm, SE-141 86, Sweden.
    Kaldo, V.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Huddinge Hospital, Region Stockholm, M58, Stockholm, SE-141 86, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Reply to Liu et al.: “Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis”2022In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 66, article id 101699Article in journal (Other academic)
  • 14.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Golboni, F.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, M. D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, United Kingdom.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Lin, C. -Y
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Weight-related stigma and psychological distress: A systematic review and meta-analysis2020In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 7, p. 2001-2013Article in journal (Refereed)
    Abstract [en]

    Background & aims:

    Individuals who are overweight or who have obesity are likely to perceive or experience unfriendly treatment (i.e., weight-related perceived stigma) from different sources such as work colleagues because of the stigma towards excess weight. People who are overweight may accept such stigma and devalue themselves (i.e., weight-related self-stigma).

    Methods:

    A systematic review and meta-analysis was conducted to examine the relationship between weight stigma (including weight-related self-stigma and weight-related perceived stigma) and psychological distress (including depression and anxiety) using random-effects meta-analyses. Utilizing five academic databases (PubMed, Scopus, WOS, Embase and ProQuest) and keywords related to weight stigma and psychological distress, empirical studies focusing on the association between weight stigma and psychological distress were selected. The timeline for the searched papers was from the inception of each database to the end of August 2019.

    Results:

    Eligible studies (N = 30; 25 on weight-related self-stigma and eight on weight-related perceived stigma) were analyzed with a total of 9345 participants experiencing weight-related self-stigma, and 15,496 experiencing weight-related perceived stigma. The pooled associations were moderate between weight-related self-stigma and psychological distress (corrected Fisher's Z = 0.40 for depression; 0.36 for anxiety) and between perceived stigma and depression (Fisher's Z = 0.44).

    Conclusions:

    Results of the meta-analysis demonstrated that weight stigma is associated with psychological distress. The comprehensive search of the literature and rigorous methodology employed are the two major strengths in the present study. Because self-stigma and perceived stigma are different concepts, their associations with psychological distress should not be merged together. 

  • 15.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Jafari, E.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ohayon, M. M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, United States.
    Lin, C. -Y
    Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Griffiths, M. D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Blom, K.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm.
    Jernelöv, S.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm.
    Kaldo, V.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science.
    Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis2022In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 64, article id 101646Article in journal (Refereed)
    Abstract [en]

    The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I2 = 84.5%; tau2 = 0.31; p &lt; 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01–0.90; I2 = 87.5%; tau2 = 0.48, p &lt; 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02–0.92; I2 = 88.3%; tau2 = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12–0.80; I2 = 52.9%; tau2 = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used.

  • 16.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, 3419759811, Iran.
    Majd, N. R.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, 3419759811, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Tsang, H. W. H.
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Singh, P.
    P. G. Department of Agriculture, Khalsa College Amritsar, Punjab, India.
    Ohayon, M. M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, United State.
    Lin, C. -Y
    Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science.
    Is alexithymia associated with sleep problems?: A systematic review and meta-analysis2022In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 133, article id 104513Article in journal (Refereed)
    Abstract [en]

    Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N = 26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES = 0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES = 0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition.

  • 17.
    Alimoradi, Zainab
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Tsang, Hector W. H.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
    Haghayegh, Shahab
    Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
    Ohayon, Maurice M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA.
    Lin, Chung-Ying
    Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Sleep problems during COVID-19 pandemic and its’ association to psychological distress: A systematic review and meta-analysis2021In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 36, article id 100916Article, review/survey (Refereed)
    Abstract [en]

    Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

    Methods: Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

    Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

    Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

  • 18.
    Alimoradi, Zainab
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Gozal, David
    Department of Child Health and the Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, USA.
    Tsang, Hector W. H.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Lin, Chung-Ying
    Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ohayon, Maurice M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, Palo Alto, CA, USA.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 1, article id e13432Article, review/survey (Refereed)
    Abstract [en]

    The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals? sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID-19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta-analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID-19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Newcastle?Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta-analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%?29%) for female participants and 27% (95% CI 24%?30%) for male participants. Although in both gender subgroups, patients with COVID-19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta-regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.

  • 19.
    Alimoradi, Zainab
    et al.
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Bülow, Pia H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Bajalan, Zahra
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Ohayon, Maurice M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, United States.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Internet addiction and sleep problems: A systematic review and meta-analysis2019In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 47, p. 51-61Article, review/survey (Refereed)
    Abstract [en]

    The pathological use of the internet – conceptualized as ‘internet addiction’ – might be crucial in initiating and increasing sleep disturbances in the community. While inconsistent evidence is reported regarding the association of internet addiction and sleep disturbances, the severity of this association remains unclear. This systematic review and meta-analysis were conducted to increase our understanding of the relationship between internet addiction and sleep disturbances. A systematic review was conducted through Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and EMBASE using keywords related to internet addiction and sleep problems. Observational studies (cohort, case-control or cross-sectional studies) focusing on association between internet addiction and sleep disturbances including sleep problems and sleep duration were selected. A meta-analysis using random-effect model was conducted to calculate the odds ratio (OR) for experiencing sleep problems and standardized mean differences (SMDs) for sleep duration. Eligible studies (N = 23) included 35,684 participants. The overall pooled OR of having sleep problems if addicted to the internet was 2.20 (95% CI: 1.77–2.74). Additionally, the overall pooled SMDs for sleep duration for the IA group compared to normal internet users was −0.24 (95% CI: −0.38, −0.10). Results of the meta-analysis revealed a significant OR for sleep problems and a significant reduced sleep duration among individuals addicted to the internet.

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  • 20.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S53-S53Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 21.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S63-S64Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 22.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Instenes, I.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Ranhoff, A. H.
    University of Bergen, Department of clinical science, faculty of medicine, Bergen, Norway.
    Schjott, J. D.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 104-105Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.

    Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.

    Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.

    Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.

    Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.

  • 23.
    Amofah, H. A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Instenes, I.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Fridlund, B.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Haaverstad, R.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Kuiper, K.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, A. H.
    Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekvål, T. M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement: A qualitative interview study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 1, article id e039959Article in journal (Refereed)
    Abstract [en]

    Objectives

    Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-Term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.

    Design

    An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.

    Setting

    Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.

    Participants

    Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.

    Results

    For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.

    Conclusions

    For octogenarian patients, sleep disturbances and delirium are long-Term burdens and need a greater attention in order to improve patient care. 

  • 24.
    Amofah, Hege A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Bjorvatn, Bjørn
    Norwegian Competence Centre for Sleep Disorders, Bergen, Norway.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.

    Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.

    Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.

    Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).

    Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

  • 25.
    Andersson, Bodil T.
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Jakobsson, Ulf
    Center for Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Broström, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Radiographers' self-assessed level and use of competencies: a national survey2012In: Insight into Imaging, ISSN 1869-4101, E-ISSN 1869-4101, Vol. 3, no 6, p. 635-645Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience.

    METHODS: A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale.

    RESULTS: Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'.

    CONCLUSION: The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement.

    MAIN MESSAGES :

    • Assessing radiographers' clinical competencies is fundamental for ensuring professional standards.

    • Most competencies received high ratings both in the nursing and in the radiographic dimensions.

    • The highest rated competencies focussed on information and adaptability to the patients needs.

    • The lowest rated competencies focussed on encountering the patient in shock and image assessments.

    • Age, years in present position and work place only explained a relatively small part of competency.

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  • 26.
    Berggren, Kristina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Firestone, A.
    ivision of Orthodontics, Ohio State University, Columbus, OH, United States.
    Wright, B.
    Division of Dental Hygiene, Ohio State University, Columbus, OH, United States.
    Josefsson, E.
    Odontologiska Institutionen, Department of Orthodontics, Jönköping, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Department of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Oral health problems linked to obstructive sleep apnea are not always recognized within dental care—As described by dental professionals2022In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 8, no 1, p. 84-95Article in journal (Refereed)
    Abstract [en]

    Objectives: Obstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA.

    Methods: A qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi-structured face-to-face interviews were performed followed by qualitative content analysis.

    Results: Interviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers.

    Conclusions: Dental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.

  • 27.
    Bini, C.
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden..
    Hjelm, C.
    Linkoping Univ, Dept Hlth Med & Care, Linkoping, Sweden..
    Hellstrom, A.
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden..
    Arestedt, K.
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden.;Reg Kalmar, Dept Res, Kalmar, Sweden..
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Linkoping Univ Hosp, Dept Clin Neurophysiol, Linkoping, Sweden..
    Sandlund, C.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden..
    Do primary health care patients with insomnia interpret and respond to the consensus sleep diary as intended?: A cognitive interview study2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no Suppl 1, article id P235Article in journal (Refereed)
  • 28.
    Björk, Maria
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Knutsson, S.
    Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Odzakovic, Elzana
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hellström, A.
    Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Sandlund, C.
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Ulander, M.
    Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.
    Lind, J.
    Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869Article in journal (Refereed)
    Abstract [en]

    Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk–benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

  • 29.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sömnapné2021In: Distriktssköterskans specialistområden / [ed] E.-K. Hultgren, Lund: Studentlitteratur AB, 2021, 1, p. 373-391Chapter in book (Other academic)
  • 30.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Alimoradi, Zainab
    Social Determinants of Health Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Lind, Jonas
    Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Lundin, Fredrik
    Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 3, article id e13783Article, review/survey (Refereed)
    Abstract [en]

    This systematic review, meta-analysis and meta-regression assessed the prevalence of restless legs syndrome (RLS) in the general adult population. Studies identified in Scopus, PubMed, Web of Science, and PsycInfo between January 2000 and February 2022 were included if they used a case–control or cross-sectional design and reported data regarding the prevalence of RLS. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022300709). A total of 97 studies including 483,079 participants from 33 different countries met the eligibility criteria. The Newcastle Ottawa Scale was used to evaluate the methodological quality, and the fill-and-trim method was used to correct probable publication bias, while the jack-knife method was performed to assess small study effect. The corrected overall pooled prevalence of RLS was 3% (95% confidence interval [CI] 1.4%–3.8%). The pooled prevalence of RLS syndrome was affected by methodological quality (no data from non-respondents in the included studies), gender (higher among women), study design (lower prevalence in case–control versus cohort and cross-sectional studies). The figures for corrected pooled prevalence among men, women, alcohol consumers and smokers were 2.8% (95% CI 2%–3.7%); 4.7% (95% CI 3.2%–6.3%); 1.4% (95% CI 0%–4.2%); and 2.7% (95% CI 0%–5.3%), respectively. The prevalence among male and female participants was lower in community-based versus non-community-based studies. Moreover, the prevalence was higher in developed versus developing countries and among elders versus adults. In conclusion, RLS is a common disorder in the general adult population, with a higher prevalence in women; however, prevalence data are affected by study design and quality.

  • 31.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Arestedt, Kristofer Franzén
    Linköping University.
    Nilsen, Per
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

  • 32.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Centre for Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Fossum, Bjöörn
    Sophiahemmet University, Stockholm, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden.
    Ulander, Martin
    Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Medicine, Linköping University, Linköping, Sweden.
    Communication during the initial visit to a CPAP clinic Practitioners’ experiences of facilitators and barriers when talking to patients with obstructive sleep apnea2021In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 30, no 4, article id e13244Article in journal (Refereed)
    Abstract [en]

    Adherence to continuous positive airway pressure treatment for obstructive sleep apnea tends to be poor. Communication influences adherence but has not previously been investigated from a practitioner perspective, although shared decision-making is known to be of great importance. The aim was to describe how practitioners experience communication with patients with obstructive sleep apnea during the initial visit at a continuous positive airway pressure treatment clinic, with focus on facilitators and barriers related to the 4 Habits Model, a communication model comprised of four types of interrelated skills to make encounters more patient-centred: investing in the beginning; exploring the patient perspective; showing empathy; and investing in the end. A descriptive design with qualitative content analysis was used. A deductive analysis was carried out based on interviews with 24 strategically selected practitioners from seven continuous positive airway pressure treatment clinics. The 4 Habits Model was used as a framework for identifying facilitators and barriers to communication. Investments in the beginning was described as creating contact, showing the agenda and being adaptive, while explore the patient perspective included showing awareness, being explorative and creating a participating climate. Show empathy consisted of showing openness, being confirmative and creating acceptance, while showing a structured follow-up plan, being open minded and invitational and creating motivation to build on were descriptions of invest in the end. Awareness of potential facilitators and barriers for patient-centred communication during the beginning, middle and end of a continuous positive airway pressure treatment consultation can be used to improve contextual conditions and personal communication competences among practitioners working with continuous positive airway pressure treatment initiation.

  • 33.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum – Academy for Health and Care, Region Jönköping County, Sweden.
    Nilsen, Per
    Division of Health Care Analysis, Department of Health and Society, Faculty of Medicine, Linköping University Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital Linköping, Sweden.
    Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 3-4, p. 568-577Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated.

    Background: Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence.

    Methods: A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patient's perspective, demonstrate empathy and invest in the end of the consultation) was conducted.

    Results: Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patient's perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end.

    Conclusions: Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel.

    Relevance to clinical practice: A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

  • 34.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Sunnergren, Ola
    Institution of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 173-184Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation.

    Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.

    Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.

    Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.

    Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

  • 35.
    Broström, Anders
    et al.
    Linköping University.
    Johansson, Peter
    Linköping University.
    Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 3, p. 183-197Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively.

    AIM: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented.

    METHODS: MEDLINE and CINAHL databases were searched from 1989 to July 2004.

    FINDINGS: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45--82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness.

    CONCLUSION: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

  • 36.
    Broström, Anders
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Nilsen, Per
    Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Linköping University, 581 83 Linköping, Sweden.
    Gardner, Benjamin
    Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK.
    Johansson, Peter
    Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85 Linköping, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
    Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea2014In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, no 929057, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of "habit" in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42-0.93), item-total correlations (0.58-0.91), and reliability ( α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.

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  • 37.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, P.
    Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    CICE, Linneus University, Växjö, Sweden.
    Ulander, M.
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated2019In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, no 3, p. 761-768Article in journal (Refereed)
    Abstract [en]

    Background: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

    Methods: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

    Results: The reliability of the EBI was confirmed using composite reliability and Cronbach’s alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

    Conclusions: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity. 

  • 38.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
    Gardner, Benjamin
    Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 6, article id UNSP e12675Article in journal (Refereed)
    Abstract [en]

    The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners' beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners' beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients' knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions. 

  • 39.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 5, article id e12808Article in journal (Refereed)
    Abstract [en]

    Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.

  • 40.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine and Public Health Science Department of Health and Society Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4040-4049Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension.

    Design: Cross-sectional design.

    Methods: A total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used.

    Results: Of the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index ≥30 kg/m2). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equation modelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good.

    Conclusion: The initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension.

    Relevance to Clinical Practice: The PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes. 

  • 41.
    Broström, Anders
    et al.
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Ulander, Martin
    Linköping University.
    Harder, Lena
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, no 4, p. 439-447Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment.

  • 42.
    Broström, Anders
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Sunnergren, Ola
    Linköping University.
    Johansson, Peter
    Linköping University.
    Svensson, Erland
    Swedish Defence Research Agency.
    Ulander, Martin
    Linköping University.
    Nilsen, Per
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis.2012In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 20, no 4, p. 287-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.

    AIM: To explore characteristics associated with undiagnosed OSA in hypertensive primary care patients.

    METHODS: Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. Main outcome: Measures symptom profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.

    RESULTS: Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.

    CONCLUSION: OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

  • 43.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sunnergren, Ola
    Linköping University.
    Nilsen, Per
    Linköping University.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 140-149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. AIM: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. METHODS: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. RESULTS: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. CONCLUSION: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

  • 44.
    Broström, Anders
    et al.
    Jönköping University, School of Health Science, HHJ. ADULT.
    Sunnergren, Ola
    Ryhov Cty Hosp, Ear Nose & Throat Clin, Jönköping, Sweden.
    Årestedt, Kristofer
    Linköping Univ, Fac Hlth Sci, Div Nursing Sci, Dept Med & Hlth Sci, Linköping, Sweden.
    Johansson, Peter
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Ulander, Martin
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Riegel, Barbara
    Linköping Univ, Fac Hlth Sci, Div Cardiovasc Med, Dept Med & Hlth Sci, Linköping, Sweden.
    Svanborg, Eva
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP > 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration > 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 45.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Ulander, M.
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, S-581 85, Sweden.
    Nilsen, P.
    Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Lin, C. -Y
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated2021In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 25, p. 627-637Article in journal (Refereed)
    Abstract [en]

    Background: Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice.

    Methods: A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed.

    Results: The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach’s alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP.

    Conclusions: The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence.

  • 46.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, Martin
    Linköping University.
    Nilsen, Per
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Arestedt, Kristofer Franzén
    Linköping University.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, no 3, p. 460-471Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbach's alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 47.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Wahlin, Åke
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Alehagen, Urban
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Johansson, Peter
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
    Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 5, p. 422-428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

    OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

    METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

    RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

    CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

  • 48.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Wahlin, Åke
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Alehagen, Urban
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Johansson, Peter
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, no 1, p. 290-298Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. Design: Cross-sectional.

    Methods: A community-dwelling sample of 675 older men and women (mean age 77.7 years, SD 3.8 years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (≤6 hours), n = 231; normal sleepers (7-8 hours), n = 338; and long sleepers (≥9 hours), n = 61. ancovas were used to explore sex-specific effects.

    Results: Depressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found.

    Conclusion: Nurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

  • 49.
    Elfström, Maria
    et al.
    Jönköping University, School of Health and Welfare. ENT Clinic, Ryhov County Hospital.
    Karlsson, Susanne
    Jönköping University, School of Health and Welfare. ENT Clinic, Ryhov County Hospital.
    Nielsen, Per
    Division of Health and Society, Department of Medical and Health Sciences, Linköping University, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Svanberg, Eva
    Department of Clinical Neurophysiology, University Hospital, Linköping, and Institution of Clinical and Experimental Medicine, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Decisive Situations Affecting Partners' Support to Continuous Positive Airway Pressure-Treated Patients With Obstructive Sleep Apnea Syndrome: A Critical Incident Technique Analysis of the Initial Treatment Phase2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 27, no 3, p. 228-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND RESEARCH OBJECTIVE: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners' support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment.

    SUBJECTS AND METHODS: A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners' support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS.

    RESULTS: Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners' support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners' support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment.

    CONCLUSION: Increased knowledge about the different situations that affect the partners' support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.

  • 50.
    Ericsson, Carin
    et al.
    Cardiology and Speciality Medicine Centre, Region Ostergotland, Linkoping, Sweden .
    Skagerström, Janna
    Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
    Schildmeijer, Kristina
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Region Ostergotland, Linkoping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
    Can patients contribute to safer care in meetings with healthcare professionals? A cross-sectional survey of patient perceptions and beliefs.2019In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 8, p. 657-666, article id bmjqs-2018-008524Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate patients' perceptions of their meetings with healthcare professionals and the extent to which they believe they can influence patient safety in these meetings.

    DESIGN: Cross-sectional survey of patients using a study-specific questionnaire. Data were analysed using both parametric and non-parametric statistics.

    SETTING: The study was conducted in primary and secondary care in three county councils in southeast Sweden by means of a survey questionnaire despatched in January 2017.

    PARTICIPANTS: Survey data were collected from 1445 patients, 333 of whom were complainants (patients who had filed a complaint about being harmed in healthcare) and 1112 regular patients (patients recruited from healthcare units).

    MAIN OUTCOME MEASURES: Patients' perceptions of meetings with physicians and nurses, beliefs concerning patients' contributions to safer care and whether the patients had suffered harm in healthcare during the past 10 years.

    RESULTS: Most respondents reported that it was easy to ask physicians and nurses questions (84.9% and 86.6%) and to point out if something felt odd in their care (77.7% and 80.7%). In general, complainants agreed to a higher extent compared with regular patients that patients can contribute to safer care (mean 1.92 and 2.13, p<0.001). Almost one-third (31.2%) of the respondents (both complainants and regular patients) reported that they had suffered harm in healthcare during the past 10 years.

    CONCLUSIONS: Most respondents believed that healthcare professionals can facilitate patient interaction and increase patient safety by encouraging patients to ask questions and take an active part in their care. Further research will need to identify strategies to support such questioning in routine practice and ensure that it achieves its intended goals.

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