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  • 151.
    Gardner, Benjamin
    et al.
    Department of Epidemiology and Public Health, University College London, UK.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Department of Health and Society, Linköping University, Sweden.
    Hrubos Ström, Harald
    Department of Otopharyngeology, Akershus University Hospital, Norway.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Skagerström, Janna
    Department of Health and Society, Linköping University, Sweden.
    Johansson, Peter
    Department of Cardiology, Linköping University Hospital, Sweden.
    From 'does it work?' to 'what makes it work?': The importance of making assumptions explicit when designing and evaluating behavioural interventions2014Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, nr 4, s. 292-294Artikkel i tidsskrift (Fagfellevurdert)
  • 152.
    Gimbler Berglund, Ingalill
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ericsson, Elisabeth
    Division of nursing science, Department of medical and health sciences, Linköping University, Sweden.
    Proczkowska-Björklund, Marie
    Division of child and adolescent psychiatry, department of clinical and experimental medicine, Linköping University.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nurse anaesthetists' experiences with pre-operative anxiety2013Inngår i: Nursing Children and Young People, ISSN 2046-2336, Vol. 25, nr 1, s. 28-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims To explore nurse anaesthetists’ experiences and actions when administering and caring for children requiring anaesthesia.

    Method A qualitative design employing critical incident technique was used. Interviews were carried out with a purposeful sample of nurse anaesthetists (n=32). The nurse anaesthetists’ experiences were grouped into two main areas: organisation focused and interrelational focused. Actions were grouped into two main areas: optimising the situation and creating interpersonal interaction.

    Findings The categories and subcategories of the nurses’ experiences appeared to influence the outcome for the child. The nurse anaesthetists’ first priority was to create an optimal environment and increase sensitivity in their interactions with the child.

    Conclusion Sensitivity to the child and flexibility in altering actions are key strategies to avoid physical restraint.

  • 153.
    Golsäter, Marie
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Futurum Academy for Health and Care Region Jönköping County, Jönköping, Sweden.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Enskär, Karin
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Knutsson, Susanne
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Are children as relatives our responsibility? How nurses perceive their role in caring for children as relatives of seriously ill patients2016Inngår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 25, s. 33-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose of this study was to elucidate how nurses perceive their role in caring for children as relatives to a parent with a serious physical illness.

    Method: A qualitative explorative design with focus group interviews was used. In total, 22 nurses working at one neurological, one haematological and two oncological wards were interviewed. The transcripts from the interviews were analysed in steps in accordance with inductive qualitative content analysis.

    Results: This study revealed six variations in how nurses perceived their role in the encounter with child relatives, ranging from being convinced that it is not their responsibility to being aware of the children's situation and working systematically to support them.

    Conclusion: Nurses should consider whether their patients have children who might be affected by their parent's illness. The nurses' self-confidence when meeting these children must be increased by education in order to strengthen their professional role. Furthermore, guidelines on how to encounter child relatives are required.

  • 154.
    Gullvåg, Marianne
    et al.
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Gjeilo, Kari Hanne
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Fålun, Nina
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Norekvål, Tone M.
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Mo, Rune
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep-disordered breathing.2019Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, nr 3, s. 750-759Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Sleep-disordered breathing, including obstructive sleep apnoea and central sleep apnoea, is a common disorder among patients with chronic heart failure. Obstructive sleep apnoea is often treated with continuous positive airway pressure, but central sleep apnoea lacks a clear treatment option. Knowledge of how sleep-disordered breathing is experienced (e.g. difficulties and care needs) and handled (e.g. self-care actions) by the patients is limited, but needed, to provide patient-centred care.

    AIM: To explore how newly verified sleep-disordered breathing is experienced by patients with chronic heart failure.

    METHODS: Data were collected through semi-structured interviews and analysed with qualitative content analysis. Seventeen participants (14 men, three women), mean age 60 years (range 41-80) diagnosed with chronic heart failure and objectively verified sleep-disordered breathing (nine obstructive, seven central and one mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    RESULTS: Patients with chronic heart failure and newly verified sleep-disordered breathing (SDB) described experiences of poor sleep that had consequences for their daily life and their partners. Different self-care strategies were revealed, but they were based on 'common sense' and were not evidence-based. The awareness of having SDB was varied; for some, it gave an explanation to their trouble while others were surprised by the finding.

    CONCLUSION: Patients with chronic heart failure and sleep-disordered breathing experienced reduced sleep quality, influencing their daily life. Possible underlying causes of disrupted sleep, such as sleep-disordered breathing, should be identified to establish proper patient-centred treatment strategies. There is a need for new strategies to approach patients with chronic heart failure (i.e. those with central sleep apnoea) who are not subject to continuous positive airway pressure treatment for their sleep-disordered breathing.

  • 155.
    Gunnarsson, A. Birgitta
    et al.
    Göteborgs universitet.
    Håkansson, Carita
    Lunds universitet.
    Wagman, Petra
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hedin, Katarina
    FoU Kronoberg, Landstinget Kronoberg, Växjö.
    Arbetsterapi för personer med depression och ångest: En randomiserad kontrollerad studie av Tree Theme Method®2015Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Tema: Intervention

    Stadier i livet: Vuxna

    Projekttyp: Forskningsarbete

    Bakgrund: Vid depression och ångest försvåras förmåga att klara vardagens aktiviteter liksom att relatera till andra. Svårigheterna bidrar till höga sjukskrivningstal. Tree Theme Method® (TTM) är en arbetsterapeutisk metod som syftar till ökad förmåga att utveckla strategier och struktur i vardagens aktiviteter. TTM består av 5 sessioner och innebär att måla och berätta sin livsberättelse med fokus på vardagslivets aktiviteter samt skapa en bild av framtida mål. Fokus i tidigare studier avseende TTM har varit processutvärdering. Nu är det viktigt att utvärdera eventuella effekter av interventionen. I den här studien prövas TTM mot kontroll. Kontrollgruppen får annan arbetsterapeutisk behandling, dvs 5 sessioner om vardagens aktiviteter och psykiskt välmående i den aktuella situationen. Hypotesen är att interventionsgruppen får högre grad av struktur i vardagens aktiviteter och förbättrad psykisk hälsa jämfört med kontrollgruppen.

    Syfte: Undersöka effekter av TTM jämfört med kontrollgrupp avseende aktivitet, psykiska symtom och självskattad hälsa.

    Metod: Randomiserad multicenterstudie i primärvård och vuxenpsykiatri. Totalt 130 patienter inkluderas. Inklusion är fastställd depression och/eller ångest, 18-65 år samt aktivitetsproblem. Patienter lottas till TTM alternativt annan arbetsterapeutisk behandling. Deltagarna besvarar självskattningsformulär avseende vardagens aktiviteter, psykiska symtom samt självskattad hälsa. Detta sker före och direkt efter behandling samt 3 och 12 månader efter avslutad behandling. Icke-parametrisk statistisk analys kommer att användas.

    Resultat/preliminärt resultat: Hittills har 55 patienter inkluderats. I nuläget finns inga preliminära resultat. Presentation av baslinjemätningar sker vid arbetsterapiforum.

    Slutsats: Det är betydelsefullt att kunna erbjuda patienter med depression och ångest olika behandlingsmetoder. Den här studien kan bidra till högre grad av evidens för arbetsterapeutisk behandling.

  • 156.
    Gunnarsson, Birgitta
    et al.
    FoU-avdelningen, Kronobergs läns landsting.
    Björklund, Anita
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Sustainable enhancement in clients who perceive the Tree Theme Method (R) as a positive intervention in psychosocial occupational therapy2013Inngår i: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 60, nr 3, s. 154-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background/aim: The Tree Theme Method® is an intervention based on creative activities and occupational storytelling. The Tree Theme Method® implies that the clients draw and paint trees symbolising various periods in their life. The pictures are then used as a starting point to tell their life story to enhance their wellbeing and management of their everyday life. This study aimed to evaluate if changes observed among clients regarding their wellbeing and everyday occupations, between baseline and the end of their term of the Tree Theme Method® therapy, persisted three years after the completion of the intervention.

    Methods: This study had a quantitative design. Thirty-one former clients were recruited to a follow-up three years after completing the intervention. Self-rating questionnaires were used regarding psychological symptoms, self-mastery, sense of coherence, activity level, occupational performance and satisfaction with occupational performance. Non-parametric methods were used for the data analysis.

    Results: The findings revealed positive significant changes regarding sense of coherence and occupational performance and satisfaction with occupational performance, measured between the end of the intervention and at the time of the three-year follow-up. Furthermore, the respondents' ratings regarding psychological symptoms, self-mastery, activity level and the extent of satisfaction with performed occupations were found to be stable.

    Conclusions: The Tree Theme Method® appeared to function well as an intervention in psychosocial occupational therapy, where the aim was that a client would enhance their wellbeing and management of their everyday life. However, there is need for further evaluation to assess the effects of the Tree Theme Method® intervention.

  • 157.
    Gunnarsson, Birgitta
    et al.
    Department of Research and Development, Region Kronoberg, Växjö, Sweden.
    Wagman, Petra
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hedin, Katarina
    Futurum, Region Jönköping County, Jönköping, Sweden.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Treatment of depression and/or anxiety – outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy2018Inngår i: BMC Psychology, E-ISSN 2050-7283, Vol. 6, nr 25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression and anxiety disorders are a major concern in western countries, and because these often have a negative affect on everyday life interventions based on activities in everyday life are needed. The Tree Theme Method® (TTM) is a client-centred occupational therapy intervention designed to increase the ability to cope with, and to enhance satisfaction with, everyday life, both at home and at work. The aim of this study was to compare the short term outcomes of the TTM intervention with regular occupational therapy treatment for people with depression and/or anxiety disorders.

  • 158.
    Gunnarsson, Birgitta
    et al.
    Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Wagman, Petra
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Hedin, Katarina
    Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine Lund University, Lund, Sweden .
    The Tree Theme Method® (TTM), an occupational therapy intervention for treating depression and anxiety: Study protocol of a randomized controlled trial2015Inngår i: BMC Psychology, E-ISSN 2050-7283, Vol. 3, nr 40, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Depression and anxiety disorders are increasing among the general population in the Western world. Individuals may need several kinds of treatment in order to maintain health, such as cognitive behavioural therapy (CBT) and drug treatment. However, having an everyday life that “works” is also important, suggesting a need for interventions based on activities that facilitate a satisfying everyday life. There is still lack of such evidence-based interventions. The Tree Theme Method® (TTM) is an occupational therapy intervention designed for a client-centred context in which an individual develops strategies to become an actor in his or her everyday life. Previous studies of the TTM have focused on process evaluation; therefore, further studies are needed to evaluate the method’s effects. The aim of this paper is to outline an intervention that can evaluate the effects of the TTM in terms of psychological symptoms, as well as everyday occupations and well-being, in patients suffering from depression and anxiety.

    Methods/Design

    This randomized clinical trial includes patients from three Swedish counties randomized to either intervention or treatment as usual. Men and women aged 18–65 years who have been diagnosed with either depression or anxiety are eligible for inclusion. Data collection is carried out at baseline, and outcomes are assessed at the end of intervention, as well as at 3 months and 12 months after intervention ends. The outcomes measured are psychological symptoms, everyday activities, and health-related factors.

    Discussion

    Depression and anxiety may create difficulties for individuals in the activities of their everyday lives to the extent that they require diagnosis and intervention. Despite this reality, evidence-based interventions that focus on everyday activities are lacking. Therefore, it would be useful to design a specific method for occupational therapy intervention that does precisely that. This study provides insight into the effects of the TTM, comparing it to occupational therapy treatment as usual.

  • 159.
    Gustafsson, Greta
    et al.
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Vrethem, Magnus
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation2015Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, nr 8, s. 1493-1497Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:

    To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

    METHODS:

    We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

    RESULTS:

    No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12 years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

    CONCLUSION:

    Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

    SIGNIFICANCE:

    Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

  • 160.
    Günal, Ayla
    et al.
    Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey.
    Pekçetin, Serkan
    Department of Occupational Therapy, Faculty of Gulhane Health Sciences, Health Sciences University, Ankara, Turkey.
    Demirtürk, Funda
    Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey.
    Şenol, Hande
    Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
    Håkansson, Carita
    Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Wagman, Petra
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Validity and reliability of the Turkish Occupational Balance Questionnaire (OBQ11-T)2019Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Occupational balance (OB) is an important concept in occupational therapy and is considered as an essential component of health and well-being.

    Aim: The aim of this study was to investigate the validity and reliability of the Turkish version of the Occupational Balance Questionnaire-11 (OBQ11-T).

    Materials and methods: The OBQ11-T was administered to 116 individuals for construct validity analysis and to 58 individuals for reliability analysis. Validity was determined using explanatory and confirmatory factor analysis. In confirmatory factor analysis, RMSEA (root mean square error of approximation) value, comparative fit index (CFI), and Chi-square to degrees of freedom ratio (CMIN/DF) were analysed. The test-retest method and Cronbach's alpha coefficient were used to assess the reliability and internal consistency of the OBQ11-T, respectively.

    Results: The model fit the data according to the indices of relative fit (RMSEA = 0.076, CMIN/DF = 1.661, and CFI = 0.875). The correlation coefficient between test and retest OBQ11-T total scores was 0.922. Total scores showed a significant statistical relationship (p<0.01), indicating good reliability. Cronbach's alpha for OBQ11-T total score was 0.785, indicating acceptable internal consistency.

    Conclusions and significance: The current study demonstrates that the OBQ11-T is a valid and reliable tool for measuring the self-rated OB of healthy individuals.

  • 161.
    Hagiwara, Magnus
    et al.
    University of Borås, School of Health Sciences, Borås, Sweden.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jonsson, Anders
    University of Borås, School of Health Sciences.
    Suserud, Björn-Ove
    University of Borås, School of Health Sciences.
    Decision Support Tool in Prehospital Care: A systematic Review of Randomized Trials2011Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, Vol. 26, nr 5, s. 319-329Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient.

    Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials.

    Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed.

    Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.

  • 162.
    Hagiwara, Magnus
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, .
    Lundberg, Lars
    School of Health Sciences, University of Borås, Borås, Sweden.
    Suserud, Björn-Ove
    School of Health Sciences, University of Borås, Borås, Sweden.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jonsson, Anders
    School of Health Sciences, University of Borås, Borås, Sweden.
    Decision support system in prehospital care: a randomized controlled simulation study2013Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 1, s. 145-153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS.

    Methods: In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST).

    Results: There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001).

    Conclusion: The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

  • 163.
    Hagiwara, Magnus
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Suserud, Björn-Ove
    School of Health Sciences, University of Borås, Borås, Sweden.
    Andersson-Gäre, Boel
    Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jonsson, Anders
    School of Health Sciences, University of Borås, Borås, Sweden.
    The effect of a Computerized Decision Support System on prehospital assessment: results of an interrupted time-series studyManuskript (preprint) (Annet vitenskapelig)
  • 164.
    Hagiwara, Magnus
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Suserud, Björn-Ove
    Högskolan i Borås, Insitutionen för vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Insitutionen för vårdvetenskap.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation2013Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, nr 46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context.

    Methods

    This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used.

    Results

    The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel.

    Conclusions

    The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

  • 165.
    Hallert, Eva
    et al.
    Linköping University.
    Björk, Mathilda
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Dahlström, Örjan
    Linköping University.
    Skogh, Thomas
    Linköping University.
    Thyberg, Ingrid
    Linköping University.
    Disease activity and disability in women and men with early rheumatoid arthritis (RA): An 8-year followup of a Swedish early RA project2012Inngår i: Arthritis Care and Research, ISSN 0893-7524, E-ISSN 1529-0123, Vol. 64, nr 8, s. 1101-1107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To compare women and men regarding course of disease activity and disability over 8 years from diagnosis of recent onset rheumatoid arthritis (RA).

    PATIENTS AND METHODS: 149 patients were followed for 8 years from RA diagnosis (1996-98) regarding 28-joint count disease activity score (DAS28), pain (visual analogue scale, VAS), grip force, Grip Ability Test (GAT), Signals of Functional Impairment (SOFI hand, upper/lower extremity), walking speed, activity limitation (Health Assessment Questionnaire, HAQ) and prescribed disease-modifying anti-rheumatic drugs (DMARDs).

    RESULTS: Disease activity pattern over time was similar in women and men, showing improvement during the first year and thereafter a stable situation during 6 years. However, at the 7- and 8-year follow-ups deterioration was seen with a less favourable course in women. HAQ did not differ between sexes at diagnosis, but at all follow-ups women had significantly higher scores than men. Women also had lower grip force and lower walking speed, but higher upper extremity mobility. DMARD prescription was similar for both sexes. Over eight years, disease duration, sex, biologics, grip force, SOFI-hand and pain intensity together explained 43% of the variation in DAS, while grip force, SOFI-lower, GAT and pain intensity could together explain 55% of variations in HAQ.

    CONCLUSIONS: Disease activity was fairly well managed, but disability gradually deteriorated. Despite similar medication, women had more disability than men. The discrepancy between disease activity and disability indicates unmet needs for multi-professional interventions to prevent progressing disability and patients at risk for disability need to be identified early in the process. © 2012 by the American College of Rheumatology.

  • 166.
    Hallgren, Jenny
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Fransson, Eleonor I.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Finkel, Deborah G.
    Dahl Aslan, Anna K.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Trajectories of motor function and cognition in relation to hospitalization2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Hospitalization among older people is common and associated with adverse outcomes. However, knowledge about long-term effects on motor functions and cognitive abilities in relation to hospitalization is scarce. In order to explore development of motor functions and cognition after hospitalization, a longitudinal study among middle-aged and older adults with up to 25 years of follow-up was conducted.

    Methods: Overall, 828 participants from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to the Swedish National Inpatient Register, which contains information on participants’ hospital admissions. Up to 8 assessments of cognitive performance and 7 assessments of motor functions i.e. fine motor, balance/upper strength, and flexibility, from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between hospitalization and subsequent motor function and cognitive performance.

    Results: A total of 735 (89 %) persons had at least one hospital admission during the follow-up. The mean age at first hospitalization was 70.2 (± 9.3) years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in all domains and in motor functions compared with those who were not hospitalized. A significantly steeper decline was observed in motor function abilities as well as in processing speed, spatial/fluid, and general cognitive ability performance of hospitalized participants. These patterns remained even after comorbidities and dementia prevalence were controlled for.

    Discussion: We are the first to show that hospitalization is associated with steeper decline in both motor function and cognitive abilities across more than two decades of post-hospitalization follow-up.

  • 167.
    Hallgren, Jenny
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Reynolds, C. A.
    University of California, USA.
    Pedersen, Nancy L.
    Karolinska Institutet.
    Dahl, Anna K.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Jonkoping Univ, Sch Hlth Sci, Inst Gerontol, Jonkoping, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Factors associated with hospitalization among older people in Sweden: Results from the Satsa Study2015Inngår i: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, s. 678-679Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Hospitalization among older people is common and associated with risk of adverse outcomes such as iatrogenic disorders and physical impairments. Knowledge about personal characteristics and social factors related to hospitalization is scarce. In order to understand which factors that are related to hospitalization risk, a prospective study with a multifactorial approach was conducted.

    Methods: In 2003, 794 Swedish persons (mean age 70.1 years, 60.7% females) answered a postal questionnaire as a part of the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). Participants were asked about physiological and psychological health, personality and socio economic factors. During seven years of follow-up, information on hospitalizations and the associated diagnoses were obtained from the Swedish National Inpatient Register.

    Results: Preliminary results show that 484 persons (61.0%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases and tumors. Cox proportional hazard regression model controlling for age, sex and dependency within twin pairs, showed that higher locus of control (HR=0.89, 95% CI=0.83-0.96), marital status (widow/widower (HR=0.64, 95 % CI=0.50-0.81) and unmarried (HR=0.67, 95% CI=0.50-0.90)), and support from friends (HR=0.93, 95% CI=0.87-0.99) were associated with lower risk of hospitalization, while greater numbers of diseases (HR=1.11, 95% CI=1.03-1.20) and negative life events (HR=1.16, 95%  CI=1.00-1.34) were associated with increased risk of hospitalization.

    Discussion: Our results show that both personal and social factors were important for the risk of hospitalization. This might be used in future interventions for understanding health care utilization.

  • 168.
    Hammarström, Sofia
    et al.
    Department of Medical and Health Science, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Nilsen, Per
    Department of Medical and Health Science, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Lindroth, Malin
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden.
    Stenqvist, Karin
    Närhälsan Knowledge Center for Sexual Health, Gothenburg, Sweden.
    Bernhardsson, Susanne
    Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
    Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics2019Inngår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 24, nr 1, s. 45-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives 

    We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT’s potential to identify young people in need of special care and monitoring.

    Methods

    The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors’ responses to SEXIT were analysed.

    Results 

    All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15–24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer.

    Conclusions

    The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors. 

  • 169.
    Hammarström, Sofia
    et al.
    Närhälsan Knowledge Centre for Sexual Health, Region Västra Götaland, Sweden.
    Stenqvist, Karin
    Närhälsan Knowledge Centre for Sexual Health, Region Västra Götaland, Sweden.
    Lindroth, Malin
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sexual health interventions for young people in state care: a systematic review2018Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, nr 8, s. 817-834Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objectives: To describe evaluated sexual health interventions for young people in state care and provide an assessment of the quality of and evidence for these interventions.

    Methods: A systematic review of sexual health interventions for young people in state care was conducted. Randomised controlled trials and quasi-experimental designs were eligible, 2051 records were screened, 412 full-text studies retrieved, and 12 publications with low-to-moderate risk of bias included.

    Results: Due to substantial heterogeneity in study populations, settings, intervention approaches, outcomes and measures, standard summary measures for intervention outcomes was not used. Instead, data were synthesised across studies and presented narratively.

    Conclusion: Without making recommendations, the result suggests that group-based educational interventions in general increase knowledge, attitudes and behaviour compared with standard care. However, these findings need to be further investigated, with a special emphasis on cultural context and the involvement of young people.

  • 170.
    Haraldsson, K
    et al.
    Research and Development Unit, General Practice and Public Health, Halland County Council, Falkenberg, Sweden.
    Lindgren, E-C
    Research and Development Unit, General Practice and Public Health, Halland County Council, Falkenberg, Sweden.
    Mattsson, B
    Sahlgrenska School of Public Health and Community Medicine, Göteborg University, Göteborg, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättringar, innovationer och ledarskap inom vård och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Marklund, B
    Research and Development Unit, General Practice and Public Health, Halland County Council, Falkenberg, Sweden.
    Adolescent girls' experiences of underlying social processes triggering stress in their everyday life: a grounded theory study2011Inngår i: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 27, nr 2, s. e61-e70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to generate a theoretical model of underlying social processes that trigger stress in adolescent girls' everyday life. In-depth interviews regarding the experiences of stress at home, school and during leisure time were conducted with 14 17-year-old schoolgirls. Data were analysed by means of the grounded theory method. Stress was triggered in the interaction between responsibility and the way in which the girls were encountered. Triggered emotional reactions took the form of four dimensions of stress included ambivalence, frustration, despair and downheartedness. These reactions were dependent on whether the girls voluntary assumed responsibility for various situations or whether they were forced, or felt they were being forced, to assume responsibility in interaction with an encounter characterized by closeness or distance. These forms of stress reactions could appear in one dimension and subsequently shift to another. From the public health perspective, the generated stress model can be used in the planning and implementation of future actions to prevent stress and promote well-being related to stress in adolescent girls.

  • 171.
    Hedberg, Berith
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, nr 5, s. 446-455Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    Aim:

    The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    Methods:

    A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    Results:

    Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    Conclusion:

    Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 172. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Madsen, Ida E. H.
    de Vroome, Ernest
    Alfredsson, Lars
    Bjorner, Jacob J.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Geuskens, Goedele A.
    Hooftman, Wendela E.
    Houtman, Irene L.
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Koskenvuo, Markku
    Lunau, Thorsten
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Dragano, Nico
    Rugulies, Reiner
    Kawachi, Ichiro
    Batty, G. David
    Singh-Manoux, Archana
    Virtanen, Marianna
    Kivimäki, Mika
    Long working hours and cancer risk: a multi-cohort study2016Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 114, s. 813-818Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear.

    METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported.

    RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity.

    CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.

  • 173.
    Heikkilä, K
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Madsen, I E H
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nyberg, S T
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerlund, H
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerholm, P. J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Virtanen, M.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, J.
    Finnish Institute of Occupational Health, Turku, Finland; Department of Public Health, University of Turku, Turku, Finland.
    Väänänen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Theorell, T.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Suominen, S. B.
    Department of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; Nordic School of Public Health, Göteborg, Sweden .
    Shipley, M. J.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Salo, P.
    Department of Public Health and Department of Psychology, University of Turku, Turku, Finland.
    Rugulies, R.
    National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health, Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Pentti, J.
    Department of Public Health, University of Turku, Turku, Finland.
    Pejtersen, J. H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Oksanen, T.
    Finnish Institute of Occupational Health, Turku, Finland.
    Nordin, M.
    Department of Psychology, Umeå University, Umeå, Sweden.
    Nielsen, M. L.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Kouvonen, A.
    School of Sociology, Social Policy & Social Work, Queen's University Belfast, Belfast, UK.
    Koskinen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Koskenvuo, M.
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Knutsson, A.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Ferrie, J. E.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Social and Community Medicine, University of Bristol, Bristol, UK.
    Dragano, N.
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Burr, H.
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Borritz, M.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Bjorner, J. B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Alfredsson, L.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G. D.
    Department of Epidemiology and Public Health, University College London, London, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK .
    Singh-Manoux, A.
    Department of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Kivimäki, M.
    Finnish Institute of Occupational Health, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK.
    Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women2014Inngår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, nr 6, s. 775-783Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.

    METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.

    RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).

    CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

  • 174.
    Heikkilä, Katriina
    et al.
    Finnish Institute of Occupational Health, Helsinki.
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyberg, Solja
    Finnish Institute of Occupational Health, Helsinki.
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Suominen, Sakari
    Steptoe, Andrew
    Salo, Paula
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Marmot, Michael
    Lunau, Thorsten
    Knutsson, Anders
    Ladwig, Karl-Heinz
    Kittel, France
    Koskenvuo, Markku
    Jöckel, Karl-Heinz
    Goldberg, Marcel
    Erbel, Raimund
    Dragano, Nico
    DeBacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Alfredsson, Lars
    Ferrie, Jane
    Singh-Manoux, Archana
    Batty, David
    Kivimäki, Mika
    Job strain and health-related lifestyle: Findings from an individual-participant meta-analysis of 118 000 working adults2013Inngår i: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 103, nr 11, s. 2090-2097Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.

    Methods. We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118 701; longitudinal data: n = 43 971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.

    Results. Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).

    Conclusions. Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause–effect relationship between work-related stress and lifestyle.

  • 175.
    Heikkilä, Katriina
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ahola, Kirsi
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Ferrie, Jane E.
    School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Nielsen, Martin L.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Department of Psychology, Umeå University, Umeå, Sweden.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, Jussi
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Job Strain and the Risk of Inflammatory Bowel Diseases: Individual-Participant Meta-Analysis of 95 000 Men and Women2014Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 2: e88711Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults.

    Methods: We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses.

    Results: Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations.

    Conclusions: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.

  • 176. Heikkilä, Katriina
    et al.
    Madsen, Ida E H
    Nyberg, Solja T
    Fransson, Eleonor I
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Nielsen, Martin L
    Nordin, Maria
    Pahkin, Krista
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J
    Suominen, Sakari B
    Theorell, Töres
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J M
    Batty, G David
    Singh-Manoux, Archana
    Kivimäki, Mika
    Job strain and COPD exacerbations: an individual-participant meta-analysis2014Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 44, nr 1, s. 247-251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To the Editor:Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and disability worldwide (1). The clinical course of COPD is characterised by exacerbations, which can be minor and manageable at home or in primary care, or severe, leading to hospitalisation or even death. Known causes of exacerbations include tobacco smoke, air pollution, dusts and fumes, and respiratory infections (1, 2). One less well understood risk factor is stress, which could plausibly lead to COPD exacerbations as it can trigger inflammation (3, 4) and is associated with increased smoking (5), which are both implicated in COPD pathology (2). Work is an important source of stress in the age groups in which COPD is typically diagnosed (1, 6). However, we are not aware of previous investigations of work-related stress and the risk of COPD exacerbations.In this study, we examined the associations between job strain (the most widely studied conceptualisation of work-related stress) and severe COPD exacerbations using individual-level data from 10 prospective cohort studies from the Individual Participant Data Meta-analysis in Working Populations (IPD-Work) Consortium (7). Job strain is defined as a combination of high demands (excessive amounts of work) and low control (having little influence on what tasks to.

  • 177. Heikkilä, Katriina
    et al.
    Nyberg, Solja
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob
    Bonenfant, Sébastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele
    Goldberg, Marcel
    Hooftman, Wendela
    Houtman, Irene
    Joensuu, Matti
    Jöckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida
    Magnusson Hanson, Linda
    Marmot, Michael
    Nielsen, Martin
    Nordin, Maria
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Töres
    Hamer, Mark
    Ferrie, Jane
    Singh-Manoux, Archana
    Batty, David
    Kivimäki, Mika
    Job strain and alcohol intake: A collaborative meta-analysis of individual-participant data from 140 000 men and women2012Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 7, s. e40101-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake.

    Methodology and Principal Findings: We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1–14, men: 1–21 drinks/week), intermediate (women: 15–20, men: 22–27 drinks/week) and heavy (women: >20, men: >27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake.

    Conclusions: Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.

  • 178. Heikkilä, Katriina
    et al.
    Nyberg, Solja T
    Fransson, Eleonor I
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob B
    Bonenfant, Sébastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A
    Goldberg, Marcel
    Hooftman, Wendela E
    Houtman, Irene L
    Joensuu, Matti
    Jöckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida E H
    Magnusson Hanson, Linda L
    Marmot, Michael G
    Nielsen, Martin L
    Nordin, Maria
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Töres
    Hamer, Mark
    Ferrie, Jane E
    Singh-Manoux, Archana
    Batty, G David
    Kivimäki, Mika
    Job strain and tobacco smoking: An individual-participant data meta-analysis of 166 130 adults in 15 European studies2012Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 7, s. e35463-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults.

    Methodology and Principal Findings: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking.

    Conclusions: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

  • 179. Heikkilä, Katriina
    et al.
    Nyberg, Solja
    Theorell, Töres
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Alfredsson, Lars
    Bjorner, Jakob
    Bonenfant, Sébastien
    Borritz, Marianne
    Bouillon, Kim
    Burr, Hermann
    Dragano, Nico
    Geuskens, Goedele
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela
    Houtman, Irene
    Joensuu, Matti
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Madsen, Ida
    Magnusson Hanson, Linda
    Marmot, Michael
    Nielsen, Martin
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Ferrie, Jane
    Singh-Manoux, Archana
    Batty, David
    Kivimäki, Mika
    Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women2013Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 345, nr f165Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers.

    Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake

    Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer.

    Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.

  • 180.
    Hellstrom, A.
    et al.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Hagell, P.
    Kristianstad Univ, Sch Hlth & Soc, PRO CARE Grp, Kristianstad, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Ulander, M.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Arestedt, K.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Initial psychometric testing of the sleep condition indicator in a Swedish context2017Inngår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, nr Suppl. 1, s. E129-E130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: There are several rating scales for insomnia; however, diagnostic criteria have changed over time. This means that the usefulness and validity of earlier scales may be compromised. The Sleep Condition Indicator (SCI) is a recently designed scale, developed in the UK, based on the DSM-V criteria of insomnia. The aim of this study was to translate and psychometrically evaluate the SCI in a Swedish context, focusing on its dimensionality.

    Materials and methods: The SCI consists of eight items with 5 ordered response categories (scored between 0 and 4). A total score between 0 and 32 is calculated; higher score indicates better sleep. The SCI was distributed through a web-questionnaire to university students and 634 completed the questionnaire . First we replicated the methodology used in the original testing of the UK SCI using principal component analysis (PCA) as the extraction method with varimax rotation and Kaisers eigenvalue >1 criterion for determination of the number of factors. We then continued with a more appropriate method for ordinal data, an exploratory factor analysis (EFA), using an unweighted least squares (ULS) extraction method based on a polychoric correlation matrix. Parallel analysis was conducted to determine the number of factors. Internal consistency was estimated using an ordinal version of Cronbach's alpha.

    Results: The PCA suggested a one factor model, with eigenvalues of 5.0 for the 1st and 0.9 for the 2nd factor, explaining 62% of the variance. Loadings varied between 0.62-0.86. With the EFA (ULS), 70% of the variance was explained by the first factor. Factor loadings varied between 0.66 and 0.92. Eigenvalues for factors 1 and 2 were 5.6 and 0.8, respectively. Corresponding 95th percentile eigenvalues from the parallel analysis were 5.3 (1st factor) and 0.4 (2nd factor). Reliability (ordinal alpha) of the total SCI score was 0.94.

    Conclusions: Both models support a unidimensional SCI structure in our sample of university students. This is a prerequisite for the calculation and validity of a total SCI score. In addition, the total score exhibited good reliability. These observations support the psychometric integrity of the Swedish SCI and provide a starting point for further testing.

  • 181.
    Hellström, Amanda
    et al.
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Hagell, Peter
    The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of clinical neurophysiology, Linköping University hospital, Linköping, Sweden.
    Ulander, Martin
    Department of clinical neurophysiology, Linköping University hospital, Linköping, Sweden.
    Luik, Annemarie I.
    Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
    Espie, Colin A.
    Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    A classical test theory evaluation of the Sleep Condition Indicator accounting for the ordinal nature of item response data2019Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 3, s. 1-13, artikkel-id e0213533Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Insomnia symptoms are common among young adults and affect about 5% to 26% of 19 to 34-year-olds. In addition, insomnia is associated with poor mental health and may affect daily performance. In research, as well as in clinical practice, sleep questionnaires are used to screen for and diagnose insomnia. However, most questionnaires are not developed according to current DSM-5 diagnostic criteria. An exception is the recently developed Sleep Condition Indicator (SCI), an eight-item scale screening for insomnia.

    AIM: The aim of this study was to perform a Classical Test Theory (CTT) based psychometric evaluation of the SCI in a sample of Swedish university students, by taking the ordinal nature of item level data into account.

    METHODS: The SCI was translated into Swedish and distributed online to undergraduate students at three Swedish universities, within programs of health, psychology, science or economy. Of 3673 invited students, 634 (mean age 26.9 years; SD = 7.4) completed the questionnaire that, in addition to the SCI, comprised other scales on sleep, stress, lifestyle and students' study environment. Data were analyzed according to CTT investigating data completeness, item homogeneity and unidimensionality.

    RESULTS: Polychoric based explorative factor analysis suggested unidimensionality of the SCI, and internal consistency was good (Cronbach's alpha, 0.91; ordinal alpha, 0.94). SCI scores correlated with the Insomnia Severity Index (-0.88) as well as with sleep quality (-0.85) and perceived stress (-0.50), supporting external construct validity.

    CONCLUSIONS: These observations support the integrity of the of the SCI. The SCI demonstrates sound CTT-based psychometric properties, supporting its use as an insomnia screening tool.

  • 182.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Diskussion2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 471-479Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 183.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Forskningsprocessen: problem, syfte och inledning/bakgrund2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 53-66Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 184.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Opponentskap och försvar2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 543-552Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 185.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Presentation av examensarbete2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 555-566Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 186.
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Vetenskaplig teori och metod: Från idé till examination inom omvårdnad2012Collection/Antologi (Annet vitenskapelig)
  • 187.
    Henricson, Maria
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Billhult, Annika
    FoU-enheten Södra Älvsborgs sjukhus.
    Kvalitativ design2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 129-137Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 188.
    Henricson, Maria
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hedberg, Berith
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    The validation of the Supervision of Thesis Questionnaire (STQ)2018Inngår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 65, s. 11-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The supervision process is characterized by differences between the supervisors’ and the students’ expectations before the start of writing a bachelor thesis as well as after its completion. A review of the literature did not reveal any scientifically tested questionnaire for evaluating nursing students’ expectations of the supervision process when writing a bachelor thesis.

    Objectives: The aim of the study was to determine the construct validity and internal consistency reliability of a questionnaire for measuring nursing students’ expectations of the bachelor thesis supervision process.

    Design & Methods: The study had a developmental and methodological design carried out in four steps including construct validity and internal consistency reliability statistical procedures: construction of the items, assessment of face validity, data collection and data analysis.

    Settings & Participants: This study was conducted at a university in southern Sweden, where students on the “Nursing student thesis, 15 ECTS” course were consecutively selected for participation. Of the 512 questionnaires distributed, 327 were returned, a response rate of 64%.

    Results: Five factors with a total variance of 74% and good communalities, ≥0.64, were extracted from the 10-item STQ. The internal consistency of the 10 items was 0.68. The five factors were labelled: The nature of the supervision process, The supervisor's role as a coach, The students’ progression to self-support, The interaction between students and supervisor and supervisor competence.

    Conclusions: A didactic, useful and secure questionnaire measuring nursing students’ expectations of the bachelor thesis supervision process based on three main forms of supervision was created.

  • 189.
    Henricson, Maria
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Publicering av examensarbete2012Inngår i: Vetenskaplig teori och metod. Från idé till examination inom omvårdnad / [ed] Henricson. M, Lund: Studentlitteratur, 2012, s. 569-581Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 190.
    Hergens, Maria-Pia
    et al.
    Department of Communicable Disease Control, Stockholm County Council, Stockholm, Sweden.
    Galanti, Rosaria
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hansson, Jenny
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Fredlund, Peeter
    Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Ahlbom, Anders
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bellocco, Rino
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden and Department of Statistics, University of Milano-Bicocca, Milano, Italy.
    Eriksson, Marie
    Department of Statistics, Umeå University, Umeå, Sweden.
    Fransson, Eleonor I
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden and School of Health Science, Jönköping University, Jönköping, Sweden.
    Hallqvist, Johan
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Jansson, Jan-Håkan
    Department of Medicine, Umeå University, Umeå, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Pedersen, Nancy
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lagerros, Ylva Trolle
    Unit of Clinical Epidemiology, Dept. of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ostergren, Per-Olof
    Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
    Magnusson, Cecilia
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation2014Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 6, s. 872-876Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.

    METHODS:: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.

    RESULTS:: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.

    CONCLUSION:: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.

  • 191.
    Hernar, Ingvald
    et al.
    Department of Medicine, Haukeland University Hospital, Bergen, Norway.
    Haltbakk, Johannes
    Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy2017Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 23-24, s. 4583-4596Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives: To assess the prevalence of lipohypertrophy, and to compare differences in external, personal and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy.

    Background: Suboptimal insulin injection behaviour is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy.

    Design: A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital. Methods: Participants (n = 215) were included consecutively at scheduled appointments. Sociodemographic, diabetes and insulin treatment data, and self-report questionnaires concerning patient activation (Patient Activation Measure), depression (Patient Health Questionnaire-2), diabetes distress (Diabetes Distress Scale), type D personality (14-item Type D scale), treatment satisfaction (Insulin Treatment Satisfaction Questionnaire) and motivation (Treatment Self-Regulation Questionnaire), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses.

    Results: Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycaemic control, higher bolus doses and reported suboptimal injection behaviour compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality or motivation between the groups.

    Discussion and conclusion: Compared to pump treatment, pen treatment requires greater awareness of injection technique. Symptoms of depression and lower treatment satisfaction might affect diabetes self-management and glycaemic control, but the association with lipohypertrophy needs further exploration.

    Relevance to clinical practice: Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also consider screening for depressive symptoms and treatment satisfaction as these factors could be associated with development of lipohypertrophy.

  • 192.
    Hill, Sophie
    et al.
    Oslo Metropolitan University.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Goihl, Tobias
    Helse Midt-Norge, Trondheim, Norway. & Trøndelag Ortopediske Verksted.
    Hjerman, Anne Katrine
    Drammen Ortopediskse Institutt, Drammen, Norway. .
    Reed Schwannborg, Linn
    Oslo Metropolitan University & Sophies Minde, Oslo, Norway.
    Bauger, Krister
    Oslo Metropolitan University.
    Developing National Curriculum Guidelines: An Appropriateness-Based Approach2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    BACKGROUND

    In 2017, the Norwegian Ministry of Education and Research began work on a project to develop national curriculum guidelines for all health and social care education programmes at Bachelor level and above. The guidelines will consist of a statement of purpose, learning outcomes and guidance on the structure of the programme. Whilst curriculum guidance exists for many professions and disciplines, there is little written about its development.

    AIM

    To develop national guidelines for prosthetics and orthotics education using an appropriateness-based approach.

    METHOD

    A modified RAND/UCLA method was used to gather information and rank appropriateness of developed learning outcomes. Collaboration with stakeholders was important and information was gathered from various professional and user organisations. Programme outlines (if available in English) from ISPO category 1 accredited programmes, together with those from northern European countries were also gathered.

    RESULTS

    A total of 23 programmes were invited to provide their programme documents or were accessible online. 11 programme documents were obtained and - without programme level outcomes - were excluded (n=4). Information was obtained via email, online discussion and focus groups from various organisations. The data were collated and organised into different competency areas. From this data 126 learning outcomes were developed and organised into an online questionnaire. All participants who had attended the focus groups and development group members rated the appropriateness of the learning outcome and its competence area. A further focus group and development meeting was held where results were discussed, and the learning outcomes reduced to 51. After drafting of the remaining sections, the document was sent out for consultation. Feedback from the consultation was collated and the guidelines adjusted as necessary.

    DISCUSSION AND CONCLUSION

    In comparison to existing programme learning outcomes from the documents obtained, there is a considerable difference in the number of learning outcomes. There are country specific differences that need to be accounted for when developing national guidelines. However, the development of national curriculum guidelines using an appropriateness-based approach ensured both a national and international focus.

  • 193.
    Hjalmarsson Österholm, Johannes
    et al.
    Linköping university.
    Björk, Mathilda
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Håkansson, Carita
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Factors of importance for maintaining work as perceived by med with arthritis2012Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Employment rates are significantly lower among individuals with arthritis compared to a generalpopulation. During the last decade new biological medications have revolutionized the treatment for many individuals witharthritis (1), reducing the disease activity and symptoms in a positive way, but also causing major direct costs since thenew medications are very expensive (2). Even though the effect is good some individuals still report disability like pain,fatigue (3) and work disability (4). This indicates that even though biological medicines generate a positive remission ofthe disease, disability such as work disability can still be present and needs to be evaluated. Previous research aboutindividuals with arthritis and their ability to work has mainly had a quantitative design focusing on what affects work andfacilitates the ability to work for women. There is, however, limited research about how men with arthritis perceive theirability to maintain working.Objectives: The aim of this study was thus to explore how men with arthritis perceive their ability to maintain working.Methods: Nine employed men with arthritis were purposively sampled. Interviews were performed and were inspired bythe central concepts of the Model of Human Occupation. The Empirical Phenomenological Psychological method wasmodified and used to analyze and interpret collected data.Results: The findings consist of six themes and fifteen sub-themes. The results showed that men with arthritis perceiveda desire to work, adjusted their activity pattern, were aware of their own capabilities, had good work conditions, hadenvironmental support and used effective medication to maintain their ability to work.Conclusions: This study has provided an understanding of how men with arthritis maintain their ability towork. In conclusion, to treat the symptoms of arthritis, in the more traditional way that for examplehand dysfunction and pain are treated, may prevent sick-leave but as found in the presentstudy the ability to work is complex and new strategies to support ability to work need to bedeveloped in the occupational aspects of rheumatology care.

  • 194. Hjelm, Carina
    et al.
    Dahl, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa. Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Johansson, Boo
    Strömberg, Anna
    The influence of heart failure on change in cognition among individuals 80 years of age and older2011Konferansepaper (Annet vitenskapelig)
  • 195.
    Hjelm, Carina
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    Dahl, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Johansson, Boo
    Department of Psychology, University of Gothenburg.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    The influence of heart failure on longitudinal changes in cognition among individuals 80 years of age and older2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 7-8, s. 994-1003Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. The aim of this study was to examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

    Background. Cognitive impairment is influenced by many factors, and the impact of heart failure is debated. Intact cognitive ability is crucial for successful self-care in patients with heart failure. Middle-aged patients with heart failure seem to have an increased risk of cognitive impairment. No studies have examined the association between heart failure and longitudinal cognitive changes in octogenarians (individuals 80 years and older).

    Design. A prospective longitudinal design.

    Methods. Cognitive tests were carried out five times (1991–2002) in 702 octogenarians from the Swedish Twin Registry, including same-sex twin pairs. The test battery included the measurement of processing speed, visuospatial ability, short-term, episodic and semantic memory. Latent growth curve modelling was employed to measure change and performance over time and compares the group diagnosed with heart failure to individuals without a heart failure diagnosis.

    Results. At baseline, the participants’ mean age was 83·5 years, 67% were women and 13% suffered from heart failure. Individuals diagnosed with heart failure scored significantly lower in spatial abilities and episodic memory than participants not diagnosed with heart failure. Moreover, measures of episodic memory declined more over time in individuals diagnosed with heart failure. There were no significant differences between the groups in other cognitive tests.

    Conclusion. Spatial problems and episodic memory have implications for everyday life. This might contribute to decreased adherence to prescribed therapy and self-care management and lead to socio-behavioural problems because of an impaired capacity to drive, read and write.

    Relevance to clinical practice. Nurses should take into account in their assessment that cognitive impairment may restrain elderly heart failure patient’s ability to make decisions and perform self-care actions. Patient education strategies should also be adapted to cognitive ability.

  • 196.
    Hjelm, Carina M.
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, Department of Cardiothoracic Surgery, County Council of Östergötland, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, Sweden.
    Riegel, Barbara
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, University of Pennsylvania School of Nursing, Philadelphia, USA.
    Årestedt, Kristofer
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, School of Health and Caring Sciences, Linnaeus University Kalmar, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, Department of Cardiology, County Council of Östergötland, Sweden.
    The association between cognitive function and self-care in patients with chronic heart failure2015Inngår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, nr 2, s. 113-119Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression. Methods: This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses. Results: Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression. Conclusions: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.

  • 197.
    Hjelmfors, Anna-Lisa
    et al.
    Linköping University.
    Van der Wal, M. H. L.
    Linköping University.
    Strömberg, A.
    Linköping University.
    Friedrichsen, M.
    Linköping University.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jaarsma, Tiny
    Linköping University.
    Challenges in discussing prognosis and end-of-life care with heart failure patients2015Inngår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, s. 351-351Artikkel i tidsskrift (Annet vitenskapelig)
  • 198.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of nursing, Faculty of Health Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    “I was told that I would not die from heart failure”: Patient perceptions of prognosis communication2018Inngår i: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 41, s. 41-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim and objectives

    To describe patients’ experiences of communication about their heart failure prognosis and explore how these experiences affected their preferences for future communication about the prognosis.

    Background

    Professionals need to discuss about the heart failure prognosis with patients in order to improve their understanding of their illness and address palliative care needs.

    Methods

    An inductive and exploratory design was used. A total of 24 patients (75% men, 52–87 years of age) in New York Heart Association class I-III from primary outpatient care participated in focus group-, or individual semi-structured interviews. Thematic analysis was used to identify and interpret patterns in the data.

    Findings

    Two overarching themes, “The message sent” and “Hoping for the best or preparing for the worst”, each with three sub-themes, were discovered during the thematic analysis. Many patients described that professionals had not provided them with any prognosis information at all. Other patients described professional information about prognosis that was given in an either very optimistic or very negative way. However, patients also described situations where professionals had given information in a way that they thought was perfect for them to handle, and in accordance with their preferences.

    Conclusion

    This study shows that patients have different experiences and preferences for communication about prognosis and uses different approaches in order to cope living with a chronic illness such as heart failure. 

  • 199.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018Inngår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, nr 1, artikkel-id 85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of this paper was to describe the development of an intervention that is developed to improve communication about the heart failure (HF) trajectory and end-of-life care. We also present data that provides a first insight in specific areas of feasibility of the intervention.

    Methods: Co-design was used and patients, family members and health care professionals were constructive participants in the design process of the intervention. Feasibility of the intervention was tested in two areas; acceptability and limited efficacy.

    Results: Two communication tools were designed and evaluated; 1) a Question Prompt List (QPL) for patients and family members and 2) a communication course for professionals which was web -based with one face-to-face training day with simulation. Data on feasibility was collected with questionnaires that were developed for this study, from the 13 participants who completed the course (all nurses). They reported improved knowledge, confidence and skills to discuss the HF trajectory and end-of-life care. The QPL was evaluated to be a useful tool in communication with patients and family members.

    Conclusions: In a co-design process, future users identified the need for a QPL and a communication course. These communication tools can be used as a dual intervention to improve communication about the HF trajectory and end-of-life care. The QPL can help patients and families to ask questions about the HF trajectory and end-of-life care. The communication course can prepare the professionals to be knowledgeable, confident and skilled to discuss the questions in the QPL. Before the tools are ready for implementation in clinical practice, further studies testing the feasibility of the intervention are needed, including also patients and their families. 

  • 200.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, s. 23-23Artikkel i tidsskrift (Annet vitenskapelig)
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