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  • 51.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Steinke, Elaine E.
    School of Nursing, Wichita State University, Wichita, KS, USA.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Using extended theory of planned behavior to determine factors associated with help-seeking behavior of sexual problems in women with heart failure: a longitudinal study2019Inngår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, s. 1-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: This study used extended theory of planned behavior (extended TPB) to understand the underlying factors related to help-seeking behavior for sexual problems among Iranian women with heart failure (HF).

    METHODS: We recruited 758 women (mean age = 61.21 ± 8.92) with HF at three university-affiliated heart centers in Iran. Attitude, subjective norms, perceived behavioral control, behavioral intention, self-stigma of seeking help, perceived barriers, frequency of planning, help-seeking behavior, and sexual function were assessed at baseline. Sexual function was assessed again after 18 months. Structural equation modeling was used to explain change in sexual functioning after 18 months.

    RESULTS: Attitude and perceived behavioral control were positively correlated to behavioral intention. Behavioral intention was negatively and self-stigma in seeking help was positively correlated to perceived barriers. Behavioral intention was positively and self-stigma in seeking help was negatively correlated to frequency of planning. Perceived behavioral control, behavior intention, and frequency of planning were positively and self-stigma in seeking help and perceived barriers were negatively correlated to help-seeking behavior. Help-seeking behavior was positive correlated to the change of FSFI latent score.

    CONCLUSIONS: The extended TPB could be used by healthcare professionals to design an appropriate program to treat sexual dysfunction in women with HF.

  • 52.
    Lin, Chung-Ying
    et al.
    Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, Iran.
    Broström, Anders
    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.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Mary MacKillop Institute of Health Research, ACU, Melbourne, Australia.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.2018Inngår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 3, s. 281-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF).

    OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran.

    METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA).

    RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47).

    CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

  • 53. Lindfors, M.
    et al.
    Frenckner, B.
    Sartipy, U.
    Bjällmark, Anna
    KTH, Medicinsk bildteknik.
    Broomé, Michael
    KTH, Medicinsk teknik.
    Venous Cannula Positioning in Arterial Deoxygenation During Veno-Arterial Extracorporeal Membrane Oxygenation-A Simulation Study and Case Report2017Inngår i: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 41, nr 1, s. 75-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA-ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno-arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario.

  • 54.
    Ljungberg, L. U.
    et al.
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Alehagen, U.
    Linköping University.
    Björck, H. M.
    Linköping University.
    Persson, K.
    Linköping University.
    Dahlström, U.
    Linköping University.
    Länne, T.
    Linköping University.
    Impaired Abdominal aortic wall Integrity in Elderly Men Carrying the Angiotensin-converting Enzyme D Allele2011Inngår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 42, nr 3, s. 309-316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: A polymorphism in the angiotensin-converting-enzyme gene (ACE I/D) has been associated with abdominal aortic aneurysm and a link between aortic aneurysm and aortic stiffness has been suggested. This study aimed to explore the links between ACE I/D polymorphism, circulating ACE and abdominal aortic wall integrity as reflected by abdominal aortic wall stiffness.

    Material: A total of 212 men and 194 women, aged 70-88 years, were studied. Methods: Mechanical properties of the abdominal aorta were determined using the Wall Track System, ACE genotype using the polymerase chain reaction (PCR) and circulating ACE level by enzyme-linked immunosorbent assay (ELISA).

    Results: In men, pulsatile diameter change differed between genotypes (II 0.70, ID 0.55 and DD 0.60 mm, P = 0.048), whereas a tendency was seen for distensibility coefficient (DC) (II 10.38, ID 7.68 and ID 8.79, P = 0.058). Using a dominant model (II vs. ID/DD), men carrying the ACE D allele had lower pulsatile diameter change (P = 0.014) and DC (P = 0.017) than II carriers. Multiple regression analyses showed additional associations between the D allele and increased stiffness beta, and reduced compliance coefficient.

    Conclusion: Men carrying the ACE D allele have stiffer abdominal aortas compared with II carriers. Deranged abdominal aortic stiffness indicates impaired vessel wall integrity, which, along with other local predisposing factors, may be important in aneurysmal disease. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  • 55.
    Ljungberg, Liza
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Länne, Toste
    Linköping University.
    Björck, Hanna
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Persson, Karin
    Linköping University.
    The association between circulating angiotensin-converting enzyme and cardiovascular risk in the elderly: a cross-sectional study2011Inngår i: jraas. Journal of the renin-angiotensin-aldosterone system, ISSN 1470-3203, E-ISSN 1752-8976, Vol. 12, nr 3, s. 281-289Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: A polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) has been associated with increased risk for cardiovascular disease (CVD). This polymorphism affects the level of circulating ACE, but there is great individual variation, even between those with the same genotype. Few previous studies have investigated the link between circulating ACE and cardiovascular risk. The aim of this study was to investigate this association, and to examine the relationship between ACE level, ACE genotype and CVD.

    Materials and methods: The study population consisted of 322 men and 350 women aged 69-87. Plasma ACE level was determined using enzyme-linked immunosorbent assay (ELISA), and ACE genotype was analysed using PCR followed by gel electrophoresis.

    Results: In men, ACE levels increased with increasing number of cardiovascular risk factors (p = 0.003). There was a significant association in men between increased ACE level and both diabetes (p = 0.007) and smoking (p = 0.037).

    Conclusions: This study shows that cardiovascular risk factors (such as smoking and diabetes) are associated with higher levels of circulating ACE in men. High ACE levels may represent one of the cellular mechanisms involved in producing the vascular damage associated with cardiovascular risk factors.

  • 56.
    Ljungberg, Liza U.
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Persson, Karin
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Länne, Toste
    Linköping University.
    Circulating angiotensin-converting enzyme is associated with left ventricular dysfunction, but not with central aortic hemodynamics2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, nr 2, s. 540-541Artikkel i tidsskrift (Annet vitenskapelig)
  • 57.
    Luttik, M.L.A.
    et al.
    Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, Netherlands.
    Goossens, E.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Ågren, S.
    Linköping University, Department of Medicine and Health Sciences, Department of Cardiothoracic Surgery, Linköping, Sweden.
    Jaarsma, T.
    Linköping University, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Thompson, D. R.
    Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia.
    Moons, P.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Strömberg, A.
    Linköping University, Division of Nursing Science, Department of Medicine and Health Sciences, Linköping, Sweden.
    Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr 4, s. 299-308Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.

    AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.

    METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).

    RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.

    CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.

  • 58.
    Länne, T.
    et al.
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    De Basso, Rachel
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    Powell, J. T.
    University Hospitals of Coventry and Warwickshire, Walsgrave, Coventry, United Kingdom.
    Influence of fibrillin-1 genotype on aortic stiffness in men: a note of caution - Reply2006Inngår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 100, nr 4, s. 1431-1432Artikkel i tidsskrift (Annet vitenskapelig)
  • 59.
    Malm, Dan
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ekblad, Helena
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Karlström, Patric
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Hag, Emma
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients2018Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, nr 7, s. 589-597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.

    Methods: A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT (n=56) or a treatment as usual (TAU) group (n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).

    Results: At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence (z=2.07, P=0.04).

    Conclusions: A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients. 

  • 60.
    Malm, Dan
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ekblad, Helena
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Impact of a cognitive behavioral intervention on quality of life and psychological distress in patients with atrial fibrillation: the importance of relatives2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S49-S50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although there is an evidence to support the efficacy of cognitive behavioral therapy (CBT) in improving quality of life and decreasing psychological distress in patients with cardiovascular diseases but involving patient’s and relatives in the CBT and its effect on patient’s general health, has not been evaluated.

    Aim: The aim was to determine whether involving the relatives in CBT for patients with Atrial Fibrillation (AF) enhances treatment outcomes relative to treatment as usual group (TAU).

    Method: In a randomized controlled trial, 78 patients diagnosed with AF were randomly assigned to experimental (EXP) or TAU groups. In the EXP group, patients and relative participated in a 6-week program while the patient in the TAU group received standard care. Short Form 36(SF-36), Hospital Anxiety and Depression Scale (HADS),Euro-QoL 5-Dimension Self-Report Questionnaire (EQ-5D) and Sense of Coherence (SOC-13) were completed at  baseline and at 12-month follow-up. 

    Results: In all 78 patients completed the assessment at 12 months. The two groups were similar for sociodemographic and clinical variables at baseline. The EXP group reported significantly higher scores in EQ-5D (F= 6.18, p = 0.01) and SOC (F= 4.15, p = 0.04) than TAU group. Compared with TAU group, patients in EXP group reported significantly lower depression (F= 4.58, p = 0.04). Thirteen percent of Indirect effect of the intervention on improving patient’s quality of life in the EXP group was related to the SOC improvement (z = 11.83, p < .01).

    Conclusions: This study provides evidence that patients and their relatives’ involvement is more effective in improving quality of life and decreasing psychological distress than those who receiving standard care. Our results also indicate that interventions should initially focus on increasing patient’s sense of coherence.

  • 61.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    The life situation of patients with heart failure in primary health care: An explorative and interventional study2002Doktoravhandling, monografi (Annet vitenskapelig)
    Abstract [en]

    ABSTRACT

    The general aim of this thesis was to obtain an understanding of the life situation of patients with mild to severe heart failure and their spouses, and to determine the effects of a nurse-led intervention on patients with heart failure in primary health care. A phe¬nomenographic approach was used to describe how male (N=12) and female (N=12) patients with heart failure conceive their life situa¬tion (I, II), and the critical incident technique was used to describe spousal (N=23) experience of factors that influence their support of the patient with heart failure.(III) A study of patients (n=48) and spouses (n=48) was conducted to compare their levels of depression and health-related quality of life, and to identify those factors that contribute to depression and health-related quality of life in patient-spouse pairs.(IV) Finally, 153 patients from eight primary health care districts were matched using a randomised block design to either a control (n=75) or an intervention group (n=78) to determine the effects of a nurse-led intervention on patients with heart failure in the primary health care setting regarding life satisfaction, health-related quality of life, and depression.(V) Men with heart failure conceived that the physical limitations caused by heart failure restricted the way they lived and that they were continually reminded of this in their everyday lives. They also experienced social restrictions in their work and leisure activities, hindering them from taking part in activities that previously had been a natural part of their lives.(I) Women with heart failure also described physical and social restrictions due to lack of energy. Difficulties in performing household tasks and providing support as usual to those close to them were difficult things to accept.(II) When spouses of patients with heart failure were given attention and treated like valued individuals, they experienced a sense of involvement with others. In these cases, spouses had someone to turn to and were included in the care. In contrast, when spouses were kept at a distance by the patient, were socially isolated, and received insufficient support from children, friends, and health care professionals, they felt like outsiders.(III) Patients with heart failure were significantly more depressed and had poorer physical quality of life compared to spouses.(IV) Patient depression was correlated with the patient’s own functional status and mental quality of life, with the combination of the six-minute walk distance and mental health-related quality of life contributing 51% of the variance in patient depression. Spousal depression and health-related quality of life did not significantly influence patient depression. The mental component of spousal health-related quality of life and the age of the patient accounted for 33% of the adjusted variance in spousal depression. The nurse-led intervention in primary health care (V) showed a limited difference in effect between the groups, with significant differences in the socio-economic and physical dimensions, as well as in depression. In comparisons within groups at the 3- and 12-month follow-ups, the intervention group, particularly the women, maintained their life satisfaction, their health-related quality of life, and their subjective experience of depression to a significanly greater extent than in the control group.

    The results from this thesis suggest that caring for elderly patients with heart failure involves taking the family situation, gender differences and diverse experiences in living with a chronic illness into consideration. Heart failure limits the life situation of elderly male and female patients in a very similar manner, but there are a number of differences in how the situation is managed, with women having more feelings of being a burden to those around them, and men having more feelings of resignation. By given spouses insufficient support, the fact that they can be an asset in the care of patients with heart failure is often overlooked. The findings further demonstrate that an intervention directed by primary health care nurses with special training in heart failure can have a positive impact on the life situation and the health-related quality of life of these patients.

  • 62.
    Neher, M. S.
    et al.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Johansson, P.
    Linkoping University, Department of Cardiology and Department of Social and Welfare studies, Linkoping, Sweden.
    Nilsen, P.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Exploring implementation issues when introducing a novel internet-based intervention to treat cardiovascular disease-associated mental health issues- the Implement-IT project.2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S52-S53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Mental health (MH) problems such as depression and insomnia are prominent among patients with cardiovascular disease (CVD). They are associated with a negative impact on quality of life, higher health care costs and a poorer prognosis. Despite this most patients with CVD will not receive support or treatment for their MH problems. Studies in other patient groups have described internet based cognitive behavioral treatment (I-CBT) as a promising intervention, but I-CBT has not been tested in CVD patients. The I-CBT HEART research project aims specifically to develop and evaluate I-CBT programs for CVD patients with psychological distress. The programs, both of which are in early stages of clinical evaluation, respectively target patients with depressive symptoms and patients with insomnia. Two randomized controlled trials will be carried out, I-CBT for insomnia (HiT-IT) and I-CBT for depression (DOHART). Implementation research has shown overwhelming evidence of the difficulties that are often encountered in the diffusion and dissemination of novel treatments, such as I-CBT for CVD. To smooth the way for future use of a successful intervention in clinical practice, a better knowledge is needed of the factors that may hinder or support implementation in practice.

    Purpose: The overall aim of the IMPLEMENT-IT study, a part of the I-CBT HEART project, is to achieve a better understanding of potential future implementation issues by exploring barriers and facilitators from different stakeholder perspectives that may be of importance in future implementation.

    Methods: Both qualitative and quantitative data will be collected in conjunction with the RCT studies HiT-IT and DOHART. Interviews with stakeholders at different levels focusing on perceptions of the role of eHealth in traditional healthcare in general, and of the I-CBT HEART intervention in particular. Informants are recruited in groups of healthcare-tasked representatives of political parties at the regional level, local decision-makers in higher healthcare administration, clinical decision-makers, healthcare profe ssionals (providers), as well as patients. Our intention is to measure implementation leadership,empowerment and implementation climate in the clinical contexts, but also to develop valid and reliable instruments to be used in future studies.

    Conclusion: Studying factors that may potentially influence the implementation of a novel I-CBT program for treatment of MH problems in CVD patients through a mixed methods approach may assist the design of future implementation strategies in clinical cardiac care.

  • 63.
    Neher, Margit
    et al.
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. 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).
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, 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.
    Johansson, Peter
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Implementing internet-delivered cognitive behavioural therapy for patients with cardiovascular disease and psychological distress: a scoping review2019Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, nr 5, s. 346-357Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20-40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care.

    AIM: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention.

    METHODS: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework.

    RESULTS: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored.

    CONCLUSIONS: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about internet-based cognitive behavioural therapy for cardiovascular disease, and about how this evidence-based intervention is implemented.

  • 64.
    Nordblom, Ann-Katrin
    et al.
    Skaraborg Hospital of Skövde, Skövde, Sweden .
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Impact on a Person's Daily Life During Episodes of Supraventricular Tachycardia: A Qualitative Content Analysis From a Holistic Perspective2017Inngår i: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 35, nr 1, s. 33-43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To describe the impact of episodes of supraventricular tachycardia (SVT) on a person’s daily life from a holistic perspective.

    Method: A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis.

    Results: Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening.

    Conclusion: Episodes of SVT entail a complex life situation as the person’s entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.

  • 65.
    Norekvål, Tone M.
    et al.
    Haukeland University Hospital, Bergen, Norway.
    Fålun, Nina
    Haukeland University Hospital, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Patient-reported outcomes on the agenda in cardiovascular clinical practice2016Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, nr 2, s. 108-111Artikkel i tidsskrift (Annet vitenskapelig)
  • 66.
    Nygårdh, Anette
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Allemann, H.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Strömberg, A.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Aidemark, J.
    Linneaus University, Department of Informatics, Vaxjö, Sweden.
    Fruberg, C.
    Qulturum, Centre for Learning and Innovation in Health Care, Jönköping, Sweden.
    Karlsson, J.-E.
    Ryhov county Hospital, Deparment of Development (Qulturum), Jönköping, Sweden.
    Askenäs, L.
    Linneaus University, Department of Informatics, Växjö, Sweden.
    An experience-based co-design to accomplish person-centered self-care support for elderly persons with heart failure2015Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, s. 51-52, artikkel-id 139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Self-care refers to activities performed with the intention of improving or restoring health and well-being. A good understanding of the adaptations needed in daily life is a prerequisite to motivate individuals to implement such changes. Facilitating the person with heart-failure’s (HF) understanding of the diagnosis, how to handle symptoms, and when to seek healthcare, is one way of proactive self-care. Previous Information and communication technology (ICT) support has proved to be effective in younger patients, but the development has not been user-driven, i.e. involving references and experiences from the patient, their family members or healthcare professionals and have rarely been implemented in clinical practice. In addition, disregard of the user hands over control and responsibility to the healthcare professionals and misses the patient’s desires and requirements.

    Aim: To describe an experience-based co-design of ICT for self-care support in the context of heart failure care

    Methods: The steps in the process of developing ICT support programs for self-care were guided by an experienced based co-design methodology including: 1) Workshops regarding self-care needs. 2) Workshops regarding self-care support as a means to cope with the phases of the disease. 3) Workshops to assess the usability of the suggested ideas. 4) Workshops to test the different supports in action. The project involved older persons with HF, their family members, healthcare professionals, IT-developers, informatics, development leaders, and researchers. There was also a quality improvement process involved to improve working routines and communication between the person with HF and the healthcare professionals, which in turn, increases the value of the innovation. Data collection include tape- and video recorded workshops and diary notes supplied by the informants. All data are to be analyzed by content analysis to identify needs, opportunities and challenges of self-care.

    Results and conclusion: This design was found to be a useful method for finding and assess usability of person-centered self-care ICT support. To involve users in the development of self-care support has improved the opportunities to realize support needed. Sharing these perspectives increases professionally and organizationally learning in order to accomplish person-centered self-care. Preliminary findings show that ICT will be a part of solving some of the self-care needs described by patients, family member and health care providers and the next step in the project will be to test and adapt these tools.

  • 67.
    Näsström, Lena
    et al.
    Research and Development Unit in Local Health Care, Department of Medical and Health Sciences, Linköping University, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Idvall, Ewa
    Department of Care Science, Malmö University, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Department of Cardiology, Linköping University, Sweden.
    Participation in Care Encounters in Heart Failure Home-Care2017Inngår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 26, nr 6, s. 713-730Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this qualitative study was to observe care encounters during home visits in Heart failure (HF) home-care to identify and describe participation in care. Seventeen patients diagnosed with HF, and 10 registered nurses participated. Data from 19 video-recorded home visits were analyzed using qualitative content analysis. Two themes were identified: (a) Participation in the care encounter is made possible by interaction, including exchanging care-related information, care-related reasoning, collaboration; and (b) participation in the care encounter is made possible by an enabling approach, including the patients expressing their own wishes, showing an active interest, while the nurse is committed and invites to having a dialogue. The HF home-care context showed good potential for patient participation. Room for discussions and collaboration facilitated for the patients to be active partners in their care, which in turn may have positive effects on outcomes.

  • 68.
    Pakpour, Amir H.
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Saffari, M.
    Baqiyatallah Medical Sciences University, Tehran, Iran.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Prospective case-control study of sexual dysfunction in female patients with Takotsubo cardiomyopathy2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S85-S86Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Regarding the lack of earlier studies on sexual function in female patients with Takotsubo cardiomyopathy (TSCM), the current study aimed at an investigation of psychological and quality of life measures associated with sexual function in female patients with TSCM.

    Methods: In this Prospective case-control study, female patients with TSCM from university hospitals in Tehran and Qazvin were enrolled and matched (1:1.1) with acute myocardial infarction (AMI) along with healthy controls (94 patients per group). Data on hospital anxiety and depression scale, SF-12, female sexual function index and female sexual distress scale were assessed at baseline, 6 months and 18 months. Multilevel logistic regressions ought associations between variables.

    Results: Sexual function, anxiety and depression at baseline were different among the groups with worse situations in female patients with TSCM (p < 0.01). Quality of life at baseline was similar among patient groups but at lower state than healthy controls. Overall, quality of life subscales especially among female patients with TSCM showed a downward trend, indicating deterioration overtime. Higher prevalence of sexual dysfunction in TSCM group was seen compared to female patients with AMI and control group over time (OR, 3.10 and 2.28 respectively). Sexual functioning was found to be a mediator between anxiety and quality of life which positively impacts on patient’s quality of life.

    Conclusions: Since the psychological and quality of life measures as well as sexual function indicated a descending trend across time, there is a necessity to intervene for these women by focus on problems like anxiety to control health deterioration.

  • 69.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    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.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Help seeking behavior for sexual dysfunction in female patients with Takotsubo cardiomyopathy: A longitudinal application of the theory of planned behavior2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S32-S33Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Many cardiac female patients suffer from sexual dysfunction and do not seek appropriate help. Understating help-seeking intentions and behavior is fundamental to develop interventions targeted to increase using sexual health services in the patients with Takotsubo cardiomyopathy (TSCM). TSCM is a reversible weakening of the left ventricle that produces symptoms that are similar to acute myocardial infarction (e.g., shortness of breath or chest pain). A variety of psycho-affective triggers and predispositions such as stress, anxiety, depression, phobia, and anhedonia have been recognized as risk factors for TSCM. The aim of the study was to investigate the application of the Ajzen’s theory of planned behavior (TPB) in explaining female TSCM patient’s behavior in seeking treatment for sexual dysfunction.

    Methods: In this longitudinal study, one hundred and sixty-three female patients with TSCM were screened for sexual dysfunction by the Female Sexual Function Index (FSFI ⩽ 26.55) at eight referral hospitals in Iran (i.e.Tehran, Qazvin, Tabriz and Zahedan). The patients were then asked to complete study measures including attitude, subjective norm, perceived behavioral control, behavioral intention, self-stigma and perceived barriers at baseline. A measure of using sexual health services was obtained from electronic patient’s records. Hierarchical linear regression and logistic regressions were used to assess how well the variables of the TPB predicted behavioral intention and using sexual health services.

    Results: Seventy-eight female patients with TCSM were diagnosed to have sexual dysfunction (mean age 62.19 ± 8.03 years). Attitudes, perceived behavioral control (PBC) and subjective norms all predicted charitable giving intentions. Patients with strong behavioral intention (OR = 1.92, 95% CI, 1.36 to 2.73) were more likely to use sexual health services at 18 months of follow-up. Patients with high Self stigma (OR = 0.664, 95 % CI, 0.48 to 0.92) and perceived barriers (OR = 0.93, 95 % CI, 0.89 to 0.98) were less likely to use sexual health services at 18 months of follow-up.

    Conclusions: The results suggest that interventions designed to promote help seeking behavior for sexual dysfunction in TSCM patients should focus on reducing barriers and self-stigma and the development of a positive attitude as well the PBC.

  • 70.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    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.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Cardiac rehabilitation teams‘ psychosocial determinants for sexual counseling of women with Takotsubo cardiomyopathy: A theory-based longitudinal study2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S53-S54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Patients with Takotsubo cardiomyopathy (TSCM) especially female, may be at risk of poor psychological adjustment and deteriorated health related quality of life. Sexual dysfunction is a significant problem for patients with TSCM. Therefore, Sexual counseling should be integrated into the cardiac rehabilitation services. However, cardiac rehabilitation teams reluctant to address patient’s sexual problems. The aim of this study was to determine factors which effect on performing sexual counseling among cardiac rehabilitation team.

    Methods: In this longitudinal study, two hundred and forty-four specialists (i.e., physical therapists, nurses, psychologists, social workers, rehabilitation specialists and cardiologists), who were working in cardiac rehabilitation teams participated in the study at eight referral hospitals in Iran (i.e., Tehran, Qazvin, Tabriz and Zahedan). The teams were asked to complete study measures including sexual knowledge (25 items), attitude (12 items), subjective norm (5 items), perceived behavioral control (8 items), behavioral intention (2 items) and perceived barriers (17 items). Six month later, the teams were then contacted to ask the frequency of the sexual counseling sessions during the past six months.

    Results: Cardiac rehabilitation teams reported that sex was rarely discussed with patients (14.3%). Attitudes, subjective norms and perceived behavioral control (PBC) emerged as significant direct predictors of intention to perform sexual consulting. Multiple logistic regression analysis showed that cardiac rehabilitation teams with strong behavioral intention (OR = 1.83, 95 % CI, 1.08  to 3.10) and low perceived barriers (OR = 0.69, 95 % CI, 0.49 to 0.97) were more likely to perform the subsequent sexual consulting.

    Conclusions: Existing cardiac rehabilitation activities are likely to continue to fail to promote patient’s sexual functioning after cardiac events in the absence of effective strategies to reduce the underlying barriers toward sexual counseling. Interventions should be targeted on reducing barriers toward sexual counseling in cardiac rehabilitation teams.

  • 71.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Lin, C-Y
    Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Webb, T. L.
    University of Sheffield, Department of Psychology, Sheffield, United Kingdom.
    Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life and mortality rates in older patients undergoing coronary artery bypass surgery?2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S1-S2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for a long time, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence is therefore important. The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

    Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment as usual (TAU; n = 144) groups using cluster randomization with center level. Medication adherence was evaluated using Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL using Short-Form 36.Data were collected at baseline; three, six, and eighteen months after intervention. Survival status was followed up at eighteen months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

    Results: Compared to patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved six months after surgery (p <0.01) and remained so eighteen months after surgery (p< 0.01). QoL also increased among patients in the EXP group as compared to those who received TAU at eighteen month post-surgery (physical component summary score p= 0.02; mental component summary score p = 0.04). HR in the EXP group compared to the TAU group was 0.38 (p = 0.04).

    Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after eighteen months. QoL and survival rates increased as a function of better medication adherence.

  • 72.
    Pettersen, Trond R.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Axelsson, Åsa
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Jørgensen, Marianne
    Department of Cardiology, Stavanger University Hospital, Norway.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Thompson, David
    Department of Psychiatry, The University of Melbourne, Australia.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    European cardiovascular nurses' and allied professionals' knowledge and practical skills regarding cardiopulmonary resuscitation.2018Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, nr 4, s. 336-344Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results.

    METHODS: This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training.

    RESULTS: Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not.

    CONCLUSION: Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

  • 73.
    Powell, J. T.
    et al.
    University Hospitals of Coventry and Warwickshire, Walsgrave, Coventry, United Kingdom.
    Turner, R. J.
    University Hospitals of Coventry and Warwickshire, Walsgrave, Coventry, United Kingdom.
    Sian, M.
    University Hospitals of Coventry and Warwickshire, Walsgrave, Coventry, United Kingdom.
    Debasso, Rachel
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    Lanne, T.
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    Influence of fibrillin-1 genotype on the aortic stiffness in men2005Inngår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 99, nr 3, s. 1036-1040Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aortic stiffness is a, predictor of cardiovascular mortality. The mechanical properties of the arterial wall depend on the connective tissue framework, with variation in fibrillin-1 and collagen I genes being associated with aortic stiffness and/or pulse pressure elevation. The aim of this study was to investigate whether variation in fibrillin-1 genotype was associated with aortic stiffness in men. The mechanical properties 4 the abdominal aorta of 79 healthy pen (range 28-81 yr) were investigated by ultrasonographic phase-locked echo tracking. Fibrillin-1 genotype, characterized by the variable tandem repeat in intron 28, and collagen type I alpha I genotype characterized by the 2,064 G>T polymorphism, were deterimined by using DNA from peripheral blood cells. Three common fibrillin-1 genotypes, 2-2, 2-3, and 2-4, were observed in 50 (64%), 10 (13%), and 11 (14%) of the men, respectively. Those of 2-3 genotype had higher pressure strain elastic modulus and aortic stiffness compared with men of 2-2 or 2-4 genotype (P = 0.005). Pulse pressure also was increased in the 2-3 genotype (P = 0.04). There was no significant association between type I collagen genotype and aortic stiffness in this cohort. In conclusion, the fibrillin-1 2-3 genotype in men was associated with increased aortic stiffness and pulse pressure, indicative of an increased risk for cardiovascular disease.

  • 74.
    Rundqvist, Louise
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Aspects of regular long-term endurance exercise in adolescents, with focus on cardiac size and function, hormones, and the immune system2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The long-term effects of starting high-intensity training at younger ages are largely unknown. The present studies focused on adolescents who had performed regular endurance exercise for several years at an elite level and compared those subjects with a control group of adolescents of similar age and sex who had not engaged in regular exercise. The knowledges generated by this research will contribute to further understanding of some of the physiological effects of strenuous regular exercise during adolescence.

    Aim: The overall aim of this research was to investigate endurance-trained adolescents, focusing on cardiac size and function, hormones associated with growth and metabolism, and impact on the immune system.

    Methods: All participants underwent echocardiography at rest as well as immediately and 15 minutes after amaximal cardiopulmonary exercise test. Blood samples were taken at rest and analyzed for biomarkers such as hormones, immune cell surface markers, and secreted cytokines and chemokines. The study design was crosssectional (Papers I, III, and IV) and comparative, with a quantitative approach in all four studies. The evaluationin Paper II used a pre-post test design with measurements of cardiac parameters before and after a maximal treadmill test. The studies in Papers I–III compared endurance-trained (active group) and untrained (controls) adolescents matched by age and sex, whereas the analysis in Paper IV considered differences between the sexes in the endurance-trained adolescents.

    Results: Compared with controls, the endurance-trained adolescents showed increased size of all four heart chambers, as well as improved cardiac systolic function at rest. Considering cardiac changes from baseline to immediately after exercise, the systolic and diastolic patterns were similar in both groups, although the diastolic function was more enhanced in the active group. Strong associations between peak oxygen uptake and cardiac size and function could be seen both at rest and after exercise. Circulating hormones at rest did not differ between the two groups. No correlation between insulin-like growth factor 1 and cardiac size was found among the endurance-trained adolescents. Compared with endurance-trained girls, endurance-trained boys exhibited an elevated response to a potent type 1 diabetes-related autoantigen. Conversely, compared with the trained boys, the trained girls showed an increased number of circulating immune cells and increased secretion of C-peptide and proinsulin.

    Conclusions: There are many benefits associated with regular exercise, and the present research did not provide any data to oppose that statement. Factors such as increased cardiac size at rest and exercise-related effects on cardiac functions do occur and therefore should be expected in endurance-trained adolescents with high peak oxygen uptake. Indeed, this should be interpreted as a sign of physiological adaptation and not as pathophysiology. The greater cardiac dimensions observed in these subjects could not be related to increased resting levels of hormones associated with growth and metabolism. The endurance-trained adolescents did show some sex-related differences with regard to their immune response at rest.

  • 75.
    Rundqvist, Louise
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden.
    Blomstrand, Peter
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform. Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden.
    Carlsson, Emma
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Faresjö, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Resting level of insulin-like growth factor 1 is not at play in cardiac enlargement in endurance-trained adolescents2019Inngår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, s. 1-7, artikkel-id 9647964Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. The study aimed to investigate resting levels of several selected growth and metabolic hormones in a group of 24 endurance-trained adolescents (aged 13-19 years) compared with 24 untrained age- and sex-matched controls, and to investigate if increased cardiac dimensions were related to these hormones at rest with emphasis on insulin-like growth factor-1 (IGF-1).

    Methods. The hormones (cortisol, IGF-1, IGF-2, follicle-stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone) were analysed with chemiluminescence microparticle immunoassay (CMIA) or multiplex fluorochrome (Luminex) technique. Cardiac dimensions were assessed by echocardiographic examination at rest. Peak oxygen uptake was obtained by a maximal cardiopulmonary exercise test on a treadmill.

    Results. Circulating levels of analysed hormones at rest did not differ between the groups. A correlation was found between increased cardiac dimensions and IGF-1 in the controls, but not in the active group. This correlation declined also among the controls when the cardiac parameters were indexed for body surface area.

    Conclusion. Increased cardiac dimensions in endurance-trained adolescents could not be related to resting levels of hormones associated with growth and metabolism, including IGF-1 and GH. In addition, the resting levels of these hormones seem not to be affected by intense regular endurance exercise in adolescents. These findings may contribute to the knowledge about cellular signaling that trigger growth as well as cardiac adaptation to endurance training in young athletes. 

  • 76.
    Rundqvist, Louise
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden.
    Faresjö, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform. The Academy of Health and Care, Region Jönköping County, Jönköping, Sweden.
    Blomstrand, Peter
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden.
    Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls2018Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, nr 6, s. 1054-1061Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO2max ). The cohort consisted of 27 endurance-trained adolescents aged 13-19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e'-ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e'-ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO2max and cardiac function including LVEF and E/e' immediately after CPET, but the strongest correlation was found between VO2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e' (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e', correlates with the increase in VO2 uptake. These findings in trained as well as un-trained teenagers have practical implications when assessing cardiac function.

  • 77.
    Rundqvist, Louise
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Engvall, Jan
    Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping.
    Faresjö, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Carlsson, Emma
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Blomstrand, Peter
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. Biomedicinsk plattform.
    Regular endurance training in adolescents impacts atrial and ventricular size and function2017Inngår i: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 18, nr 6, s. 681-687Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: The aims of the study were to explore the effects of long-term endurance exercise on atrial and ventricular size and function in adolescents and to examine whether these changes are related to maximal oxygen uptake (VO2max).

    Methods and results: Twenty-seven long-term endurance-trained adolescents aged 13–19 years were individually matched by age and gender with 27 controls. All participants, 22 girls and 32 boys, underwent an echocardiographic examination at rest, including standard and colour tissue Doppler investigation. VO2max was assessed during treadmill exercise. All heart dimensions indexed for body size were larger in the physically active group compared with controls: left ventricular end-diastolic volume 60 vs. 50 mL/m2 (P <0.001), left atrial volume 27 vs. 19 mL/m2 (P <0.001), and right ventricular (RV) and right atrial area 15 vs. 13 and 9 vs. 7 cm2/m2, respectively (P <0.001 for both). There were strong associations between the size of the cardiac chambers and VO2max. Further, we found improved systolic function in the active group compared with controls: left ventricular ejection fraction 61 vs. 59% (P= 0.036), tricuspid annular plane systolic excursion 12 vs. 10 mm/m2 (P= 0.008), and RV early peak systolic velocity s′ 11 vs. 10 cm/s (P = 0.031).

    Conclusion: Cardiac remodelling to long-term endurance exercise in adolescents is manifested by an increase in atrial as well as ventricular dimensions. The physically active group also demonstrated functional remodelling with an increase in TAPSE and systolic RV wall velocity. These findings have practical implications when assessing cardiac enlargement and function in physically active youngsters.

  • 78.
    Saffari, Mohsen
    et al.
    Health Research Center, Baqiyatallah University of Medical Sciences Tehran, Iran.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    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.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Burri, Andrea
    Health and Rehabilitation Research Institute, Auckland University of Technology, New Zealand.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Investigating sexual problems, psychological distress and quality of life in female patients with Takotsubo cardiomyopathy: A prospective case-control study2017Inngår i: European Journal of Cardiovascular Nursing, Vol. 16, nr 7, s. 614-622Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Takotsubo cardiomyopathy (TSCM) has detrimental effects on both physical and psychological health of sufferers. However, little is known whether TSCM also affects sexual functioning in female patients.

    Aim: The aim of this study was to investigate psychological distress (depression and anxiety), health-related quality of life, and sexual functioning in women with TSCM and compare them with women with acute myocardial infarction and with healthy controls.

    Methods: A three group prospective case-control design was used. Female patients with TSCM or acute myocardial infarction, as well as healthy controls (94 in each group), were recruited across eight Iranian university hospitals. Data were collected at baseline and after six and 18 months using the Hospital Anxiety and Depression Scale, the Short Form-12, the Female Sexual Function Index and the Female Sexual Distress Scale. Multilevel logistic regression was conducted.

    Results: The TSCM group showed worst sexual functioning and the highest level of anxiety and depression at baseline (p<0.01) compared with the two other groups. The TSCM and AMI groups showed comparable health-related quality of life at baseline, which was lower in both groups compared with the healthy controls (p<0.01). Overall, depression, anxiety and health-related quality of life showed a significant change over time, especially in the TSCM group, with health-related quality of life decreasing, while anxiety and depression were increasing. Compared with the acute myocardial infarction and healthy control groups, the TSCM group showed a higher prevalence of sexual problems (odds ratios = 3.10 and 2.28, respectively) across time. Moreover, sexual functioning was found to be a mediator between anxiety and health-related quality of life in the TSCM group.

    Conclusion: Depression, anxiety, health-related quality of life, and sexual dysfunction tend to increase over time in female patients with TSCM; thus, healthcare providers should pay attention to these problems and provide appropriate treatment where necessary. 

  • 79.
    Saffari, Mohsen
    et al.
    Baqiyatallah University of Medical Science, Tehran, Iran.
    Zeidi, Isa Mohammadi
    Qazvin University of Medical Sciences, Iran.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Chen, Hui
    University of Technology Sydney, Australia .
    Pakpour, Amir H.
    Qazvin University of Medical Sciences, Iran.
    A Persian adaptation of medication adherence Self-Efficacy Scale (MASES) in hypertensive patients: Psychometric properties and factor structure2015Inngår i: High Blood Pressure & Cardiovascular Prevention, ISSN 1120-9879, E-ISSN 1179-1985, Vol. 22, nr 3, s. 247-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Poor adherence to anti-hypertensive treatment significantly contributes to the failure to achieve well-controlled blood pressure in patients with hypertension.

    AIM: To convert the original English version of Medication Adherence Self-efficacy Scale (MASES) into a Persian version for clinical application in hypertensive patients.

    METHODS: The backward-forward translation method was used to produce the Persian version of the questionnaire. Then the internal consistency was assessed using Cronbach's alpha. Exploratory Factor Analysis was applied to extract the components of the questionnaire. Correlation between blood pressures and drug adherence was then determined using the Persian MASES in hypertensive patients.

    RESULTS: Cronbach's alpha coefficient of the Persian version of MASES was >0.92, suggesting that it can yield consistent results. Exploratory Factor Analysis suggested an uni-dimensionality of the scale. Patients with uncontrolled hypertension showed poor adherence to hypertensive medications, therefore had significant lower self-efficacy scores than those with well-controlled blood pressure by medications.

    CONCLUSION: The Persian version of MASES is valid and reliable to assess self-efficacy of antihypertensive medication adherence in hypertensive patient, which is helpful to improve medication compliance in such patients in order to achieve better blood pressure controls.

  • 80.
    Sedlar, N. Natasa
    et al.
    National Institute of Public Health, Ljubljana, Slovenia.
    Lainscak, M.
    Gen Hosp Murska Sobota, Dept Internal Med, Murska Sobota, Slovenia.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Strömberg, A.
    Linköping University, Linköping, Sweden.
    Jaarsma, T.
    Linköping University, Linköping, Sweden.
    Farkas, J.
    Gen Hosp Murska Sobota, Dept Internal Med, Murska Sobota, Slovenia..
    Factors associated with self-care behaviours in heart failure: a systematic review of european heart failure self-care behaviour scale (EHFScBS) studies2017Inngår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, s. 140-140Artikkel i tidsskrift (Fagfellevurdert)
  • 81.
    Sedlar, Natasa
    et al.
    National Institute of Public Health, Ljubljana, Slovenia.
    Lainscak, Mitja
    Department of Internal Medicine, General Hospital Murska Sobota, Slovenia.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Farkas, Jerneja
    National Institute of Public Health, Ljubljana, Slovenia.
    Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr 4, s. 272-282Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing.

    Aims: The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS.

    Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored.

    Results: We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies.

    Conclusion: A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors. 

  • 82.
    Sedlar, Natasa
    et al.
    National Institute of Public Health, Slovenia.
    Socan, Gregor
    Department of Psychology, University of Ljubljana, Slovenia.
    Farkas, Jerneja
    National Institute of Public Health, Slovenia.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Mary MacKillop Institute for Health Research, Australian Catholic University, Australia.
    Lainscak, Mitja
    Faculty of Medicine, University of Ljubljana, Slovenia.
    Measuring self-care in patients with heart failure: A review of the psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS).2017Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 7, s. 1304-1313Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to review and evaluate the evidence related to psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS) that was developed and tested to measure health maintenance behaviours of heart failure (HF) patients and translated into several languages.

    METHODS: PRISMA guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect), to identify relevant studies. A literature search was undertaken in November 2015. An integrative review, aiming to bring together all evidence relating to the psychometric properties (validity, reliability) of the EHFScBS was conducted.

    RESULTS: 13 eligible studies were included. The results showed content, discriminant and convergent validity of the 9- and 12-item scale across the samples, while the factor structure of both versions of the scale was inconsistent. Most commonly used reliability estimates (Cronbach's alpha) of the total scale were satisfactory.

    CONCLUSION: Overall, published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for measuring health maintenance behaviours of HF patients.

    PRACTICE IMPLICATIONS: Taking the findings regarding the factorial structure of the scale into account, we recommend the use of the total EHFScBS score or scores on specific items.

  • 83.
    Siebmanns, Sandra
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, M.
    Linkoping University Hospital, Department of clinical neurophysiology, Linkoping, Sweden.
    Sandberg, Jonas
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Johansson, Linda
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Johansson, P.
    Linkoping University Hospital, Department of Cardiology and Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Insomnia in patients with cardiovascular disease - a review of causes, consequences and nursing interventions2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S31-S31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Insomnia is defined as a subjective complaint of difficulty to initiate sleep, difficulty to maintain sleep, and early morning awakenings that occur at a minimum of 3 nights per week for 3 months. The prevalence of insomnia in the general adult population is estimated to 12–20%. The prevalence is even higher among those with cardiovascular disease (CVD). Insomnia has a significant impact on the individual’s health and quality of life.

    Aim: To examine causes, consequences and nursing interventions for insomnia in patients with CVD.

    Design: Literature review.

    Method: Electronic search through PubMed and Cinahl for studies published 2001-2016. Insomnia, CVD, causes, consequences, interventions and nurse-led intervention were used as keywords. Detected duplicates, irrelevant studies and others (i.e., editorials, letters) were removed. “Insomnia and CVD” resulted in 214 hits, “insomnia and CVD and causes” in 394 hits, “insomnia and CVD and consequences” in 35 hits, and “insomnia and CVD and interventions” resulted in 51 hits.

    Results: Insomnia causes impaired daytime functioning, poorer cognitive function and a feeling of isolation. The pathophysiological consequences of insomnia are associated with increased risk for arteriosclerosis and CVD (i.e., caused by an increased inflammatory processes). Pharmacological treatment for insomnia have been used for some time (i.e., sedative, hypnotics and antidepressant), but there are concerns about tolerance and dependence, as well as other side effects (i.e., falls, cognitive changes and unusual sleep behaviours) which requires a thorough risk and benefit analysis before prescription. Non-pharmacological treatments such as Cognitive behavioural therapy (CBT) and internet-based CBT (I-CBT) for insomnia, led by therapists, is a less expensive intervention used in previous studies for othe rpatient groups. Despite positive results for both CBT andI-CBT (i.e., improved performance, increased quality of life and reduced symptom burden) in these studies no nurse-led interventions (i.e., of any type) intended for patients with CVD and insomnia were found.

    Conclusion: I-CBT for insomnia seems to be an accessible and effective treatment for other patient groups. The lack of nurse-led interventions, highlights the need for future studies in patients with CVD and insomnia.

  • 84.
    Siebmanns, Sandra
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, M.
    Linkoping Univ Hosp, Dept Clin Neurophysiol, Linkoping, Sweden.
    Sandberg, Jonas
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Johansson, P.
    Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    "You can’t always get what you want” - methodological challenges with an internet-based CBT intervention for insomnia among patients with cardiovascular disease2018Inngår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, nr 1, SI, s. 291-291, artikkel-id P437Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives/Introduction: Internet‐based cognitive behavioural therapy for insomnia (ICBTi) is a frequently used intervention. Published studies are promising, but methodological limitations (e.g., heterogeneity, low number of participants, unclear adherence to the intervention) have been reported. The aim was to describe methodological challenges perceived in the Hit‐IT study, an ongoing ICBTi study for patients with insomnia and cardiovascular disease (CVD).

    The Hit‐IT study: Design: RCT with 1‐year follow‐up. All patients with CVD (i.e., myocardial infarction, heart failure, atrial fibrillation and angina) from 6 primary care centers are screened for insomnia and during a clinical examination diagnosed according to DSM‐V criteria.Intervention: 9 weeks I‐CBTi (1‐week introduction, 2 weeks psychoeducation on CVD/insomnia, 6 weeks of sleep hygiene, stimulus control and sleep restriction) vs 3 weeks internet‐based sleep hygiene education.Questionnnaires: Sleep (Pittsburg Sleep Quality Index, Insomnia Severity Index, sleep diary), depressive‐ and cardiac symptoms (Patient Health Qurestionnaire‐9, Cardiac Anxiety Questionnaire) and Quality of Life (SF‐12) at baseline, during and after intervention (after 6 and 12 months).

    Methods: Interim analysis with descriptive statistics.

    Results: Out of 2170 approached patients with diagnosed CVD1508 (70%) responded (No=1330/Yes=178). Of the 178 approvals (124 men/54 women), 54 did not complete internet‐based screening (no e‐mail, declined participation and for unknown reasons). Of the 124 participants who completed screening, 40 (34 men/6 women, age range 42‐84 years) were excluded (ISI < 8). In addition, 32 were excluded after telephone contact and clinical examination (declined participation n = 10, no clinical insomnia n = 14, sleep apnea n = 4,restless legs n = 2, epilepsy n = 1, pharmacological side effect n = 1). Currently 46 participants have been randomized in the Hit‐IT study (15 females, 31 males, mean age 71 years/Range 41‐92 years). 19 participants have completed control group (1 dropout related to technical problems, 3 in treatment). In the intervention group, 6 have completed, 4 intentions to treat, 3 dropouts (n = 2 unknown reason, n = 1 technical problems), 10 participants in treatment.

    Conclusions: Clear methodological challenges with regard to the strenuous patient inclusion process are identified. The current study has a higher mean age and higher number of participating men than current ICBTi studies in general population.

    Disclosure: Nothing to disclose.

  • 85.
    Steinke, E.
    et al.
    School of Nursing, Wichita State University, Wichita, KS, USA.
    Palm Johansen, P.
    Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    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.
    Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review2016Inngår i: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, nr 1, s. 5-19Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Aims

    Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.

    Methods

    A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.

    Results

    Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.

    Conclusions

    The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

  • 86.
    Subic, Ana
    et al.
    Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
    Cermakova, Pavla
    National Institute of Mental Health, Klecany, Czech Republic.
    Religa, Dorota
    Polish Academy of Sciences, Mossakowski Medical Research Center, Warsaw, Poland.
    Han, Shuang
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    von Euler, Mia
    Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Johnell, Kristina
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Fastbom, Johan
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Bognandi, Liselia
    Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
    Winblad, Bengt
    Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Kramberger, Milica G
    Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
    Eriksdotter, Maria
    Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
    Garcia-Ptacek, Sara
    Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
    Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry2018Inngår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, nr 3, s. 1119-1128Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF).

    OBJECTIVE: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF.

    METHODS: Of 49,792 patients registered in the Swedish Dementia Registry 2007-2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death.

    RESULTS: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59-0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01-1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03-1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment.

    CONCLUSIONS: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.

  • 87.
    Ulin, Kerstin
    et al.
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    What is known about the benefits of patient-centered care in patients with heart failure2015Inngår i: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 12, nr 6, s. 350-359Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective.

  • 88.
    Valaker, I.
    et al.
    Western Norway University of Applied Sciences , Faculty of Health Studies, Førde, Norway.
    Norekvaal, T. M.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Raaholm, M-B
    Western Norway University of Applied Sciences , Faculty of Health Studies, Førde, Norway.
    Nordrehaug, J. E.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Rotevatn, S.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Relational continuity with healthcare providers after percutaneous coronary interventions: the patient perspective2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S89-S89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Relational continuity plays an important role when organizing the health care services for patients after early discharge. However, little is known about how patients experience relational continuity after percutaneous coronary interventions (PCI). Relational continuity has been defined as an ongoing therapeutic relationship between a patient and one or more healthcare providers.

    Purpose: To explore how patients undergoing PCI experience relational continuity after early discharge.

    Methods: Patients undergoing PCI hospitalized 6-8 weeks earlier, ⩾ 18 years and living at home at the time of inclusion were eligible for the study. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. The study used an explorative design, and semistructured interviews were conducted with nine women and 13 men. The majority were older than 67 years, suffered an ST-elevation infarction and did not participate in cardiac rehabilitation. Interviews were analyzed using qualitative content analysis according to Graneheim and Lundman.

    Results: Important dimensions inherent in relational continuity found in this study were: (1) genuine interest in the patient as a person, (2) fostering a trusting relationship,(3) knowledge about the patient’s current health status (4) the importance of a motivated and supportive healthcare provider, and (5) being in competent and safe hands.

    Conclusions: Establishing trusting relationships with multiple healthcare providers and especially with the GP provide patients with a sense of security and predictability. At present, GPs are joined by numerous of other healthcare providers offering supplemental services. Developing clinical pathways, interdisciplinary teams, and adding more nursing personnel on advanced level in primary careseems to be important. Furthermore, collaboration with user organizations could be an arena for better communication between healthcare providers and patients undergoing PCI. There is a need for new knowledge about relational continuity through research and education within this field.

  • 89.
    Valaker, Irene
    et al.
    Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Råholm, Maj-Britt
    Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway.
    Nordrehaug, Jan Erik
    Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Rotevatn, Svein
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr 5, s. 444-452Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI.

    Aim: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge.

    Methods: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6-8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis.

    Findings: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments.

    Conclusions and implications: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.

  • 90.
    Van der Wal, M. H. L.
    et al.
    Linköping University, Sweden.
    Hjelmfors, L.
    Linköping University, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Stromberg, A.
    Linköping University, Sweden.
    Jaarsma, T.
    Linköping University, Sweden.
    Factors related to discussing prognosis by nurses at heart failure clinics in Sweden and the Netherlands2015Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, s. 38-38Artikkel i tidsskrift (Annet vitenskapelig)
  • 91.
    van der Wal, Martje H. L.
    et al.
    Department of Cardiology, University Medical Centre Groningen, University of Groningen, Netherlands.
    Hjelmfors, Lisa
    Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Friedrichsen, Maria
    Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
    Strömberg, Anna
    UCI Program in Nursing Science, University of California, Irvine, CA, United States.
    Jaarsma, Tiny
    UCI Program in Nursing Science, University of California, Irvine, CA, United States.
    Variables Related to Communication About Prognosis Between Nurses and Patients at Heart Failure Clinics in Sweden and the Netherlands.2018Inngår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 2, s. E1-E6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In contrast to recommendations in recent guidelines, prognosis is not optimally discussed with patients with heart failure (HF). Reasons for not doing so can be related to both patient and provider characteristics.

    PURPOSE: The purpose of the study was to explore which patient- and nurse-related variables influence discussing prognosis with patients at an HF clinic.

    METHOD: Data from a previous survey on attitudes and clinical practice of HF nurses on discussing prognosis that was conducted in Sweden and the Netherlands were combined with data from a registration on topics that nurses discussed with their patients during a prespecified week at the HF clinic. Multivariable logistic regression analysis was performed to assess which variables are related to discussing prognosis.

    RESULTS: A total of 275 HF nurses (mean age, 49 years) and data of 1633 patients with HF (mean age, 71 years) were included in the study. Prognosis was discussed with 42% of all patients during the visit at the HF clinic. Patients with whom prognosis was discussed were more often in New York Heart Association classes III to IV (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.44-2.26). Nurses discussing prognosis reported more knowledge on the topic (OR, 1.71; 95% CI, 1.36-2.16) and discussed more topics with the patient (OR, 1.27; 95% CI, 1.21-1.32). Dutch HF nurses were more likely to discuss prognosis compared with their Swedish colleagues (OR, 1.83; 95% CI, 1.43-2.33).

    CONCLUSIONS: Discussing prognosis with patients with HF by nurses at the HF clinic is related to the characteristics of patients and HF nurses. Future interventions to improve communications about prognosis therefore should have a broad approach.

  • 92.
    Vellone, Ercole
    et al.
    Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
    Chialà, Oronzo
    Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
    Boyne, Josiane
    Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands.
    Klompstra, Leonie
    Department of Social and Welfare Studies, Faculty of Health Science, Linköping University, Linköping, Sweden.
    Evangelista, Lorraine S.
    Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States.
    Back, Maria
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ben Gal, Tuvia
    Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Strömberg, Anna
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Faculty of Health Science, Linköping University, Linköping, Sweden.
    Cognitive impairment in patients with heart failure: an international study2019Inngår i: ESC Heart Failure, E-ISSN 2055-5822Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.

    Methods and results: A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.

    Conclusions: CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

  • 93.
    Wibring, Kristoffer
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Department of Ambulance and Prehospital Care, Region Halland, Sweden.
    Herlitz, Johan
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Christensson, Lennart
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lingman, Markus
    Department of Medicine, Region Halland, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 219, s. 373-379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).

    Aim: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain.

    Methods: Several databases were searched for relevant articles. Identified articles were quality-assessed using the Scottish Intercollegiate Guidelines Network checklists. Extracted data was analysed using a semi-quantitative synthesis evaluating the level of evidence of each identified factor.

    Results: In total, 10 of 1245 identified studies were included. These studies provided strong evidence for an increased risk of an acute LTC with increasing age, male gender, elevated heart rate, low systolic blood pressure and ST elevation or ST depression on a 12-lead ECG. The level of evidence regarding the history of myocardial infarction, angina pectoris or presence of a Q wave or a Left Bundle Branch Block on the ECG was moderate. The evidence was inconclusive regarding dyspnoea, cold sweat/paleness, nausea/vomiting, history of chronic heart failure, smoking, Right Bundle Branch Block or T-inversions on the ECG.

    Conclusions: Factors reflecting age, gender, myocardial ischemia and a compromised cardiovascular system predicted an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.

  • 94.
    Wu, E.
    et al.
    Karolinska University Hospital, Dept. of Cardiology, Stockholm, Sweden.
    Broström, Anders
    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.
    Undergoing enhanced external counterpulsation treatment - a qualitative study of patients with refractory angina pectoris2018Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, s. 12-13Artikkel i tidsskrift (Fagfellevurdert)
  • 95.
    Wu, E.
    et al.
    Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Enhanced external counterpulsation as an intervention for patients with refractory angina pectoris - a review of performed research2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S38-S38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Despite optimal pharmacological treatments and invasive procedures, patients with refractory angina pectoris (RAP) remain symptomatic. Enhanced External Counterpulsation (EECP) is a non-invasive therapy based on 35 one-hour sessions. External pneumatic cuffs wrapped around the patient’s lower extremities inflate during cardiac diastole to create retrograde diastolic counterpulsation which leads to an improved coronary perfusion. EECP has for the past decade been used in European countries and has recently been updated in the European Guidelines as a clinical treatment option for patients with RAP.

    Purpose: The purpose was to describe the design and outcome variables of studies using EECP as a treatment for RAP.

    Methods: Search methods: Databases (i.e., PubMed,Wiley Online Library, Science Direct) were used to identify abstracts, reviews and journal articles related to this subgroup and EECP. Selection criterias: The chosen key words were EECP and refractory angina pectoris. Between time period 2000 to October 2016. Data collection and analysis: The literature search resulted in a total of 155 hits. Detected duplicates, irrelevant studies and others (i.e., editorials, letters) were removed (n=75). Research area and study design were reviewed in all remaining articles (n=80). In 56 of these, where design and content allowed, further analyses regarding follow-uptime and outcomes variables were performed.

    Results: An uneven distribution regarding research area was found among the analysed papers with dominance (48%) of studies within medicine and biology. Only 12% of the studies were performed within nursing. Prospective and longitudinal designs dominated (47%). Out of eight retrospective studies five were registry studies. Only two studies used a RCT design. No study used a qualitative approach. Out of 24 prospective studies 18 (75%) had a follow-up of 12 months or longer. 52% used biomedical outcomes (i.e., hemodynamic, biomarker, arterial stiffness, peripheral vascular reactivity) and 41% used clinical/patient reported outcomes (i.e., quality of life, functional classes, physical capacity, psychological aspects). Cost effectiveness was calculated in 7% of the studies.

    Conclusions/implications: EECP is recommended in guidelines as a possible treatment for patients with RAP. There is, however, a great need for increased nursing research both with qualitative and quantitative approaches. RCTs are sparse, as well as cost-effectiveness-studies.

  • 96. Zhan, Y.
    et al.
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, R.
    Tillander, A.
    Reynolds, C. A.
    Pedersen, Nancy L.
    Hägg, S.
    Exploring the Causal Pathway from Telomere Length to Coronary Heart Disease: A Network Mendelian Randomization Study2017Inngår i: Circulation Research, ISSN 0009-7330, E-ISSN 1524-4571, Vol. 121, nr 3, s. 214-219Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale: Observational studies have found shorter leukocyte telomere length (TL) to be a risk factor for coronary heart disease (CHD), and recently the association was suggested to be causal. However, the relationship between TL and common metabolic risk factors for CHD is not well understood. Whether these risk factors could explain pathways from TL to CHD warrants further attention.

    Objective: To examine whether metabolic risk factors for CHD mediate the causal pathway from short TL to increased risk of CHD using a network Mendelian randomization design.

    Methods and Results: Summary statistics from several genome-wide association studies were used in a 2-sample Mendelian randomization study design. Network Mendelian randomization analysis - an approach using genetic variants as the instrumental variables for both the exposure and mediator to infer causality - was performed to examine the causal association between telomeres and CHD and metabolic risk factors. Summary statistics from the ENGAGE Telomere Consortium were used (n=37 684) as a TL genetic instrument, CARDIoGRAMplusC4D Consortium data were used (case=22 233 and control=64 762) for CHD, and other consortia data were used for metabolic traits (fasting insulin, triglyceride, total cholesterol, low-density lipoprotein cholesterol, fasting glucose, diabetes mellitus, glycohemoglobin, body mass index, waist circumference, and waist:hip ratio). One-unit increase of genetically determined TL was associated with -0.07 (95% confidence interval, -0.01 to -0.12; P=0.01) lower log-transformed fasting insulin (pmol/L) and 21% lower odds (95% confidence interval, 3-35; P=0.02) of CHD. Higher genetically determined log-transformed fasting insulin level was associated with higher CHD risk (odds ratio, 1.86; 95% confidence interval, 1.01-3.41; P=0.04).

    Conclusions: Overall, our findings support a role of insulin as a mediator on the causal pathway from shorter telomeres to CHD pathogenesis.

  • 97.
    Zupanic, Eva
    et al.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.
    Kåreholt, Ingemar
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Norrving, Bo
    Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    Secnik, Juraj
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Winblad, Bengt
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.
    Religa, Dorota
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.
    Kramberger, Milica Gregoric
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden.
    Johnell, Kristina
    Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Eriksdotter, Maria
    Karolinska University Hospital, Stockholm, Sweden.
    Garcia-Ptacek, Sara
    Karolinska University Hospital, Stockholm, Sweden.
    Acute stroke care in dementia: A cohort study from the Swedish Dementia and Stroke Registries2018Inngår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 66, nr 1, s. 185-194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    METHODS: Retrospective analysis of prospectively collected data 2010-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who suffered an acute ischemic stroke (AIS) (n = 1,356) were compared with matched non-dementia AIS patients (n = 6,755). Outcomes included length of stay in a stroke unit, total length of hospitalization, and utilization of diagnostic tests and assessments.

    RESULTS: The median age at stroke onset was 83 years. While patients with dementia were equally likely to be directly admitted to a stroke unit as their non-dementia counterparts, their stroke unit and total hospitalization length were shorter (10.5 versus 11.2 days and 11.6 versus 13.5, respectively, p < 0.001). Dementia patients were less likely to receive carotid ultrasound (OR 0.36, 95% CI [0.30-0.42]) or undergo assessments by the interdisciplinary team members (physiotherapists, speech therapists, occupational therapists; p < 0.05 for all adjusted models). However, a similar proportion of patients received CT imaging (97.4% versus 98.6%, p = 0.001) and a swallowing assessment (90.7% versus 91.8%, p = 0.218).

    CONCLUSIONS: Patients with dementia who suffer an ischemic stroke have equal access to direct stroke unit care compared to non-dementia patients; however, on average, their stay in a stroke unit and total hospitalization are shorter. Dementia patients are also less likely to receive specific diagnostic tests and assessments by the interdisciplinary stroke team.

    BACKGROUND: Previous studies have shown that patients with dementia receive less testing and treatment for stroke.

    OBJECTIVES: Our aim was to investigate hospital management of acute ischemic stroke in patients with and without dementia.

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