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  • 1.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wambui, Theresah
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Perceptions of family planning among low-income men in Western Kenya: Original Article2009In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, no 3, p. 340-345Article in journal (Refereed)
    Abstract [en]

    Background: Men have rarely been involved in either receiving or providing information on sexuality, reproductive health or birth spacing. They have also been ignored or excluded in one way or the other from participating in many family planning programmes as family planning is viewed as a womans affair.

    Aim: To describe the perceptions of family planning among low-income men in Western Kenya. Methods: A qualitative study using focus group interviews and content analysis was conducted, with 64 men aged 15-54 years participating actively.

    Findings: Perceptions of family planning were manifold. For example, some perceived it as meaning having the number of children one is able to provide for. Most men knew about traditional and modern methods of birth control, although their knowledge was poor and misconceived. Modern methods were thought to give side effects, discouraging family planning. Low instances of family planning were also because of the fact that culturally, children are considered wealth. A law advocating family size limitation was regarded as necessary for the future.

    Conclusion: Mens perceptions of family planning are manifold. Their knowledge about contraception is poor and sometimes misconceived. Preferences regarding a childs gender are strong, thus attitudes and cultural beliefs that might hinder family planning have to be considered. A policy on male contraception and contraceptive services is seen as necessary.

  • 2.
    Bachrach-Lindström, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Christensson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikationer för områdena smärta, munhålan, nutrition, trycksår2005Report (Other academic)
  • 3.
    Bachrach-Lindström, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Torsten
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study2000In: Aging, ISSN 1945-4589, E-ISSN 1945-4589, Vol. 12, no 5, p. 366-374Article in journal (Refereed)
    Abstract [en]

    The primary aim of this study was to evaluate the effect of two different surgical methods on nutritional status and functional capacity during the first postoperative year in patients with displaced femoral neck fractures. A further aim was to evaluate the effect of nutritional support. One hundred patients were randomly assigned to treatment with either primary total hip arthroplasty (THA) or osteosynthesis. Half of the patients in each treatment group received protein- and energy-enriched food in the hospital in addition to individual nutritional advice in order to optimize their intake of protein- and energy-rich food. Nutritional state and functional capacity were examined at baseline, one and three months, and one year after the operation. Pain was examined at three months and one year. The effect of nutritional intervention was equal within both surgical groups. Logistic regression showed that the dependent variable "living at one year" was significantly associated with serum albumin levels at one month. Advanced age, mental impairment and deteriorated nutritional status were predominant in the non-survivors. Overall, the primary THA group performed better compared with the osteosynthesis group concerning weight change over time, locomotion and pain. This study also showed that primary THA could safely be performed in the elderly without an increased postoperative mortality rate.

  • 4.
    Bachrach-Lindström, Margaretha
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Förebygg undernäring!2002In: Äldre i centrum, ISSN 1401-5110, Vol. 3, p. 16-17Article in journal (Other (popular science, discussion, etc.))
  • 5.
    Bachrach-Lindström, Margaretha
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nutritional state and functional capacity among elderly Swedish people with acute hip fracture2000In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 14, no 4, p. 268-274Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe characteristics in a group of elderly men and women with hip fracture, regarding presumed risk factors, such as nutritional state and functional capacity. A total of 142 men and women aged 75 years or more were consecutively included on admittance to the hospital. Anthropometry and body composition were measured 4-6 days after the fracture. Data on functional status, activities of daily living and living arrangements at the time of the fracture were collected. The women and men had a body mass index (BMI) of 22.3 ▒ 3.7 kg/m2 and 21.7 ▒ 2.1 kg/m2, respectively. Of the whole group, 71% had a BMI < 24 kg/m2 and 25% a BMI < 20.0 kg/m2. Forty-five percent of the patients needed daily home help, and a majority of them were mentally impaired (p < 0.0001). Women with a trochanteric hip fracture were shorter, had lower body weight, lower lean body mass and lower arm muscle circumference (AMC) than the cervical fracture group (p < 0.05). Fewer women with a trochanteric fracture and fewer women with mental impairment took walks outside before the fracture, (p = 0.023 and p = 0.002, respectively). Characteristics found in the group were low BMI, low muscle mass as indicated by low lean body mass and mental impairment. It seems important to evaluate such factors when developing post-operative care plans aimed at avoiding further deterioration. Extra frail sub-groups of patients, such as people who are mentally impaired, women with trochanteric fracture and women with high dependency concerning ADL functions were identified.

  • 6.
    Bachrach-Lindström, Margaretha
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Arnqvist, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture2001In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 20, no 3, p. 217-223Article in journal (Refereed)
    Abstract [en]

    Background & Aims: The aim of this study of women with hip fracture was to describe nutritional status with biochemical markers and anthropometric variables, and to evaluate the effect of nutritional intervention with the intention of increasing protein and energy intake.

    Methods: The first consecutive 44 women were included, and used as controls. The next 44 were matched for age, fracture and mental state. Anthropometric variables, IGF-I, hormones and serum albumin were collected 4–6 days (baseline), 1 and 3 months after surgery. Twenty-four women filled out a 7-day food record.

    Results: At baseline, one fourth had BMI <20 kg/m2and subnormal triceps skinfold thickness. Baseline serum albumin, IGF-I and growth hormone levels were low, probably as an acute response to trauma. Women with BMI <20 kg/m2had lower IGF-I levels compared to those with higher BMI. At 3 months, one-third of both groups were protein and energy malnourished. The intervention group obtained higher daily energy percentage from fat but none of the groups reached their calculated energy need.

    Conclusions: Using biochemical markers in the acute postoperative situation to assess nutritional status is not recommended. The intervention had no impact on anthropometric or biochemical variables.

  • 7.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses2015In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 24, no 8, p. 346-358Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.

    Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.

    Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.

    Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.

  • 8.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions2014In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, p. 761-771Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

    METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

    RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

    CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

  • 9.
    Bergstrand, Sara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Blood flow at different depth in the tissue measured with PPG and laser Doppler technique2008In: Third Congress of the World Unionof Wound Healing Societies,2008, 2008, p. 31-31Conference paper (Other academic)
    Abstract [en]

       

  • 10.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindén, Maria
    Mälardalen University, Västerås, Sweden.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Blood flow measurements at different depths using photoplethysmography and laser Doppler techniques2009In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 15, no 2, p. 139-147Article in journal (Refereed)
    Abstract [en]

    Background/purpose: This study has evaluated a multi-parametric system combining laser Doppler flowmetry and photoplethysmography in a single probe for the simultaneous measurement of blood flow at different depths in the tissue. This system will be used to facilitate the understanding of pressure ulcer formation and in the evaluation of pressure ulcer mattresses.

    Methods: The blood flow in the tissue over the sacrum was measured before, during and after loading with 37.5 mmHg, respectively, 50.0 mmHg. The evaluation of the system consisted of one clinical part, and the other part focusing on the technicalities of the probe prototype.

    Results: An increase in blood flow while loading was the most common response, but when the blood flow decreased during loading it was most affected at the skin surface and the blood flow responses may be different due to depths of measurement. Reactive hyperaemia may occur more frequently in the superficial layers of the tissue.

    Conclusion: The study showed that the new system is satisfactory for measuring tissue blood flow at different depths. The laser Doppler complements the photoplethysmography, and further development of the system into a thin flexible probe with the ability to measure a larger area is required.

  • 11.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Lindén, Maria
    n/a.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Tissue blood flow responses to external pressure in the sacral region using PPG and laser Doppler technique.2009In: European Pressure Ulcer Advisory Panels, Amsterdam., 2009Conference paper (Refereed)
  • 12.
    Bringman, S
    et al.
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Haglind, E
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Heikkinen, TJ
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kylberg, F
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ramel, S
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Wallon, Conny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Anderberg, B
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study2001In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, ISSN 1051-7200, E-ISSN 2331-2254, Vol. 11, no 5, p. 322-326Article in journal (Refereed)
    Abstract [en]

    Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon, There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups, Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.

  • 13.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Individually adjusted meals for older people with protein-energy malnutrition: a single-case study2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, p. 491-502Article in journal (Refereed)
    Abstract [en]

    • The objective of this study was to investigate the effect of a 3-month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein-energy malnourished on admission to a municipal care Institution.

    • Using a single-case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week.

    •  During a 3-month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin-fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity.

    • We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents.

  • 14.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margaretha
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Attitudes of nursing staff towards nutritional nursing care2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 3, p. 223-231Article in journal (Refereed)
    Abstract [en]

    Fulfilling nutritional requirements in residents with eating problems can be a challenge for both the person in need of help and for the caregiver. In helping and supporting these residents, a positive attitude is assumed to be as important as practical skill. The aim of this study was to test the hypothesis that nutritional education and implementation of a nutritional programme would change the attitudes towards nutritional nursing care among nursing staff with daily experience of serving food and helping residents in municipal care. The study was carried out as a before and after experimental design. An attitude scale, staff attitudes to nutritional nursing care (SANN scale), was developed and used. The response on the scale gives a total SANN-score and scores in five underlying dimensions: self ability, individualization, importance of food, assessment and secured food intake. Nursing staff at eight different residential units (n = 176) responded to the attitude scale and, of these, staff at three of the units entered the study as the experimental group. After responding to the attitude scale, nutritional education was introduced and a nutritional programme was implemented in the experimental units. One year later, attitudes were measured a second time (n = 192). Of these, 151 had also responded on the first occasion. Education and implementation of a nutritional programme did not significantly change attitudes. Overall, nursing staff responded with positive attitudes towards nutritional nursing care. Most of the positive attitudes concerned items within the dimension importance of food. In contrast, items within self ability showed the lowest number of staff with positive attitudes.

  • 15.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care2002In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 56, no 9, p. 810-818Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM).

    Design: Cross-sectional study with consecutive selection of residents aged 65 y.

    Setting: A municipality in the south of Sweden.

    Subjects: During a year, starting in October 1996, 148 females and 113 males, aged 65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study.

    Results: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished.

    Conclusions: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

  • 16.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Malnutrition in elderly people newly admitted to a community resident home1999In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 3, no 3, p. 133-139Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to assess nutritional status in elderly people, newly admitted to a community resident home, and to describe the characteristics of residents with protein-energy malnutrition (PEM). The participants were 261 people, 65 to 103 years of age (M= 84.8+/-7.1 in women, 82.5+/-6.4 in men) who during one year entered special types of housing for the elderly in a municipality in the south of Sweden. During the first two weeks after admission nutritional status was assessed using weight index, triceps skinfold thickness, arm muscle circumference, serum albumin and transthyretin. Demographic and sociomedical data and eating-related factors were collected by using structured interviews and studying residents records. PEM was found in 29% of the residents who entered municipal care from their own homes, 33% among those moving within municipal care and 43% of the residents who entered from hospital care. Pressure sores or leg ulcers, psychological stress or acute disease in the previous 3 months, reduced fluid intake, deteriorated appetite, reduced mobility, need of help during meals and gastrointestinal symptoms were factors associated with PEM.

  • 17.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unossoon, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition2003In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 7, no 4, p. 257-262Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    As nutritional preventative measures are more effective in elderly people assessed as non protein-energy malnourished (non-PEM) than such interventions are in those who are malnourished, early detection of those at risk of malnutrition is important.

    OBJECTIVE:

    This study tests the hypothesis that health problems measured by the Nottingham Health Profile (NHP) can predict residents at risk of malnutrition.

    DESIGN:

    Nutritional status was assessed in 261 residents newly admitted to municipal care using a combination of anthropometry and serum protein measurements. From this sample, 20 non-PEM residents, simultaneously assessed as moderately malnourished according to a subjective method, were consecutively included. Using a paired matched design, 20 other non-PEM residents, who were simultaneously subjectively assessed as well nourished, completed the pairs.

    RESULTS:

    Univariate logistic regression analyses showed that the dimensions of emotional reactions, energy, pain, physical mobility and sleep had significant power to predict residents at risk of malnutrition. In the multiple logistic regression analysis, energy had the highest explanatory power.

    CONCLUSION:

    Non-PEM residents, assessed as moderately malnourished according to the Subjective Global Assessment, perceived significantly greater health problems than non-PEM residents subjectively assessed as well nourished. Measurement of health problems adds important information to that used in early detection of residents at risk of malnutrition.

  • 18.
    Dini, Francesca
    et al.
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Capuano, Rosamaria
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Strand, Tillan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Paolesse, Roberto
    Department of Chemical Science and Technology, University of Rome Tor Vergata, Rome, Italy.
    Di Natale, Corrado
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Lundström, Ingemar
    Linköping University, Department of Physics, Chemistry and Biology, Biosensors and Bioelectronics. Linköping University, The Institute of Technology.
    Volatile Emissions from Compressed Tissue2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 7Article in journal (Refereed)
    Abstract [en]

    Since almost every fifth patient treated in hospital care develops pressure ulcers, early identification of risk is important. A non-invasive method for the elucidation of endogenous biomarkers related to pressure ulcers could be an excellent tool for this purpose. We therefore found it of interest to determine if there is a difference in the emissions of volatiles from compressed and uncompressed tissue. The ultimate goal is to find a non-invasive method to obtain an early warning for the risk of developing pressure ulcers for bed-ridden persons. Chemical analysis of the emissions, collected in compresses, was made with gas-chromatography – mass spectrometry and with a chemical sensor array, the so called electronic nose. It was found that the emissions from healthy and hospitalized persons differed significantly irrespective of the site. Within each group there was a clear difference between the compressed and uncompressed site. Peaks that could be certainly deemed as markers of the compression were, however, not identified. Nonetheless, different compounds connected to the application of local mechanical pressure were found. The results obtained with GC-MS reveal the complexity of VOC composition, thus an array of non-selective chemical sensors seems to be a suitable choice for the analysis of skin emission from compressed tissues; it may represent a practical instrument for bed side diagnostics. Results show that the adopted electronic noses are likely sensitive to the total amount of the emission rather than to its composition. The development of a gas sensor-based device requires then the design of sensor receptors adequate to detect the VOCs bouquet typical of pressure. This preliminary experiment evidences the necessity of studies where each given person is followed for a long time in a ward in order to detect the insurgence of specific VOCs pattern changes signalling the occurrence of ulcers.

  • 19.
    Edell-Gustafsson, Ulla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    The relevance of sleep, circadian rhythm and lifestyle as related to a holistic theory of health1992In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 6, no 1, p. 29-35Article in journal (Refereed)
  • 20.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Immobilitet og sengeleie2006In: Tverrfaglig geriatri: en innføring / [ed] Margareth Bondevik og Harald A. Nygaard, Bergen, Norge: Fagbokforlaget , 2006, 2, p. 229-242Chapter in book (Other academic)
  • 21.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Naturvetenskaplig angreppspunkt. Teoriutveckling inom omvårdnadsvetenskap i Norden. Naturvetenskapligt angreppssätt exemplifierat med teoriutveckling inom området trycksår.2001In: From witchcraft to science :: rapport från två forskarseminarier om "Annan överkänslighet" / [sammanställd av] Arbetsgruppen för annan överkänslighet, Vårdalstiftelsen, Statens folkhälsoinstitut, Linköping: Linköpings universitet , 2001, p. 69-75Chapter in book (Other academic)
  • 22.
    Ek, Anna-Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    Boken om trycksår, en kunskapssammanställning1997Book (Other academic)
  • 23.
    Ek, Anna-Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Näringstillståndets betydelse för utveckling och läkninga av trycksår.2003In: Incitament, ISSN 1103-503X, Vol. 1, p. 76-78Article in journal (Other academic)
  • 24.
    Ek, Anna-Christina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Melhus, Åsa
    Klinisk bakteriologi, Uppsala Universitet.
    Silverförband vid behandling av kroniska sår2010Report (Other academic)
  • 25.
    Ek, Anna-Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Nordström, Gun
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikatorer för patienter med eller med risk för trycksår.2001In: Kvalitetsindikatorer inom omvårdnad. / [ed] Ewa Idvall, Linköping: Linköpings universitet , 2001, p. 11-28Chapter in book (Other academic)
  • 26.
    Engström, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Faculty of Health Sciences.
    Flensner, Gullvi
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Landtblom, Anne-Marie
    Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurosurgery UHL.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Fatigue and cognitive effort in multiple sclerosis: an fMRI study2011Conference paper (Other academic)
    Abstract [en]

    Despite recent advances in therapy and diagnosis, fatigue remains a mayor challenge in multiple sclerosis (MS).  To further the understanding of the neural underpinnings of fatigue, we undertook a study using functional magnetic resonance imaging (fMRI) to investigate neural networks that may be affected by MS-related fatigue. Twelve MS patients and 12 age- and sex matched controls were administered the Fatigue Impact Scale (FIS) to assess clinically significant fatigue, and underwent a neuropsychological examination. The participants performed a working memory task (Daneman’s  ‘Reading Span’ task) while being monitored by means of a 1.5 T Philips Achieva MR scanner. We have previously shown that this task triggers an executive network comprising frontal and parietal areas typically involved in working memory. In addition, the task engages a core network involving the anterior insula and the anterior cingulate cortex.  This latter network may be implicated in allocation of mental resources and monitoring of the present state of the individual. There were two main findings. MS participants evidenced less activation than controls in the anterior cingulate and the left parietal cortex (Brodmann area 7) and more activation in left hemisphere language areas as well as the anterior insula. The second main finding was that clinical ratings of fatigue were strongly correlated with activity in wide areas of the core network, as well as posterior language areas. We take this finding to indicate that fatigue is related to compensatory involvement of the core network, and that excess activity in the core network possibly could be used as an objective marker of fatigue in MS.

  • 27.
    Engström, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Flensner, Gullvi
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. University West, Trollhättan, Sweden.
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Thalamo-striato-cortical determinants to fatigue in multiple sclerosis2013In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 3, no 6, p. 715-728Article in journal (Refereed)
    Abstract [en]

    Background

    The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue.

    Methods

    MS participants with self-reported fatigue were examined by functional magnetic resonance imaging (fMRI) during the performance of a complex working memory task. In this task, cognitive effort was challenged by a parametric design, which modeled the cerebral responses at increasing cognitive demands. In order to explore the theory of central fatigue in MS we also analyzed the cerebral responses by adding perceived fatigue scores as covariates in the analysis and by calculating the functional connectivity between regions in the thalamo-striatocortical network. The main findings were that MS participants elicited altered brain responses in the thalamo-striato-cortical network, and that brain activation in the left posterior parietal cortex and the right substantia nigra was positively correlated to perceived fatigue ratings. MS participants had stronger cortical-to-cortical and subcortical-to-subcortical connections, whereas they had weaker cortical-to-subcortical connections.

    Conclusions

    The findings of the present study indicate that the thalamo-striato-cortical network is involved in the pathophysiology of fatigue in MS, and provide support for the theory of central fatigue. However, due to the limited number of participants and the somewhat heterogeneous sample of MS participants, these results have to be regarded as tentative, though they might serve as a basis for future studies.

  • 28.
    Fex, Angelika
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Söderhamn, Olle
    Department of Nursing, Health and Culture, University West, Trollhättan.
    Self-care among persons using advanced medical technology at home2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, p. 2809-2817Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed to describe lived experiences of self-care among persons using advanced medical technology at home.

    Background. An increased number of people are performing self-care while using different sorts of advanced medical technology at home. Knowledge of different patient groups' lived experiences of this situation may be useful for nurses and other caregivers in educating and supporting these patients.

    Design. A qualitative design was used.

    Methods. Suitable patients in western Sweden were informed by their nurses and invited to participate. Ten people, who performed self-care at home, either while using long-term oxygen therapy from a ventilator or oxygen cylinder, or while performing peritoneal or haemodialysis, were interviewed. The interviews were analysed using a descriptive phenomenological methodology.

    Results. Prerequisites for self-care when using advanced medical technology at home were: support from professional caregivers and significant others; cognitive capacity; and a positive attitude to life. This type of self-care contains steps for living healthy, for planning and for adjusting technology. It involves a process of learning and feelings both of being tied up and of feeling free. Additionally, it has influences on the home environment.

    Conclusion. Self-care in this context can be described on a generic level. Self-care is more than mastering the technology; it also means dealing with daily life activities for healthy living, planning for the use of the equipment and activities, having knowledge about bodily signs of good and ill-health, and adjusting treatment according to the circumstances.

    Relevance to clinical practice. Self-care in this context involves a learning process with education and continuing access to support from professional caregivers. With knowledge and support, patients are able to assume substantial responsibility for self-care. Needs for design improvements of medical technology for use at home are raised.

  • 29.
    Fex, Angelika
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flensner, Gullvi
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Söderhamn, Olle
    Department of Health, Faculty of Health and Sport and Centre for Caring Research Southern Norway.
    Health-illness transition among persons using advanced medical technology at home2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 253-261Article in journal (Refereed)
    Abstract [en]

    Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition.

  • 30.
    Fex, Angelika
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flensner, Gullvi
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Söderhamn, Olle
    Department of Nursing, Health and Culture, University West, Sweden/Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Norway.
    Living with an adult family member using advanced medical technology at home2011In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 18, no 4, p. 336-347Article in journal (Refereed)
    Abstract [en]

    An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from health-care professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs were receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

  • 31.
    Fex, Angelika
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flensner, Gullvi
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Söderhamn, Olle
    Department of Nursing, Health and Culture, University West, Sweden/Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Norway.
    Self-Care Agency and Perceived Health Among Persons Using Advanced Medical Technology at Home2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 806-815Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study of self-care agency and perceived health in a group ofpersons using advanced medical technology at home.

    Background. An increasing number of persons are using medical technology for self-care. Few studies describe daily life in this context at an overriding level, irrespective of the specific sort of technology. A connection between self-care, perceived health and sense of coherence has previous been implied.

    Methods. A descriptive, comparative, cross-sectional quantitative design was used. Data were collected from a questionnaire in the winter 2009/2010. The questionnaire addressed perceiveed health and daily life with medical technology, and applied Swedish versions of the Appraisal of Self-care Agency scale and the 13-item version of Antonovsky’s sense of coherence scale.

    Results. The questionnaire was answered by 180 adults performing self-care at home involving long-term oxygen, a ventilator, peritoneal or blood dialysis. Health-related and technology-related variables in daily life were rated as satisfactory to a high extent. Perceived health was rated significantly lower among participants using long-term oxygen. Sufficient sense of coherence and knowledge of how to use technology, close contacts with other persons, and not feeling helpless contributed positively as factors for self-care agency. Positive factors for perceived health were being satisfied with life, having an active life, and not feeling helpless, while age was a negative factor.

    Conclusion. Daily life is manageable for persons using these types of technology. Long-term oxygen treatment and advanced age can be seen as risk factors for perceiving ill health.

  • 32.
    Flensner, Gullvi
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Landtblom, Anne-Marie
    Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
    Söderhamn, Olle
    Faculty of Health and Sport, University of Agder, Arendal, Norway.
    Fatigue in relation to perceived health: people with multiple sclerosis compared with people in the general population2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 391-400Article in journal (Refereed)
    Abstract [en]

    Fatigue is not only a complex phenomenon accompanying different illness conditions but is also a common complaint among individuals in the general population. Among individuals diagnosed with the chronic neurological disease multiple sclerosis (MS), one-third describe fatigue as the very first symptom, however it is invisible to others. When adopting an action-theoretic approach to health, fatigue may be considered to influence the individual’s goals of life and subjectively perceived health. The aim of this study was to describe perceived fatigue in relation to perceived health among working-aged individuals diagnosed with MS (n = 155), and in a comparative group of individuals randomly selected from the general population living in the same geographical area (n = 190). A self-report questionnaire including the Fatigue Impact Scale, a checklist of six symptoms, questions covering perceived health and levels of and perceptions of fatigue was used for the data collection. The responses on perceived health were dichotomized into two categories: ‘good health’ and ‘ill health’. Of the individuals with MS, 50% graded their perceived health as ill compared with 18% in the reference group (p < 0.001), and 68% graded fatigue as one of their worst symptoms compared with 21% in the reference group. In both groups, higher presence of symptoms and impact of fatigue in daily activities correlated negatively to perceived health. Compared with the individuals in the reference group, the individuals with MS reported higher impact of fatigue in physical areas in both the category of ‘good health’ (p < 0.001) and ‘ill health’ (p < 0.01). The perceived impact of fatigue was mirrored in increased problems in social and family activities. In conclusion, individuals with MS perceive fatigue as one of their worst symptoms three times as often as individuals in the general population. However, individuals with MS probably also adapt themselves or shift in their response to fatigue more than individuals in the general population.

  • 33.
    Flensner, Gullvi
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Soderhamn, Olle
    University West.
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey2011In: BMC NEUROLOGY, ISSN 1471-2377, Vol. 11, no 27Article in journal (Refereed)
    Abstract [en]

    Background: Many individuals diagnosed with Multiple Sclerosis (MS) are sensitive to increased body temperature, which has been recognized as correlating with the symptom of fatigue. The need to explore this association has been highlighted. The aim of this study was to investigate the occurrence of heat sensitivity and its relations to disease course, disability, common MS-related symptoms and ongoing immunosuppressive treatments among individuals 65 years of age or younger diagnosed with MS. Methods: A cross-sectional designed survey was undertaken. A questionnaire was sent to MS-patients with an Expanded Disability Status Score (EDSS) in the interval of 0-6.5 and who were between 20 and 65 years of age, living in an eastern region of Sweden (n = 334). Besides occurrence of heat sensitivity (Yes/No) and corresponding questions, the Fatigue Severity Scale (FSS), the MS-related symptom checklist and the Perceived Deficit Questionnaire (PDQ) were included. Data were analysed in relation to data level using Chi-square, Mann Whitney U-test, and Students t-test. Pearsons and Spearmans correlations were calculated. In the logistic regression analyses (enter) dichotomized MS-symptoms were used as dependent variables, and EDSS, disease-course, time since onset, heat-sensitivity, age and sex (female/male) were independent variables. In the linear regression analyses, enter, mean FSS and summarized PDQ were entered as dependent variables and EDSS, disease-course, time since onset, heat sensitivity, age and sex (female/male) were independent variables. Results: Of the responding patients (n = 256), 58% reported heat sensitivity. The regression analyses revealed heat sensitivity as a significant factor relating not only to fatigue (p andlt; 0.001), but also to several other common MS symptoms such as pain (p andlt; 0.001), concentration difficulties (p andlt; 0.001), and urination urgency (p = 0.009). Conclusions: Heat sensitivity in MS patients is a key symptom that is highly correlated with disabling symptoms such as fatigue, pain, concentration difficulty and urination urgency.

  • 34.
    Flensner, Gullvi
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Söderhamn, Olle
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lived experience of MS-related fatigue: a phenomenological interview study2003In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 40, no 7, p. 707-717Article in journal (Refereed)
    Abstract [en]

    Fatigue is a major problem among individuals diagnosed with multiple sclerosis (MS), but its meaning in daily living is unclear. The aim was to describe MS-related fatigue as lived by a group of individuals diagnosed with MS. Interviews with nine individuals were analysed from a phenomenological perspective.

    Main findings: MS-related fatigue is living with a time-consuming and all absorbing phenomenon, involving the body and the whole human being. Fatigue is commonly non-constructively perceived and expressed in terms of energy loss, emotional afflictions, dependency and restrictions of life in general, however, it is also constructively perceived and involves a desire to accept life and strive for a better situation.

    Conclusion: MS-related fatigue is a comprehensive phenomenon and its relationship with self-care requires further investigation.

  • 35.
    Flensner, Gullvi
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Söderhamn, Olle
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Reliability and validity of the Swedish version of the Fatigue Impact Scale (FIS)2005In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 12, no 4, p. 170-180Article in journal (Refereed)
    Abstract [en]

    Fatigue is a complex phenomenon that, for those not affected, is hard to understand. To achieve better assessments, caregivers need reliable and valid tools. The aim of this study was to investigate the reliability and validity of the Swedish version of the Fatigue Impact Scale (FIS) among working-aged individuals diagnosed with multiple sclerosis (MS), as well as in a comparative group randomly selected from the general population in the same geographical area. Both individuals with MS (n=161) and individuals recruited from the general population (n=194) participated in the study. A questionnaire was used for the data collection. The data were analysed using non-parametric statistical methods. Reliability of FIS was addressed by item-to-item and item-to-total correlations. Concurrent validity was tested for by analysing correlations between the FIS and general questions, and construct validity by investigation of differences in the FIS scores between known groups. The FIS was found to be homogenous, with item-to-total correlation coefficients of 0.42 ≤ rs≤0.86 (p<0.001), reflecting the instrument's reliability. The correlations between the FIS and the general questions confirm its concurrent validity, 0.27 ≤ rs≤0.84 (p<0.001). The differences in FIS scores between known groups demonstrate its construct validity. Furthermore, the FIS showed the ability to discriminate between groups of individuals with differences in perceived impact of fatigue.

  • 36.
    Flensner, Gullvi
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Soderhamn, Olle
    University of West, Sweden .
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13Article in journal (Refereed)
    Abstract [en]

    Background: Among individuals diagnosed with the chronic neurologic disease, multiple sclerosis (MS), a majority suffers from fatigue, which strongly influences their every-day-life. The aim of this study was to investigate work capacity and health-related quality of life (HRQoL) in a group of MS patients and also to investigate if work capacity and HRQoL could be predicted by background factors, fatigue, heat sensitivity, cognitive dysfunction, emotional distress or degree of disability. less thanbrgreater than less thanbrgreater thanMethods: A descriptive, cross-sectional, designed survey was undertaken A questionnaire was sent to 323 individuals diagnosed with MS, aged between 20 and 65 years, with physical disability on the expanded disability status score (EDSS) in the interval 0 andgt;= EDSS andlt;= 6.5, living in sterg"tland county in eastern Sweden. Questions on background factors, occupation and work, together with the health-related quality of life short form instrument (SF-36), the fatigue severity scale (FSS), the perceived deficit questionnaire (PDQ) and the hospital anxiety depression scale (HAD) were posed. Associations between variables were analyzed using Pearsons and Spearmans correlations. Differences between groups were tested using the Chi-square test, the Mann Whitney U-test, and the Students t-test. Predictive factors were analyzed using multiple linear and multiple logistic regression analysis. less thanbrgreater than less thanbrgreater thanResults: Of those who completed the questionnaire (n = 257, 79.6%), 59.8% were working. Work capacity was found significantly more among men (p andlt; 0.005), those with a higher level of education (p andlt; 0.001), those reporting less fatigue (p andlt; 0.001), and those having no heat sensitivity (p = 0.004). For work capacity, significant predictors were low physical disability (EDSS), low fatigue, higher level of education, male sex and lower age. Those with work capacity showed significantly higher HRQoL than those who had no work capacity (p andlt; 0.001). Levels of fatigue, cognition and emotional distress were found to be major contributing factors for HRQoL. less thanbrgreater than less thanbrgreater thanConclusions: Work capacity and HRQoL among individuals diagnosed with MS are highly influenced by fatigue which can be considered as a key symptom. Work capacity was influenced by heat-sensitivity, cognitive difficulties and emotional distress and significant predictive factors besides fatigue, were physical disability (EDSS), age, sex, and level of education. Remaining at work also gives a better HRQoL.

  • 37.
    Foldemo, Annica
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bogren, Lennart
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Needs in outpatients with schizophrenia, assessed by the patients themselves and their parents and staff2004In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 39, no 5, p. 381-385Article in journal (Refereed)
    Abstract [en]

    Background:

    There has been a change in psychiatric care from a hospital-oriented care system to an outpatient-centred system, which has underlined the importance of support alternatives.

    Methods:

    The sample was drawn from outpatients with schizophrenia at an outpatient clinic in 2001. We used structured interviews when interviewing outpatients, parents and staff. The interview with the patient included the patient’s needs, global function, clinical global impression and insight. Both parents and staff were interviewed about the patient’s needs.

    Results:

    The mean value of GAF was 56 ± 10, CGI 4 ± 1 and 89% of the patients had full insight into their illness. The patients rated the total score of the severity of needs at a mean of 7 ± 4, while the parents’ and staff’s rating was 9 ± 5. The needs ranking between patients and parents and patients and staff showed a correlation of rho = 0.65 (p < 0.01) and parents and staff rho =0.95 (p < 0.01). The parents rated more problems involving physical health and money than the patients.

    Conclusion:

    When planning mental health in the future, it is important to assess the views of the patients, the parents and the staff from a multiple perspective.

  • 38.
    Foldemo, Annica
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Gullberg, Mats
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bogren, Lennart
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Quality of life and burden in parents of outpatients with schizophrenia2005In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 40, no 2, p. 133-138Article in journal (Refereed)
    Abstract [en]

    Background

    Since the late 1950s, several studies have reported the burden faced by families living with a mentally ill relative. These studies have pointed out the importance of a progressive mental health service, focusing not only on the treatment of the patients, but also on the needs of the relatives. The aims of the present study were to compare the quality of life of parents of outpatients with schizophrenia with a randomly selected reference group and the relation between quality of life and burden on the parents.

    Subjects

    The sample comprised all parents (n=38) of outpatients with schizophrenia at an outpatient clinic in 2001, where the patients had contact at least once a week with both parents and staff. The parents were compared with a reference group (n=698).

    Methods

    The self-rating scale Quality of Life Index (QLI) was used to assess quality of life in both groups. In the case of the parents, semistructured interviews were supplemented by the data collection to assess the degree of burden with the Burden Assessment Scale (BAS). The outpatients were also interviewed to assess their global function with the Global Assessment of Functioning scale (GAF) and the Clinical Global Impression scale (CGI).

    Results

    The parents were significantly less satisfied with their overall quality of life (p<0.05). There was a correlation between lower overall quality of life and higher perceived burden r=0.58 (p<0.01). There was also a correlation between lower values on the family subscale and social subscale within the QLI and higher subjective burden r=0.54 (p<0.01) and r=0.52 (p<0.01), respectively.

    Conclusion

    These results indicate that caregiving has an influence on the family situation and on the quality of life of parents. These findings suggest that the professions working with the parents must have an approach focusing not only on the care given to the ill daughter or son, but also on the parents’ situation.

  • 39.
    Foldemo, Anniqa
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Gustafsson, Lars-Åke
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Bogren, Lennart
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Between hope and worry: a phenomenological study of parents of outpatients with schizophreniaManuscript (preprint) (Other academic)
    Abstract [en]

    Background: In recent decades, most of the care for the severely mentally ill has shifted from hospital care to care in the community. In the community, the families' responsibilities for care and support has increased. The objectives of the present study were to describe the experiences and strategies when being a parent of an outpatient with schizophrenia. Two researchers interviewed eight parents of outpatients with schizophrenia. A phenomenological perspective guided the study and the analysis was performed in accordance with the Empirical Phenomenological Psychological Method (EPP). Four themes created the meaniog of liviog with a mentally ill child. These themes were: emotions in parenthood, change in the families, interaction with others and adaptation to the illness

    The results have been interpreted and discussed io the light of the first onset of the ilioess, loss and grief and the creation of meaning and hope.

    Conclusion: these results suggest that atl the parents in the present study experienced a loss of their former child, underwent a grief process, needed to interact with others and used emotionally focused coping strategies.

  • 40.
    Funkesson, Kajsa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Äldre - vård - civilsamhälle (ÄVC) .
    Anbäcken, Els-Marie
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Äldre - vård - civilsamhälle (ÄVC) .
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study2007In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 7, p. 1109-1119Article in journal (Refereed)
    Abstract [en]

    Background: Nurses' clinical reasoning is of great importance for the delivery of safe and efficient care. Pressure ulcer prevention allows a variety of aspects within nursing to be viewed. Objective: The aim of this study was to describe both the process and the content of nurses' reasoning during care planning at different nursing homes, using pressure ulcer prevention as an example. Design: A qualitative research design was chosen. Settings: Seven different nursing homes within one community were included. Participants: Eleven registered nurses were interviewed. Method: The methods used were think-aloud technique, protocol analysis and qualitative content analysis. Client simulation illustrating transition was used. The case used for care planning was in three parts covering the transition from hospital until 3 weeks in the nursing home. Result: Most nurses in this study conducted direct and indirect reasoning in a wide range of areas in connection with pressure ulcer prevention. The reasoning focused different parts of the nursing process depending on part of the case. Complex assertations as well as strategies aiming to reduce cognitive strain were rare. Nurses involved in direct nursing care held a broader reasoning than consultant nurses. Both explanations and actions based on older ideas and traditions occurred. Conclusions: Reasoning concerning pressure ulcer prevention while care planning was dominated by routine thinking. Knowing the person over a period of time made a more complex reasoning possible. The nurses' experience, knowledge together with how close to the elderly the nurses work seem to be important factors that affect the content of reasoning. © 2006 Elsevier Ltd. All rights reserved.

  • 41.
    Fägerskiöld, Astrid
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Expectations of the child health nurse in Sweden: two perspectives2003In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 50, no 2, p. 119-128Article in journal (Refereed)
    Abstract [en]

    Background: the child health service exists to support and stimulate parents in order to reduce stress and to encourage an advantageous development of the preschool child.

    Aim: To explore and describe similarities and differences in expectations of the child health nurse, from the perspective of the recently delivered first-time mother, as compared to an expression of what the child health nurse believed mothers of infants expected of them. The data consisted of 15 interviews with child health nurses and 20 interviews with first-time mothers. Thematic content analysis resulted in seven categories of expectations. The child health nurse was expected to be someone to approach, who could assess the child's development and give immunizations and to be a supporter, counsellor, safety provider and a parent group organizer with knowledge. Similarities between the mothers’ and the nurses’ statements occurred more frequently than differences, which is suggested to depend on the Swedish tradition among new mothers of visiting the child health clinic. The mothers expected participation in parent groups to a higher degree than the nurses thought they did. Child health nurses who fulfil the mothers’ expectations appear to require a good relationship with the mother in order to find out what she desires, which the allocation of sufficient time for regular meetings, will facilitate. Moreover, the nurse requires knowledge about children's requirements and the transition to motherhood as well as the father's important role.

  • 42.
    Fägerskiöld, Astrid M.
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wahlberg, Vivian
    The Nordic School of Public Health, Gothenburg, Sweden.
    Ek, Anna-Christina
    The Nordic School of Public Health, Gothenburg, Sweden.
    Maternal expectations of the child health nurse2001In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 3, no 3, p. 139-147Article in journal (Refereed)
    Abstract [en]

    The main aim of this study was to identify what first-time mothers in Sweden expected of Child Health Nurses. A further aim was to investigate what help and support was received by the new mothers and whether they felt that anything was missing. Twenty new mothers were interviewed according to grounded theory and the data were analyzed by the constant comparative method. It was found that first-time mothers expected Child Health Nurses to have faith in a new mother's own strength and to be accessible, approachable and knowledgeable, providing advice and support. New mothers indicated that they had experienced most of these characteristics, especially accessibility and approachability, but some felt that there were deficiencies (e.g. a lack of continued interest in their own bodies and health, as well as a lack of support when they ceased to breast-feed). The Child Health Service was taken for granted by new mothers. First-time mothers indicated that they appreciated the service, particularly those mothers who did not have a good social network. However, some of the new mothers expressed negative feelings regarding the Child Health Service provided.

  • 43.
    Fägerskiöld, Astrid M.
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wahlberg, Vivian
    The Nordic School of Public Health, Gothenburg. Sweden .
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    What child health nurses believe mothers with infants expect of them2000In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 2, no 2, p. 83-91Article in journal (Refereed)
    Abstract [en]

    The aims were to identify what the child health nurse believed was expected of her by women who had recently become mothers, primipara and multipara, to investigate which problems the nurse found most difficult to deal with and to analyse why they were difficult. The grounded theory method was employed for conducting interviews with 15 nurses. The data analysis showed that the nurses thought mothers expected care of the infant and the family from the nurse, comprising support, advice and child health assessments. What the nurses found most difficult to deal with were obstacles to interaction with mothers such as motherhood problems, hidden, social and organisational problems. They wanted to have a positive interaction with mothers to be able to fulfil the task of supporting parents and identifying risks to the child's healthy upbringing. This task places great demands on nurses' competence and knowledge about the child and family.

  • 44.
    Fägerskiöld, Astrid
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    The view of the child health nurse among mothers2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 2, p. 160-168Article in journal (Refereed)
    Abstract [en]

    The aim of this exploratory study was to investigate mothers' experiences of their encounters with the child health (CH) nurse. A cross-sectional design was used for the study, based on data from 140 mothers gathered by the critical incident technique. The analysis was accomplished by a thematic content analysis, using inductive reasoning in three steps. Symbolic interactionism was used as a frame of reference. The results suggest that the central factor in the encounter between mother and nurse is that they are able to share the realm of motherhood, meaning that the nurse is open and willing to share all types of emotions, experiences and attitudes related to being a mother. Given this basis, other important factors are the supply of sound advice and practical interventions, and that the nurse is reassuring and accessible. The majority of the participating mothers had experienced CH nurses who had provided them with valuable support during troublesome incidents. However, there were also several dissatisfied mothers who had expected support but thought they received insulting treatment instead. The mothers and the nurses have varying experiences and background and therefore different perspectives, which may lead to difficulties in understanding each other. Knowledge about the important factors, that affect the mother–nurse encounter, can be used to strengthen the nurses' positive behaviours and facilitate understanding of how disappointed mothers have experienced their health care encounters.

  • 45.
    Galan Perroca, Marcia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Assessing patient's care requirements: A comparison of instruments2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 390-396Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to compare two patient classification instruments developed in different countries, Perroca's (Brazil) and the Beakta (Sweden) systems and to investigate if both instruments equally assess patients' care requirements. The survey sample comprised 85 patients from a university hospital in southeast Sweden. Statistical analysis used Spearman's correlation and Kappa. The Spearman's correlation coefficient for total scores and classifications were 0.83 and 0.80, respectively (P-value < 0.01). The level of agreement between the instruments related to the different care categories pointed to an overall kw of 0.60 (95% CI: 0.50-0.71). The findings indicate a high degree of association between the total scores and patient classification assessment using the Beakta and Perroca systems and also a moderate level of agreement between the two instruments in the different care categories. There are few surveys that compare classification instruments between countries making it difficult to know to what extent cultural differences influence measurement approaches. © 2007 Nordic College of Caring Science.

  • 46.
    Galan Perroca, Marcia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Home Care Avancado na Suecia: uma Breve Descricao2003In: HB científica, ISSN 1414-6142, Vol. 10, p. 103-110Article in journal (Refereed)
  • 47.
    Galan Perroca, Marcia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Swedish advanced home care: organizational structure and implications of adopting this care model in Brazilian health care system2004In: Revista latino-americana de enfermagem, ISSN 0104-1169, Vol. 12, p. 851-858Article in journal (Refereed)
  • 48.
    Galan Perroca, Marcia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff2007In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, no 5, p. 472-480Article in journal (Refereed)
    Abstract [en]

    Background Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. Aim This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. Method A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. Results and conclusion The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.

  • 49.
    Gullberg, Mats T.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hollman-Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Reference values for the Quality of Life Index in the general  Swedish population 18-80 years of age2010In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 19, no 5, p. 751-760Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim in the present study was to establish underlying dimensions of quality of life in Sweden, measured by QLI, and to obtain reference values among a representative sample between 18 and 80 years of age from the general Swedish population. METHOD: A total of 1,680 randomly selected persons completed the questionnaire (57% response rate). All data were coded and entered into the statistical software. Factor analysis, maximum-likelihood method with oblique rotation, was employed to explore and reveal underlying dimensions of the QLI. To describe QLI total and subscale reference values for different age groups and men and women, respectively, means and 95% CI as well as medians and quartiles were used. For comparisons related to demographic and background variables, parametric and non-parametric analyses were used (alpha=0.01). All data were analysed using SPSS 14.0 statistical software. RESULTS: Four underlying dimensions emerged: Family and friends, Health and functioning, Social and economic and Psychological/spiritual. Mean values for the total QLI and the four subscales ranged between 17.2 and 23.7 (possible range=0.0-30.0). CONCLUSIONS: The overall QLI and subscale scores correspond with those presented by other researchers. Population-based measures of generic quality of life and underlying dimensions are important considering the gain when results from specific patient groups are viewed.

  • 50.
    Hagblad, J.
    et al.
    Mälardalen University.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Kaisdotter Andersson, A.
    Mälardalen University.
    Bergstrand, Sara
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Folke, M.
    Mälardalen University.
    Linden, M.
    Mälardalen University.
    A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths2010In: Medical and Biological Engineering and Computing, ISSN 0140-0118, Vol. 48, no 5, p. 415-422Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to validate a non-invasive optical probe for simultaneous blood flow measurement at different vascular depths combining three photoplethysmography (PPG) channels and laser Doppler flowmeter (LDF). Wavelengths of the PPG were near-infrared 810 nm with source-to-detector separation of 10 and 25 mm, and green 560 nm with source-to-detector separation of 4 mm. The probe is intended for clinical studies of pressure ulcer aetiology. The probe was placed over the trapezius muscle, and depths from the skin to the trapezius muscle were measured using ultrasound and varied between 3.8 and 23 mm in the 11 subjects included. A provocation procedure inducing a local enhancement of blood flow in the trapezius muscle was used. Blood flows at rest and post-exercise were compared. It can be concluded that this probe is useful as a tool for discriminating between blood flows at different vascular tissue depths. The vascular depths reached for the different channels in this study were at least 23 mm for the near-infrared PPG channel (source-to-detector separation 25 mm), 10-15 mm for the near-infrared PPG channel (separation 10 mm), and shallower than 4 mm for both the green PPG channel (separation 4 mm) and LDF.

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