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  • 201.
    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.

  • 202.
    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.

  • 203.
    Flemme, I
    et al.
    Högskolan i Halmstad.
    Hallberg, U
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Living with uncertainty - main concern for recipients of implantable cardioverter defibrillator - a qualitative study.2010Conference paper (Refereed)
  • 204.
    Flemme, I
    et al.
    Högskolan i Halmstad.
    Johansson, I
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator2010Conference paper (Refereed)
  • 205. Order onlineBuy this publication >>
    Flemme, Inger
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.

    The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).

    The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

    The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.

    In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

    List of papers
    1. Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study
    Open this publication in new window or tab >>Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study
    Show others...
    2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, p. 563-572Article in journal (Refereed) Published
    Abstract [en]

    • The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study.

    •  Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time.

    • Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001).

    • Satisfaction increased within the domains health-functioning, socio-economic, psychological–spiritual, and family.

    • The ability to act within the domain health-functioning showed a statistical significance (P < 0.05).

    • The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05).

    • The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation.

    •  The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients’ life situations as well as more education in teaching skills for health care personnel.

    Keywords
    Implantable cardioverter defibrillator, patient experiences, uncertainty, information, satisfaction
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18520 (URN)10.1046/j.1365-2702.2001.00494.x (DOI)000169890600020 ()11822504 (PubMedID)
    Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2017-12-13Bibliographically approved
    2. Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator
    Open this publication in new window or tab >>Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator
    Show others...
    2005 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 34, no 6, p. 386-392Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up.

    METHODS: Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale.

    RESULTS: The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL.

    CONCLUSION: QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18521 (URN)10.1016/j.hrtlng.2005.05.003 (DOI)16324957 (PubMedID)
    Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2017-12-13Bibliographically approved
    3. "Striving to resume command" - main concern for recipients of implantable cardioverter defibrillator
    Open this publication in new window or tab >>"Striving to resume command" - main concern for recipients of implantable cardioverter defibrillator
    2009 (English)Article in journal (Other academic) Submitted
    Abstract [en]

    Background: Earlier studies have shown that individuals with implantable cardioverter defibrillator (ICD) experience fear, stress, anxiety, and depression in their daily life, but also feelings of gratitude, safety, and belief in the future. Uncertainty and restrictions in physical, psychological and social functioning are common responses to their experiences. Aim: The aim of the study was to illuminate the main concern of individuals living with an ICD and how they handle this in their daily life.

    Method: Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed during 2007. Data was collected and analyzed in a simultaneous process according to guidelines for classical grounded theory.

    Results: In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command” illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

    Conclusions: Based on empirical data, a substantive theory was generated illuminating the main concern for ICD recipients and strategies they used to manage this in daily life. The theory deepens the understanding of the recipients´ striving to resume command over their lives in an ongoing adjustment process which they have to face. This knowledge has clinical relevance and suggests that nurses should support the ICD recipients in this respect and thereby contribute to optimizing their sense of control in daily life. Future research could focus on the role of family members of ICD recipients and in what way they can support rather than overprotect their closely related.

    Keywords
    Defibrillators, implantable, heart diseases, nursing, qualitative research, quality of life
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18522 (URN)
    Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-03Bibliographically approved
    4. Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator
    Open this publication in new window or tab >>Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator
    2009 (English)Article in journal (Other academic) Submitted
    Abstract [en]

    Objectives: To explore relationships between quality of life (QOL), coping strategies, anxiety, depression and perceived control in recipients living with an implantable cardioverter defibrillator (ICD) and compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication.

    Methods: A cross-sectional, correlational design was used, and 147 individuals (mean age 63 years, 121 men) who had lived with an ICD between 6 to 24 months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale.

    Results: Anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of the use of coping strategies with optimism being the most used coping strategy. No relationship was found between QOL and the use of different coping strategies. No differences were found in QOL, coping, anxiety, depression and perceived control between ICD recipients having the device less or more than one year and treated either on a primary or secondary preventive indication.

    Conclusions: Recipients with an ICD did not use a multitude of coping strategies, but anxiety increased the use of coping. Perceived control was the most influential predictor of QOL. Practice implications: Supportive long term follow up interventions should be tailored to the recipients that have problems adapting to the device and perceive poor control in everyday life and a decreased psychological well-being.

    Keywords
    Anxiety, arrhythmia, defibrillators, depression, perceived control, quality of life
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18523 (URN)
    Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-12Bibliographically approved
    Download full text (pdf)
    Living with life-saving technology
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  • 206.
    Flemme, Inger
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bolse, Kärstin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ivarsson, Anita
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Jinhage, Britt-Marie
    Sahlgrenska University Hospital, Goöteborg, Sweden.
    Sandstedt, Bengt
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Edvardsson, Nils
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Fridlund, Bengt
    School of Social & Health Sciences, Halmstad University, Halmstad, Sweden.
    Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, p. 563-572Article in journal (Refereed)
    Abstract [en]

    • The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study.

    •  Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time.

    • Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001).

    • Satisfaction increased within the domains health-functioning, socio-economic, psychological–spiritual, and family.

    • The ability to act within the domain health-functioning showed a statistical significance (P < 0.05).

    • The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05).

    • The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation.

    •  The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients’ life situations as well as more education in teaching skills for health care personnel.

  • 207.
    Flemme, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Edvardsson, Nils
    Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Hinic, Hansi
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Jinhage, Britt-Marie
    Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Dalman, Margareta
    Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Fridlund, Bengt
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;Department of Health Sciences, Lund University, Lund, Sweden.
    Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator2005In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 34, no 6, p. 386-392Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up.

    METHODS: Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale.

    RESULTS: The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL.

    CONCLUSION: QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

  • 208.
    Flemme, Inger
    et al.
    Halmstad University.
    Hallberg, Ulrika
    Nordic School of Public Health, Gothenburg.
    Johansson, Ingela
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Uncertainty is a major concern for patients with implantable cardioverter defibrillators2011In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 40, no 5, p. 420-428Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The study objective was to explore the main concern of individuals living with an implantable cardioverter defibrillator (ICD) and how they handle this in daily life. For improved management and follow-up, it is important to understand how the ICD affects the recipients daily life. METHODS: A grounded theory method was used. Sixteen Swedish recipients (9 men) living with an ICD for 6 to 24 months were interviewed. RESULTS: The core category labeled, "Incorporating uncertainty in daily life," illuminates the main concern. To handle uncertainty, recipients used the following strategies: restricting activities, distracting oneself, accepting being an ICD recipient, and reevaluating life. CONCLUSION: Recipients were not paralyzed by uncertainty. Instead, they incorporated uncertainty in life by using strategies to handle their daily life. Questions, comments, and plans for supportive communication were provided, which can be used by healthcare professionals in cardiac rehabilitation.

  • 209.
    Flemme, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hallberg, Ulrika
    Nordic School of Public Health, Göteborg, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    "Striving to resume command" - main concern for recipients of implantable cardioverter defibrillator2009Article in journal (Other academic)
    Abstract [en]

    Background: Earlier studies have shown that individuals with implantable cardioverter defibrillator (ICD) experience fear, stress, anxiety, and depression in their daily life, but also feelings of gratitude, safety, and belief in the future. Uncertainty and restrictions in physical, psychological and social functioning are common responses to their experiences. Aim: The aim of the study was to illuminate the main concern of individuals living with an ICD and how they handle this in their daily life.

    Method: Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed during 2007. Data was collected and analyzed in a simultaneous process according to guidelines for classical grounded theory.

    Results: In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command” illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

    Conclusions: Based on empirical data, a substantive theory was generated illuminating the main concern for ICD recipients and strategies they used to manage this in daily life. The theory deepens the understanding of the recipients´ striving to resume command over their lives in an ongoing adjustment process which they have to face. This knowledge has clinical relevance and suggests that nurses should support the ICD recipients in this respect and thereby contribute to optimizing their sense of control in daily life. Future research could focus on the role of family members of ICD recipients and in what way they can support rather than overprotect their closely related.

  • 210.
    Flemme, Inger
    et al.
    Halmstad University.
    Johansson, Ingela
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 311-321Article in journal (Refereed)
    Abstract [en]

    Aims.  To describe coping strategies and coping effectiveness in recipients with an implantable cardioverter defibrillator and to explore factors influencing coping.

    Background.  Implantable cardioverter defibrillators are documented as saving lives and are used to treat ventricular tachycardia and ventricular fibrillation. Despite the implantable cardioverter defibrillator not evidently interfering with everyday life, there is conflicting evidence regarding the psychosocial impact of an implantable cardioverter defibrillator implantation such as anxiety, depression, perceived control and quality of life and how these concerns may relate to coping.

    Design.  Cross-sectional multicentre design.

    Methods.  Individuals (n = 147, mean age 63 years, 121 men) who had lived with an implantable cardioverter defibrillator between 6–24 months completed the Jalowiec Coping Scale-60, Hospital Anxiety and Depression Scale, Control Attitude Scale and Quality of Life Index-Cardiac version.

    Results.  Implantable cardioverter defibrillators recipients seldom used coping strategies, and the coping strategies used were perceived as fairly helpful. Optimism was found to be the most frequently used (1·8 SD 0·68) and most effective (2·1 SD 0·48) coping strategy, and recipients perceived moderate control in life. Anxiety (β = 3·5, p ≤ 0·001) and gender (β = 12·3, p = 0·046) accounted for 26% of the variance in the total use of coping strategies, suggesting that the more symptoms of anxiety and being women the greater use of coping strategies.

    Conclusions.  Most recipients with an implantable cardioverter defibrillator did not appraise daily concerns as stressors in need of coping and seem to have made a successful transition in getting on with their lives 6–24 months after implantation.

    Relevance to clinical practice.  Nurses working with recipients with an implantable cardioverter defibrillator should have a supportive communication so that positive outcomes such as decreased anxiety and increased perceived control and quality of life can be obtained. Through screening for anxiety at follow-up in the outpatient clinic, these recipients perceiving mental strain in their daily life can be identified.

  • 211.
    Flemme, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Ingela
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator2009Article in journal (Other academic)
    Abstract [en]

    Objectives: To explore relationships between quality of life (QOL), coping strategies, anxiety, depression and perceived control in recipients living with an implantable cardioverter defibrillator (ICD) and compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication.

    Methods: A cross-sectional, correlational design was used, and 147 individuals (mean age 63 years, 121 men) who had lived with an ICD between 6 to 24 months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale.

    Results: Anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of the use of coping strategies with optimism being the most used coping strategy. No relationship was found between QOL and the use of different coping strategies. No differences were found in QOL, coping, anxiety, depression and perceived control between ICD recipients having the device less or more than one year and treated either on a primary or secondary preventive indication.

    Conclusions: Recipients with an ICD did not use a multitude of coping strategies, but anxiety increased the use of coping. Perceived control was the most influential predictor of QOL. Practice implications: Supportive long term follow up interventions should be tailored to the recipients that have problems adapting to the device and perceive poor control in everyday life and a decreased psychological well-being.

  • 212.
    Flemme, Inger
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Ingela
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Quality of life and coping strategies in recipients with an implantablecardioverter defibrillator2010In: 10th Annual Spring Meeting on Cardiovascular Nursing / European Journal of Cardiovascular Nursing 9 Suppl. 1 (2010), 2010Conference paper (Other academic)
  • 213.
    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.

  • 214.
    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.

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  • 215.
    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.

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  • 216.
    Fluur, Christina
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Bolse, Kärstin
    Halmstad University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Patients' experiences of the implantable cardioverter defibrillator (ICD); with a focus on battery replacement and end-of-life issues2013In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 42, no 3, p. 202-207Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    ICD deactivation at end-of-life is technically uncomplicated. However, it may present a psychological challenge to healthcare professionals, patients, and next-of-kin.

    OBJECTIVE:

    This study explored patients' experiences of complex issues of battery replacement and deactivation of the ICD.

    METHODS:

    Semistructured interviews were administered to 37 medically stable ICD-recipients.

    RESULTS:

    The ICD-recipients lived with an uncertain illness trajectory, but the majority had not reflected on battery replacement or elective ICD deactivation. Healthcare professionals had rarely discussed these issues with patients. However, this was consistent with the ICD-recipients' wishes. Many patients had misconceptions about the lifesaving capacity of the ICD and the majority stated that they would not choose to deactivate the ICD, even if they knew they were terminally ill, and it meant they would receive multiple shocks.

    CONCLUSION:

    The ICD-recipients tended not to think about end-of-life issues, which imply that many patients reach the final stages of life unaware of the option of ICD deactivation.

  • 217.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mötet med individer med psykisk ohälsa i olika öppenvårdsformer2010In: Omvårdnad vid psykisk ohälsa / [ed] Skärsäter, I., Studentlitteratur , 2010, p. 483-Chapter in book (Other academic)
    Abstract [sv]

    Omvårdnad vid psykisk ohälsa - på grundläggande nivå presenterar översiktlig kunskap om psykisk ohälsa, psykiatriska sjukdomar och individers problematik rörande psykisk ohälsa. Den första delen fokuserar på de mest förekommande ohälsoproblemen inom psykiatrisk vård. Bokens senare del belyser viktiga områden som har betydelse för hur vården kring patienten kan förstås och hanteras, såsom vårdens miljö och organisation, attityder kring psykiska dilemman, närståendes medverkan och kvalitets arbete inom psykiatrisk vård. I bokens fokus står den unge, den vuxna och den äldre individen och dennes problematik. Utgångspunkten är ett omvårdnadsperspektiv med hänvisningar till omgivande områden såsom medicin, sociologi, farmakologi och psykologi. Det genomgående perspektivet är omvårdnad vid psykisk ohälsa även om de konkreta åtgärder som beskrivs också kan inspirera och vägleda andra professioner i deras hälsoarbetare.  Boken vänder sig främst till studenter i grundutbildningen till sjuksköterska, men den kan också med fördel användas inom utbildningar med inriktning mot folkhälsa och av kliniskt verksamma sjuksköterskor inom kommunal, primär- eller specialistvård.  Boken innehåller en individuell aktiveringskod som ger tillgång till ett pedagogiskt webbkomplement. För att säkerställa att du som köpare får den unika koden säljs boken inplastad.

  • 218.
    Foldemo, Anniqa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
    Wärdig, Rikard
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Holmberg, Tommy
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Valter, L
    Östergötlands Läns Landsting.
    Osby, U
    Danderyd Stockholm.
    QUALITY OF LIFE IN METABOLIC RISK PATIENTS WITH PSYCHOSIS IN RELATION TO THE POPULATION in SCHIZOPHRENIA BULLETIN, vol 37, issue , pp 264-2642011In: SCHIZOPHRENIA BULLETIN, Oxford University Press , 2011, Vol. 37, p. 264-264Conference paper (Refereed)
    Abstract [en]

    n/a

  • 219.
    Franzén Årestedt, Kristofer
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Andreae, Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Initial psychometric evaluation of the council of nutrition apetite queestionnaire (QNAC)2012Conference paper (Other academic)
  • 220.
    Franzén Årestedt, Kristofer
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, Anders
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Design and methodology of the NutriHeart study: an interdisciplinary approach to investigate nutrition and cardiac cachexia in patients with chronic heart failure.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Conference paper (Refereed)
  • 221.
    Franzén Årestedt, Kristofer
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flemme, Inger
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Psychometric properties of the Swedish version of the Control Attitude Sclae for patients with heart disease and their family members2010Conference paper (Refereed)
  • 222.
    Fredrikson, M
    et al.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Hursti, T J
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Steineck, G
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Fürst, C J
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Peterson, C
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Delayed chemotherapy-induced nausea is augmented by high levels of endogenous noradrenaline.1994In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 70, no 4, p. 642-645Article in journal (Refereed)
    Abstract [en]

    The relation between pretreatment night-time urinary catecholamine excretion and chemotherapy-induced nausea and vomiting was studied. The first cohort included 17 women and three men with various cancer forms receiving low or moderately emetogenic chemotherapy. The second cohort included 42 women receiving cisplatinum (50 mg m-2) for ovarian cancer and ondansetron as an antiemetic (8 mg i.v. x 3 at chemotherapy and 8 mg p.o. x 3 for 5 days). Relatively higher noradrenaline, but not adrenaline, excretion was associated with an increased intensity of delayed nausea following treatment. Vomiting was not consistently related to the excretion of either catecholamine. The results indicate that noradrenaline modulates delayed nausea resulting from chemotherapy.

  • 223. Fridell, K
    et al.
    Hollman Frisman, G
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Patienters upplevelse och behov av stöd av dietist vid nyupptäckt celiaki2010In: Dietistaktuellt, Vol. 19, no 4, p. 24-26Article in journal (Other (popular science, discussion, etc.))
  • 224.
    Fridlund, B
    et al.
    Högskolan i Halmstad.
    Lindgren, E.-C
    Högskolan i Halmstad.
    Ivarsson, A
    Sahlgrenska Universitetssjukhuset.
    Jinhage, B.-M
    Sahlgrenska Universitetssjukhuset.
    Bolse, Kärstin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flemme, Inger
    Högskolan i Halmstad.
    Sandstedt, B
    Sahlgrenska Universitetssjukhuset.
    Mårtensson, J
    Högskolan i Halmstad.
    Patients with implantable cardioverter-defibrillators and their conceptions of the life situation: a qualitative analysis2000In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 9, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    • The implantable cardioverter-defibrillator (ICD) is today widely used for the treatment of sudden cardiac near-death episodes as a result of malignant ventricular dysrhythmia.

    • After examining the literature, only four descriptive studies, all carried out in the USA, with a qualitative analysis based on ICD-patients’ own perspectives on their life situation have been found.

    •  The aim of this study was to describe how patients living with an ICD-device in south-western Sweden conceive their life situation.

    •  As the focus was on patients’ conceptions seen from a holistic perspective, an analysis inspired by phenomenography was employed on a strategic sample of 15 ICD-patients.

    • Six categories emerged: a feeling of safety, a feeling of gratitude, a feeling of being, having a network, having a belief in the future, and gaining awareness.

    • Although the findings cannot be generalized because of the descriptive research design, they illuminate the beneficial as well as intrusive effects of such a device, and emphasize the need for support groups for patients and families as well as further education for personnel in hospital and primary health care.

  • 225. Order onlineBuy this publication >>
    Frödin, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Health-related quality of life during and after stem cell transplantation2013Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Hematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant diseases, as well as a small proportion of non-malignant disorders. The treatment before the HSCT (called conditioning) can be either myeloablative (MAC) or given with reduced intensity (RIC). MAC is associated with high toxicity due to high doses of chemotherapy with or without total body irradiation (TBI), and is used in both autologous and allogeneic HSCT. In autologous HSCT the patient is the donor, and in allogeneic HSCT the donor is a sibling or an unrelated donor. RIC regimens are associated with reduced toxicity and are only for patients undergoing allogeneic HSCT. Both autologous and allogeneic HSCT have a strong effect on the patients’ health-related quality of life (HRQL). The two studies in this thesis were initiated when RIC was introduced at a hematological department in south-east Sweden in 2001. The overall purpose was to evaluate HRQL in patients undergoing HSCT. The studies covered the whole inpatient period and the following three years in order to have a comprehensive assessment of the patients’ HRQL over time. HRQL was assessed 13 times from baseline up to three years after HSCT with the instrument EORTC QLQ-C-30. The instrument consists of 30 items divided into three major domains: functional status, symptom status, and global health/QoL. Almost all functional scales, global health status/QoL, symptom scales and single items were significantly affected in the two studies during the first two to three weeks from baseline. The symptoms that patients estimated to be the most severe in the studies were nausea and vomiting, loss of appetite, fatigue, and diarrhea. Two months after HSCT nearly all functional scales, global health status/QoL, symptom scales and single items in Study I had returned to the same value as at baseline in patients undergoing autologous HSCT. It took up to two years for patients undergoing allogeneic HSCT in Study II to return to the same value as at baseline. For patients in Study I, role-, emotional-, and social function, fatigue and dyspnea had significantly improved at the 3-year follow-up compared to baseline, whereas role function was the only function that had improved in Study II. Patients with lymphoma in Study I experienced significantly worse HRQL in week 2 and appetite loss at month 2 than patients with multiple myeloma (MM). Patients treated with MAC in Study II had significantly worse fatigue and nausea and vomiting at baseline and pain, sleep disturbance, appetite loss and diarrhea at weeks 3 and 4 than patients treated with RIC. Patients with extensive chronic Graft versus Host Disease (GvHD) in Study II reported significantly impaired physical function, role function, and global health status/QoL than patients with limited or no chronic GvHD. These results provide a good overview of patients’ symptoms and HRQL during and after HSCT and indicate when they require increased support from healthcare professionals. The results also demonstrate the importance of close follow-ups during the first year after HSCT in order to improve preventive interventions. The quick recovery of patients in Study I suggests that the extensive treatment is well tolerated.

    List of papers
    1. A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up
    Open this publication in new window or tab >>A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up
    2011 (English)In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 46, no 10, p. 1345-1352Article in journal (Refereed) Published
    Abstract [en]

    Few studies have evaluated long-term health-related quality of life (HRQL) in patients during auto-SCT. This prospective study examined HRQL in 96 eligible patients before, during and up to 3 years after auto-SCT. The aim of the study was to make a comprehensive assessment of the frequency and severity of different symptoms in patients undergoing auto-SCT. The European Organization for Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) was administered 13 times. The second week during treatment was the period when patients had the lowest HRQL regarding both total quality of life and function and symptom scales. The patients recovered quickly and just two months after transplantation the baseline values were restored. Three years after transplantation most of the items in the questionnaire had stabilized, except role function and dyspnea, which had improved. There were significant differences between multiple myeloma (MM) and lymphoma patients’ physical function, quality of life, fatigue and pain during week 2. At the 3-year follow-up, lymphoma patients indicated a better HRQL than MM patients. The quick recovery of patients after transplantation suggests that treatment is well tolerated; however, the supportive care could be improved at week 2, especially for the lymphoma patients.

    Place, publisher, year, edition, pages
    Nature Publishing Group, 2011
    Keywords
    auto-SCT, health-related quality of life, multiple myeloma, lymphoma, symptoms
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-63193 (URN)10.1038/bmt.2010.304 (DOI)000296279000010 ()
    Note
    Funding agencies|County Council of Ostergotland||Lund University Hospital||Available from: 2010-12-13 Created: 2010-12-13 Last updated: 2017-12-11
    2. Early and Long-Term Follow-Up of Health-Related Quality of Life Following Allogeneic Hematopoietic Stem-Cell Transplantation
    Open this publication in new window or tab >>Early and Long-Term Follow-Up of Health-Related Quality of Life Following Allogeneic Hematopoietic Stem-Cell Transplantation
    Show others...
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Health-related quality of life (HRQL) of 94 consecutive patients undergoing allogeneic stem cell transplantation (SCT) with myeloablative conditioning (MAC, n = 18) or reduced intensity conditioning (RIC, n = 76) was evaluated using the EORTC QLQ C-30 questionnaire at baseline and 12 times up to 3 years after SCT. Functional status and the global quality of life decreased from baseline to weeks 2 and 3, especially role and social functions. Symptoms increased significantly during the first three weeks, particularly appetite loss, nausea and vomiting, diarrhea, and fatigue. It took at least one year for HRQL to return to the baseline level. The only function that improved significantly three years after SCT was role function. MAC patients experienced worse HRQL at baseline than RIC patients, and subsequently more pain, sleep disturbance, and appetite loss in weeks 3 and 4. Patients with extensive chronic graft-versus-host disease (GvHD) experienced reduced HRQL. These results provide a good overview of patients’ symptoms and HRQL during and after SCT and indicate when they require increased support. The results also demonstrate the importance of close follow-ups during the first year after SCT in order to improve the preventive interventions, particularly regarding appetite loss and chronic GvHD.

    Keywords
    auto-SCT, health-related quality of life, multiple myeloma, lymphoma, symptoms
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-92805 (URN)
    Available from: 2013-05-22 Created: 2013-05-22 Last updated: 2013-09-03Bibliographically approved
    Download full text (pdf)
    Health-related quality of life during and after stem cell transplantation
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  • 226.
    Frödin, Ulla
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Lyth, Johan
    Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Lotfi, Kourosh
    Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pharmacology.
    A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up2011In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 46, no 10, p. 1345-1352Article in journal (Refereed)
    Abstract [en]

    Few studies have evaluated long-term health-related quality of life (HRQL) in patients during auto-SCT. This prospective study examined HRQL in 96 eligible patients before, during and up to 3 years after auto-SCT. The aim of the study was to make a comprehensive assessment of the frequency and severity of different symptoms in patients undergoing auto-SCT. The European Organization for Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) was administered 13 times. The second week during treatment was the period when patients had the lowest HRQL regarding both total quality of life and function and symptom scales. The patients recovered quickly and just two months after transplantation the baseline values were restored. Three years after transplantation most of the items in the questionnaire had stabilized, except role function and dyspnea, which had improved. There were significant differences between multiple myeloma (MM) and lymphoma patients’ physical function, quality of life, fatigue and pain during week 2. At the 3-year follow-up, lymphoma patients indicated a better HRQL than MM patients. The quick recovery of patients after transplantation suggests that treatment is well tolerated; however, the supportive care could be improved at week 2, especially for the lymphoma patients.

  • 227.
    Frödin, Ulla
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lotfi, Kourosh
    Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pharmacology.
    Fomichov, Victoria
    Östergötlands Läns Landsting, Centre for Health and Developmental Care, Regional Cancer Centre.
    Juliusson, Gunnar
    Department of Hematology and Coagulation, Skåne County Council, Stem Cell Center, Lund University, Lund, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Early and Long-Term Follow-Up of Health-Related Quality of Life Following Allogeneic Hematopoietic Stem-Cell Transplantation2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Health-related quality of life (HRQL) of 94 consecutive patients undergoing allogeneic stem cell transplantation (SCT) with myeloablative conditioning (MAC, n = 18) or reduced intensity conditioning (RIC, n = 76) was evaluated using the EORTC QLQ C-30 questionnaire at baseline and 12 times up to 3 years after SCT. Functional status and the global quality of life decreased from baseline to weeks 2 and 3, especially role and social functions. Symptoms increased significantly during the first three weeks, particularly appetite loss, nausea and vomiting, diarrhea, and fatigue. It took at least one year for HRQL to return to the baseline level. The only function that improved significantly three years after SCT was role function. MAC patients experienced worse HRQL at baseline than RIC patients, and subsequently more pain, sleep disturbance, and appetite loss in weeks 3 and 4. Patients with extensive chronic graft-versus-host disease (GvHD) experienced reduced HRQL. These results provide a good overview of patients’ symptoms and HRQL during and after SCT and indicate when they require increased support. The results also demonstrate the importance of close follow-ups during the first year after SCT in order to improve the preventive interventions, particularly regarding appetite loss and chronic GvHD.

  • 228.
    Fägerskiöld, Astrid
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    A change in life as experienced by first-time fathers2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 1, p. 64-71Article in journal (Refereed)
    Abstract [en]

    Research suggests that the attitude of men towards pregnancy, childbirth and child-caring is different from that of women. Up to now, research has focused mainly on motherhood. The aim of this study was to explore first-time fathers’ experiences during early infancy of their children. Grounded theory and constant comparative method were used and 20 fathers aged 20–48 participated. Interviews were carried out in 2002–2003. ‘Changing life’ emerged as the core category consisting of the categories: becoming a father, alternating between work and home, changing relationship towards partner and developing relationship with their child. Changing life implied that they have left bachelor life and become responsible for a child. Becoming a father was much more fantastic than they could have imagined and they suggested that they performed childcare to the same extent as the mother when both parents were at home. Still fathers viewed the mother as the main parent, partly because of their alternating between work and home and because the mothers breast-feed the infants. Fathers’ attitude towards breast-feeding seemed to be ambiguous; it was a matter of necessity, but made them feel insignificant. Changing relationship towards partner was common but it was not necessarily for the worst and often resulted in a more closely united relationship. However, tiredness because of lack of sleep could result in increased irritability towards problems. Developing relationship with their child implied increasing possibilities to learn to know the infant’s signals. Fathers are one of two parents, and hence are important for their child’s growth and development, emotional health and cognitive development. Knowledge about first-time fathers’ experiences during the early infancy of their children may bring about increased support from midwives and child health nurses.

  • 229.
    Fägerskiöld, Astrid
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Att vara en outsider inne i samhället.2009In: Barnveckan, Uppsala, 2009Conference paper (Refereed)
  • 230.
    Fägerskiöld, Astrid
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Daily life from the perspective of disabled children and adolescents.2009In: The 1st International Congress on Nursing Education, Research & Practice, Thessaloniki., 2009Conference paper (Refereed)
  • 231.
    Fägerskiöld, Astrid
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Glad Mattsson, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Disabled children and adolescents may be outsiders in the community2010In: INTERNATIONAL NURSING REVIEW, ISSN 0020-8132, Vol. 57, no 4, p. 470-477Article in journal (Refereed)
    Abstract [en]

    Background: Most children with neurogenic bladder and bowel dysfunctions suffer from myelomeningocele and shunted hydrocephalus. Fewer such births and better treatment have led to more children reaching adulthood. Increased knowledge about their lived experiences can direct support to help them. Aim: The study aims to investigate how children and adolescents aged between 10 and 18 years old with neurogenic bladder and bowel dysfunction live their everyday life. Methods: Hermeneutic phenomenology was appropriate to investigate the participants experiences in depth. Thirteen qualitative interviews were analysed by coding line-by-line in order to find the essence and themes that underpin their responses. Findings: The major theme being an outsider in the community, was built upon the themes, constraint and togetherness. Constraint was caused by their need for regular clean intermittent catheterization, bowel movement, aids and assistance from others, which identified a participant as being an outsider. They were only partially outsiders because they were inside the community and they enjoyed togetherness in their everyday life from their families, peers and other significant people. They appeared to be rather unaware of their problems. Limitations: The wide range of participants ages was a limitation, as these young people develop a great deal between these ages; in order to guarantee confidentiality, the participants were too few to divide into groups. Conclusions: These young people would be helped if supported more towards independence by people inside their circle. Today, support is usually given by personal assistants and by the use of advanced techniques. Less support is given for development towards independence. Competent health-care professionals working together with the parents should have the opportunity to provide such valuable support.

  • 232.
    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.

  • 233.
    Fäldt, Camilla
    et al.
    Trollhättan.
    Hansson, Ann
    Trollhättan.
    Emilsson, Maria
    Högskolan Väst, Trollhättan.
    Sandén, Inger
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Granskning av sjuksköterskors omvårdnadsdokumentation rörande urininkontinens hos äldre personer.2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 4, no 94, p. 20-24Article in journal (Refereed)
  • 234.
    Gimbler Berglund, Ingalill
    et al.
    Omvårdnad, Hälsohögskolan i Jönköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Proczkowska-Björklund, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Omvårdnad, Hälsohögskolan i Jönköping.
    Nurse anaesthetists' experiences with pre-operative anxiety2013In: Nursing Children and Young People, ISSN 2046-2336, Vol. 25, no 1, p. 28-34Article in journal (Refereed)
    Abstract [en]

    AIMS:

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

    METHOD:

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

    FINDINGS:

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

    CONCLUSION:

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

  • 235.
    Grahn Kronhed, Ann-Charlotte
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hallberg, Inger
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ödkvist, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Möller, Margareta
    Centre for Health Care Sciences, Örebro University Hospital.
    Effect of training on health-related quality of life, pain and falls in osteoporotic women2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 154-165Article in journal (Refereed)
    Abstract [en]

    Physical inactivity is a risk factor for osteoporosis and fractures. The aim of the study was to see if supervised training would improve health-related quality of life (HRQL), reduce pain and falls in osteoporotic women. Women with established osteoporosis (n=124) were invited to a 1-year, follow-up study. Seventy-three women aged 60-81 years met the inclusion criteria and were randomized to an exercise (E) or control (C) group. A 4-month, supervised group training programme was designed. Participants were studied using HRQL questionnaires, clinical tests and dynamic posturography. Thirty-one women in the E-group and 34 women in the C-group completed the study. The E-group improved in six SF-36 domains and mental component summary (MCsum) index and also in worst pain intensity (p<0.01) after the supervised exercise training. Differences were found between the groups when comparing changes in four SF-36 domains, MCsum and worst pain (p=0.001). Physical activity level decreased in the E-group after the supervised period. Mean time to first fall occurred earlier in the C-group than in the E-group for the first 4 months but the trend did not last for the 1-year follow-up. The study suggests that supervised group training is beneficial for women with established osteoporosis.

  • 236.
    Grossmann, Benjamin
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Department of Medicine and Health Sciences.
    Karlsson, Oskar
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Department of Medicine and Health Sciences.
    Patient-kontrollerad epidural analgesi (PCEA) med bupivacaine, fentanyl och epinephrine som postoperativ smärtlindring: en retrospektiv studie2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Patientkontrollerad epidural smärtlindring (PCEA) är idag en vedertagen metod för postoperativ smärtlindring med få komplikationer. Försök har gjorts för att titrera fram den mest gynnsamma kombinationen med fokus på att maximera smärtlindringen och minimera sidoeffekterna. Syftet med studien är att identifiera smärta, sidoeffekter och behandlingstid samt patientens subjektiva skattning av smärtlindring vid postoperativ PCEA-behandling med bupivacaine, fentanyl och epinephrine.

    Metod: Studien är retrospektiv inkluderande 1088 patienter vilka postoperativt behandlats med PCEA och kombinationslösningen bupivacaine (1mg/ml), fentanyl (2μg/ml) och epinephrine (2μg/ml). Studien har undersökt skillnaden mellan kön, ålder och typ av kirurgi avseende smärta i vila respektive smärta vid mobilisering/hosta, infusionshastighet, givna och begärda bolusdoser, behandlingstid, sidoeffekter samt patientens subjektiva skattning av smärtlindringen.

    Resultat: Smärta i vila och vid mobilisering/hosta var under de studerade dygnen generellt låg, smärtan kulminerade under dygn 2. De yngre patienterna visade sig skatta smärta högre under behandlingstiden. Studien visade att smärta vid mobilisering/hosta var högre vid längre behandlingstid. Kvinnor hade mer illamående och klåda, vilket inte entydigt påverkade behandlingstiden. Patienter vilka hade haft smärta både i vila och vid mobilisering/hosta skattade ett lägre betyg gällande smärtlindringen vid hemgång. Andelen patienter som avslutade PCEA-behandlingen relaterat till minskat behov var 78%.

    Konklusion: Patienterna upplevde att den postoperativa smärtlindringen med PCEA med kombinationslösningen var mycket god. Typ av kirurgi, kön och smärta vid mobilisering/hosta visade sig påverka behandlingstiden. Förekomsten av sidoeffekter var hög men påverkade inte patientens betyg negativt. Smärtan hos patienterna var generellt låg.

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  • 237.
    Grundström, Hanna
    et al.
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Norrköping.
    Wallin, Karin
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    'You expose yourself in so many ways': young women's experiences of pelvic examination2011In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 32, no 2, p. 59-64Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify and describe young women's experiences of pelvic examination (PE). Qualitative interviews were conducted with nine women aged 18--23 years, who had undergone at least one PE. Data were analysed using an interpretative phenomenological approach. Three general themes were identified: (1) relinquishing and regaining control, (2) facilitation of the situation by the examiner and (3) PE is an unpleasant necessity. These general themes had a common structure that represented the essence: an intimate situation. The women experienced PE as an intimate situation, which they associated with their sexuality. They felt exposed both bodily and mentally and were placed in a vulnerable situation. PE was considered as unpleasant but necessary to confirm their health. During the PE, the women felt that they lost control of the situation by exposing their intimate parts. To regain control, the women felt a need for continuous information from the examiner. The vulnerable situation could be made less vulnerable if the examiner built a trusting relationship and made the women feel secure and seen as individuals. A deeper understanding of the situation from the women's perspective could facilitate the examiner's performance of PE, leading to more positive experiences among young women.

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  • 238.
    Guldbrand, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Dizdar, B.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Bunjaku, B.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Department of Medical and Health Sciences, Endocrinology. Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Department of Medical and Health Sciences, Endocrinology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss2012In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 55, no 8, p. 2118-2127Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: The study aimed to compare the effects of a 2 year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD), based on four group meetings to achieve compliance. METHODS: This was a prospective randomised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and randomised by drawing ballots. Patients that did not speak Swedish could not be recruited. The primary outcomes in this non-blinded study were weight and HbA(1c). Patients on the LFD aimed for 55-60 energy per cent (E%) and those on LCD for 20 E% from carbohydrate. RESULTS: The mean BMI and HbA(1c) of the participants were 32.7 ± 5.4 kg/m(2) and 57.0 ± 9.2 mmol/mol, respectively. No patients were lost to follow-up. Weight loss did not differ between groups and was maximal at 6 months: LFD -3.99 ± 4.1 kg (n = 31); LCD -4.31 ± 3.6 kg (n = 30); p < 0.001 within groups. At 24 months, patients on the LFD had lost -2.97 ± 4.9 kg and those on LCD -2.34 ± 5.1 kg compared with baseline (p = 0.002 and p = 0.020 within groups, respectively). HbA(1c) fell in the LCD group only (LCD at 6 months -4.8 ± 8.3 mmol/mol, p = 0.004, at 12 months -2.2 ± 7.7 mmol/mol, p = 0.12; LFD at 6 months -0.9 ± 8.8 mmol/mol, p = 0.56). At 6 months, HDL-cholesterol had increased with the LCD (from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l, p = 0.018) while LDL-cholesterol did not differ between groups. Insulin doses were reduced in the LCD group (0 months, LCD 42 ± 65 E, LFD 39 ± 51 E; 6 months, LCD 30 ± 47 E, LFD 38 ± 48 E; p = 0.046 for between-group change). CONCLUSIONS/INTERPRETATION: Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative. TRIAL REGISTRATION: ClinicalTrials.gov NCT01005498 FUNDING: University Hospital of Linköping Research Funds, Linköping University, the County Council of Östergötland, and the Diabetes Research Centre of Linköping University.

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  • 239.
    Gullberg, Mats
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Health care professionals' self description1996Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the present thesis was to survey and analyse professional self of health care professionals, focusing on perceptions of self, and on their attitudes towards aspects of sense of responsibility.

    Studies were accomplished with quantitative techniques using questionnaires and/or instruments. A total of 803 respondents was included, and the first study (I) presented the development of the PSDF and comprised 30 registered nurses. The next study (II) examined results from 332 medical laboratory technologists who answered the PSDF. In the third study (III) 68 occupational therapists responded to the PSDF. The fourth study (IV) was a six-year follow-up of 43 registered nurses from the beginning of their training to three years after graduation, and they responded to the PSDF, the SRF and to the Form for ranked sources of encouragement. The fifth study (V) comprised four professional groups from a university hospital in Sweden (physicians, physiotherapists, registered nurses and enrolled nurses), and 312 responded to the set of forms (the PSDF, the SRF, and the Form for ranked sources of encouragement).

    The main theoretical approach was based on symbolic interactionism, where the self is a significant notion. Concepts on attitude, sense of responsibility and encouragement were important.

    The results showed that there are components of self description that is 'specific to one professional group, but also components that uncover similarities. Three important components of professional self were outlined; professional conduct, work ability and empathy. Important issues were also encouragement for work done, which influences the professional self, and that the positive attitudes to sense of responsibility showed similarities with characteristics of professional self.

    In conclusion, two propositions were addressed: that professionals' self description is composed of three meaningful dimensions; professional conduct, work ability and empathy, and that the professional self can be improved throughdevelopment of intrinsic attitudes and behaviours.

  • 240.
    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.

  • 241.
    Gunhardsson, Inger
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Centre of Competence in Palliative Care.
    Svensson, Anna
    Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Centre of Competence in Palliative Care.
    Berterö, Carina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Documentation in palliative care: Nursing documentation in a palliative care unit - A pilot study2008In: AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, ISSN 1049-9091, Vol. 25, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    Palliative care seeks to enhance quality of life in the face of death by addressing the physical, psychological, social, and spiritual needs of patients with advanced disease. The purpose of this paper is to explore whether palliative patients needs, nursing actions, and evaluation can be identified in the nursing documentation. Data consisted of reviews of patients' case records in a palliative care unit. Data were analyzed using content analysis and counting frequency of keywords used from the Well-being Integrity Prevention and Safety (VIPS) model, followed by an inductive analysis of the case record documentation aiming to identify palliative care components. The result shows that the documentation revealed physical care, especially pain, more frequently than other needs. Nursing documentation focuses on identification more than on nursing actions and evaluation.

  • 242.
    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.

  • 243.
    Hagblad, Jimmie
    et al.
    Mälardalen University.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Kaisdotter Andersson, Annika
    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, Mia
    Mälardalen University.
    Lindén, Maria
    Mälardalen University.
    Simultan registrering av blodflöde på flera djup2009Conference paper (Refereed)
  • 244.
    Hallberg, I
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Toss, G
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology UHL.
    Ek, A-C
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hjortswang, H
    Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology UHL.
    Bachrach-Lindström, M
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Health-related Quality of Life after Vertebral or Hip Fracture in Women - Short Health Scale Useful for Clinical Practice?2010Conference paper (Other academic)
  • 245. Order onlineBuy this publication >>
    Hallberg, Inger
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms.

    Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV).

    Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis.

    Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways.

    Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL.

    List of papers
    1. Women with low-energy fracture should be investigated for osteoporosis
    Open this publication in new window or tab >>Women with low-energy fracture should be investigated for osteoporosis
    Show others...
    2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 6, p. 813-821Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information? Material and methods: We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm. Results: The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture. Interpretation: Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems warranted in every woman between the ages of 55 and 75 with a recent low-energy fracture, with highest priority being given to those with vertebral, hip, or multiple fractures. Copyright© Taylor & Francis 2007. all rights reserved.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-41402 (URN)10.1080/17453670710014608 (DOI)56296 (Local ID)56296 (Archive number)56296 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
    2. Health-related quality of life after osteoporotic fractures
    Open this publication in new window or tab >>Health-related quality of life after osteoporotic fractures
    Show others...
    2004 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 15, no 10, p. 834-841Article in journal (Refereed) Published
    Abstract [en]

    Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24150 (URN)10.1007/s00198-004-1622-5 (DOI)3733 (Local ID)3733 (Archive number)3733 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study
    Open this publication in new window or tab >>Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study
    Show others...
    2009 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, no 135Article in journal (Refereed) Published
    Abstract [en]

    Background

    The negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.

    Methods

    Ninety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student’s t-tests, ANCOVA, and partial correlation.

    Results

    Sixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p<0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.

    Conclusions

    The long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.

    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-51527 (URN)10.1186/1471-2474-10-135 (DOI)
    Note
    Original Publication: Inger Hallberg, Margareta Bachrach-Lindström, Staffan Hammerby, Göran Toss and Anna-Christina Ek, Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study, 2009, BMC Musculoskeletal Disorders, (10), 135, . http://dx.doi.org/10.1186/1471-2474-10-135 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2017-12-12Bibliographically approved
    4. A striving for independence: a qualitative study of women living with vertebral fracture
    Open this publication in new window or tab >>A striving for independence: a qualitative study of women living with vertebral fracture
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.

    Methods: The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.

    Results: The findings of this study revealed three themes related to the influence on HRQOL and daily life: A threatened independence, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; Strategies for maintaining independence, i.e. coping, self-care and support; and The importance of maintaining independence, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. As a result of how their HRQOL and daily life have been affected by their vertebral fractures, the women in this study are striving for independence or maintaining their independence by trying to manage the different types of symptoms and consequences in different ways.

    Conclusion: HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. One possible effective intervention for the future may be to support women in using self-management strategies so that they can be in charge of their situation and positively influence their HRQOL and daily life to achieve independence, but further evaluation is still needed. Information from this study may provide a foundation for guidelines for health care professionals to offer empathic and supportive care to women living with prevalent vertebral fracture.

    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-51531 (URN)
    Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2010-01-14Bibliographically approved
    Download full text (pdf)
    Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures
    Download (pdf)
    Cover
  • 246.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hammerby, Staffan
    Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
    Toss, Göran
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    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.
    Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study2009In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, no 135Article in journal (Refereed)
    Abstract [en]

    Background

    The negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.

    Methods

    Ninety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student’s t-tests, ANCOVA, and partial correlation.

    Results

    Sixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p<0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.

    Conclusions

    The long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.

    Download full text (pdf)
    FULLTEXT01
  • 247.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology 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.
    Health-Related Quality of Life 7 Years After Hip or Vertebral fractures2007Conference paper (Other academic)
  • 248.
    Hallberg, Inger
    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. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Toss, Göran
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    A striving for independence: a qualitative study of women living with vertebral fractureManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.

    Methods: The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.

    Results: The findings of this study revealed three themes related to the influence on HRQOL and daily life: A threatened independence, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; Strategies for maintaining independence, i.e. coping, self-care and support; and The importance of maintaining independence, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. As a result of how their HRQOL and daily life have been affected by their vertebral fractures, the women in this study are striving for independence or maintaining their independence by trying to manage the different types of symptoms and consequences in different ways.

    Conclusion: HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. One possible effective intervention for the future may be to support women in using self-management strategies so that they can be in charge of their situation and positively influence their HRQOL and daily life to achieve independence, but further evaluation is still needed. Information from this study may provide a foundation for guidelines for health care professionals to offer empathic and supportive care to women living with prevalent vertebral fracture.

  • 249.
    Hallberg, Inger
    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.
    Toss, Göran
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    A striving for independence: a qualitative study of women living with vertebral fracture2010In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 9, no 7Article in journal (Refereed)
    Abstract [en]

    Background

    Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.

    Methods

    The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.

    Results

    The findings of this study revealed three themes related to the influence on HRQOL and daily life: A threatened independence, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; Strategies for maintaining independence, i.e. coping, self-care and support; and The importance of maintaining independence, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. The women were striving for independence or maintaining their independence by trying to manage different types of symptoms and consequences in different ways.

    Conclusion

    HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. Information from this study may provide new knowledge and understanding of the women's experiences of living with vertebral fracture from an insider's point of view in order to obtain a deeper understanding of the women's everyday life. However, further evaluation is still needed in larger study groups.

    Download full text (pdf)
    fulltext
  • 250.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Rosenqvist, A. M
    Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
    Kartous, L
    Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
    Löfman, Owe
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Wahlström, Ola
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Toss, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Health-related quality of life after osteoporotic fractures2004In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 15, no 10, p. 834-841Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

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