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  • 301.
    Johansson, Peter
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Jonköping University, Sweden.
    Sanderman, Robbert
    Health Psychology Section, Department of Health Sciences, University of Groningen, University Medical Centre Groningen, the Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations.2015Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, nr 5, s. 403-410Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Sleep problems are common in patients with heart failure (HF) and might be associated with patient outcomes.

    AIMS: The aim of this study was to describe the course of sleep problems in HF patients over 1 year and the association between sleep problems and rehospitalization.

    METHODS: Data from 499 HF patients (mean age, 70 years) were used in this analysis. Sleep problems were assessed with the item "Was your sleep restless" from the Center for Epidemiological Studies Depression Scale during hospitalization for HF (baseline) and after 1 year.

    RESULTS: A total of 43% of patients (n = 215) reported sleep problems at baseline, and 21% of patients (n = 105), after 1 year. Among the 215 patients with problems with sleep at baseline, 30% (n = 65) continued to have sleep problems over time. Among the 284 patients without sleep problems at baseline, 14% (n = 40) reported sleep problems after 1 year. After adjustments for potential cofounders, patients with continued sleep problems had an almost 2-fold increased risk for all-cause hospitalizations (hazard ratio, 2.1; P = .002) and cardiovascular hospitalizations (hazard ratio, 2.2; P = .004).

    CONCLUSION: One-third of HF patients with sleep problems at discharge experienced persistent sleep problems at follow-up. Continued sleep problems were associated with all-cause and cardiovascular rehospitalizations.

  • 302.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Lesman-Leegte, Ivonne
    Department of Cardiology, University Medical Centre Groningen, Univeristy of Groningen.
    Lundgren, Johan
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hillege, Hans L
    Department of Cardiology and Department of Epidemiology, University Medical Center Groningen, University of Groningen.
    Hoes, Arno
    Department of General Practice, Julius Centre for Health Sciences and Primary Care,.
    Sanderman, Robbert
    Health Psychology Section, Department of Health Sciences, University of Groningen,.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Time-course of depressive symptoms in patients with heart failure2013Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 74, nr 3, s. 238-243Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background It is unclear how depressive symptoms in patients with heart failure develop

    over time and whether this trajectory of depressive symptoms is associated with hospital admission and prognosis.

    Aim To describe the time-course of depressive symptoms and determine the relationship with hospital admission and mortality.

    Method Data was analysed using 611 patients with completed CES-D questionnaires at baseline and at 18 months. Data on hospital readmission was collected 18 months after discharge and data on mortality was collected 18 and 36 months post-discharge.

    Results The prevalence of depressive symptoms was 38% (n=229) at discharge and 26% (n=160) after 18 months. A total of 140 (61%) of the 229 patients with depressive symptoms at discharge had recovered from depressive symptoms after 18 months whereas 71 (18%) of the 382 non-depressed developed depressive symptoms and 89 (39%) of the 229 depressed remained depressed. Depressive symptoms at discharge were not associated with mortality after 18 months but patients with recently (i.e. during 18 months) developed depressive symptoms showed a significantly higher risk for cardiovascular readmissions (HR 1.7, p=0.016). After 36 months, patients with developed depressive symptoms after discharge were at a higher risk of all-cause mortality (HR 2.0, p=0.012) and there was a trend towards a higher risk of all-cause mortality in patients with ongoing depressive symptoms (HR 1.7, p=0.056).

    Conclusion A significant proportion of patients with HF, who were reported depressive symptoms at discharge recovered from depressive symptoms during the following 18 months. However, patients who remained having depressive symptoms or patients who developed depressive symptoms had a worse prognosis.

  • 303.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Lesman-Leegte, Ivonne
    University of Groningen.
    Svensson, Erland
    Swedish Defence Research Agency.
    Voors, Adriaan
    University of Groningen.
    van Veldhuisen, Dirk J.
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Depressive symptoms and inflammation in patients hospitalized for heart failure2011Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 161, nr 6, s. 1053-1059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Depressive symptoms in patients with heart failure (HF) are common and might be associated with inflammation. No studies have examined both the cross-sectional and prospective association between inflammation and depressive symptoms in patients with HF with adequate correction for disease severity. The aim of this study was to describe if the cytokines interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with depressive symptoms in hospitalized HF patients. Methods Data from 517 patients hospitalized for HF from the COACH study were analyzed on inflammation markers (IL-6 and CRP) and depressive symptoms (Center for Epidemiological Studies Depression-Scale). Results Heart failure patients with depressive symptoms (n = 208, 40%) had significantly higher plasma values of IL-6 (median 12.8 pg/mL vs median 11.0 pg/mL, P = .018) and CRP (median 2.4 mg/mL vs median 2.1 mg/mL, P = .03) compared with the nondepressed patients. Structural equation modelling showed that the factor inflammation (including IL-6 and CRP) was associated with depressive symptoms (beta = 0.18, P less than .05) when left ventricular ejection fraction and plasma values brain natriuretic peptides were included in the model. A small negative (beta = -0.18, P less than .05) effect was found between inflammation at baseline and the change in depressive symptoms during the 18 months of follow-up. Conclusions Higher levels of inflammatory markers are independently associated with depressive symptoms in HF patients, even after correcting for disease severity. There is no clear relationship between inflammation at baseline and depressive symptoms during the 18 months of follow-up.

  • 304.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Nieuwenhuis, M
    University of Groningen.
    Lesman-Leegte, I
    University of Groningen.
    Van Veldhuisen, D J
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Depression and delay between symptom onset and hospitalisation in heart failure patients in EUROPEAN HEART JOURNAL, vol 31, issue , pp 945-9452010Ingår i: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, s. 945-945Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 305.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Nieuwenhuis, Maurice
    University of Groningen.
    Lesman-Leegte, Ivonne
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Depression and the delay between symptom onset and hospitalization in heart failure patients.2011Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 13, nr 2, s. 214-219Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Heart failure (HF) patients frequently suffer from episodes of deterioration and may need medical treatment. An adequate reaction from the patient is needed to decrease the delay between the onset of deterioration and consulting a medical professional (i.e. consulting behaviour). The aim of the present study was to evaluate whether depressive symptoms are associated with the duration of the delay between the onset of symptoms of worsening HF and hospitalization, and to examine how consulting behaviour correlates to depressive symptoms and delay in HF patients. METHODS AND RESULTS: Data on the time between the onset of symptoms of worsening HF and hospitalization, depressive symptoms, and self-care behaviour were collected in 958 HF patients (37% female; age 71 ± 11 years; New York Heart Association functional class II-IV), using validated questionnaires. The median delay time of the total sample was 72 h (ranging from 0 to 243 days). Patients with depressive symptoms delayed longer compared with those without depressive symptoms (120 vs. 54 h, P= 0.001). Patients with depressive symptoms had a 1.5 times higher risk for a delay of ≥72 h, independent of demographic and clinical variables (P= 0.008). Consulting behaviour did not correlate with depressive symptoms but was weakly associated with delay (r= -0.07, P= 0.03). CONCLUSIONS: Heart failure patients with depressive symptoms have a significantly longer delay between HF deterioration and hospital admission. Interventions designed to improve the consulting behaviour in HF patients with depressive symptoms may have a limited effect on delay. Further research is needed to obtain more insight into the mechanisms underlying the relationship between delay and depression.

  • 306.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Riegel, Barbara
    University of Pennsylvania, Philadelphia, PA, USA.
    Svensson, Erland
    Swedish Defence Research Agency, Linköping, Sweden.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Sickness behavior in community-dwelling elderly associations with impaired cardiac function and inflammation2014Ingår i: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 16, nr 1, s. 105-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sickness behavior is a cluster of symptoms that occur as a response to an infection and alterations in the inflammatory response. Under normal circumstances, sickness behavior is fully reversible once the pathogen has been cleared. Aging and chronic illness such as heart failure are associated with enhanced inflammatory activity that lasts for a long duration and no longer represents an adaptive response. The aim of this study was to explore whether inflammation mediates the relationship between impaired cardiac function and a symptom cluster including anhedonia, fatigue, and sleepiness, which might represent sickness behavior in community-dwelling elders. Structural equation modeling (SEM) showed that the factor impaired cardiac function (i.e., N-terminal fragment of pro-brain natriuretic peptide, left ventricular ejection fraction, and the heart failure medications angiotensin converting enzyme inhibitor, angiotensin receptor blockade, β-blocker, and diuretics) was associated with both inflammation (i.e., C-reactive protein; β = .26) and the symptom cluster (β = .31). Inflammation had a significant direct, but smaller, association with the symptom cluster (β = .21). By this pathway, inflammation also mediated an indirect association between impaired cardiac function and the symptom cluster (β = .05). Including creatinine, blood glucose, ischemic heart disease, previous and current tumor, respiratory disease, age, and body mass index in the SEM model did not change these associations. Our results imply that some aspects of the symptom panorama in elderly individuals with impaired cardiac function or heart failure could represent sickness behavior.

  • 307.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Riegel, Barbara
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA .
    Svensson, Erland
    Swedish Defence Research Agency, Sweden .
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    The Contribution of Heart Failure to Sleep Disturbances and Depressive Symptoms in Older Adults2012Ingår i: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 25, nr 3, s. 179-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF). Methods: A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506). Results: Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (beta = 0.64 vs beta = 0.45, P = .006). Conclusion: In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms.

  • 308.
    Johansson, Peter
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Svensson, Erland
    Swedish Defence Research Agency, Linköping .
    Alehagen, Urban
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Dahlström, Ulf
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonköping University, Sweden.
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 263-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS: Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS: Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS: Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 309.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Svensson, Erland
    Swedish Defence Research Agency, Sweden.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Broström, Anders
    Department of Nursing Science, Jönköping University, Sweden.
    The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease2015Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, nr 3, s. 222-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims:

    This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality.

    Method:

    A total of 331 community-dwelling elderly aged 71–87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years.

    Results:

    In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002).

    Conclusion:

    In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

  • 310.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    van der Wal, Martje
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Association Between Prehospital Delay and Subsequent Clinical Course in Patients With/Hospitalized for Heart Failure2012Ingår i: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, nr 3, s. 202-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The clinical consequences of prehospital delay in heart failure (HF) patients are unknown. This study explores the relationship between prehospital delay of HF patients and length of hospital stay, plasma values of brain natriuretic peptides (BNP) as well as the association of delay with all-cause mortality, readmission for HF, or all-cause readmissions during short-(60 days) and long-term (18 months) follow-up. less thanbrgreater than less thanbrgreater thanMethods: Data from 1023 hospitalized HF patients mean aged 71 years from the Coordinating study evaluating Outcomes of Advising and Counselling in HF study were analyzed. less thanbrgreater than less thanbrgreater thanResults: Patients who delayed less than 1 day had significantly shorter stay in hospital (10 days vs. 11 days, P = 0.033). They also had significantly (P = 0.004) lower median plasma values of BNP (377 pg/mL) at discharge compared to patients who delayed andgt;24 hours (492 pg/mL). Delay was not related to all-cause mortality and/or readmissions for HF. less thanbrgreater than less thanbrgreater thanConclusion: Although patients with a prehospital delay less than 1 day were more symptomatic on admission, they had a shorter hospital stay as well as lower plasma values of BNP at discharge. Delay was not associated hospital readmissions or mortality after discharge.

  • 311. Beställ onlineKöp publikationen >>
    Johansson Stark, Åsa
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Empowering knowledge and Quality of Recovery after hip or knee replacement2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients and their spouses. Patient education is linked to and promotes the recovery process and can improve the outcome after elective hip or knee replacement. Fulfilment of knowledge expectations is essential for enabling people to become empowered during the period of recovery.

    Aim

    The overall aim was to explore the association between empowering knowledge and patients’ quality of recovery after elective hip or knee replacement.

    Methods

    The design of the four papers was descriptive, prospective and comparative. Consecutively included patients and their spouses from Cyprus, Finland, Greece, Iceland and Sweden answered questionnaires before surgery and at discharge from hospital. Data was collected during the years 2009-2012. Relationships and associations between a number of factors and fulfilment of knowledge expectations, and patients’ quality of recovery were investigated. Comparisons between patients undergoing hip or knee replacement and between patients and their spouses were made.

    Results

    Patients and their spouses had similar knowledge expectations, and these were not fulfilled during the hospital stay. Spouses had less fulfilled knowledge expectations compared with the patients. Swedish patients and spouses had less fulfilled knowledge expectations compared with the Icelandic and Finnish ones. Patients who experienced the hospital stay as meeting their general expectations had more fulfilled knowledge expectations compared with those who did not.

    Access to knowledge was the main predictor of the variance in fulfilment of knowledge expectations. Negative emotions, such as depressive state and impatience, were associated with less fulfilled knowledge expectations. For patients undergoing hip replacement, a higher level of professional education was associated with less fulfilled knowledge expectations. For patients undergoing knee replacement, a history of employment in social services or healthcare was associated with less fulfilled knowledge expectations.

    Patients’ experience of greater satisfaction with care was associated with better quality of recovery for both kinds of arthroplasty. Patients with fulfilled knowledge expectations experienced better quality of recovery. The spouserelated factors, namely uncertainty and depressive state, were associated with lower quality of recovery. Factors associated with greater quality of recovery among the patients were spouses with a history of employment in social services or health care, and nurses explaining matters concerning the care and treatment for the spouses.

    Conclusion

    Patients and their spouses had high knowledge expectations that were not fulfilled during the hospital stay. Patients’ emotional state and their access to knowledge were important for their fulfilment of knowledge expectations. Patients’ and spouses’ emotional state also played an important role in determining the patients’ quality of recovery, and greater satisfaction with care among the patients was associated with better quality of recovery.

    These results emphasise the need to detect patients and their spouses in need of support in their preparation and recovery process. It is therefore important to assess patients’ and spouses’ personal knowledge expectations, and adapt to their emotional state while fulfilling them.

    The content of patient education should be personalised in future care, and informal caregivers should be seriously taken into account during the period of early recovery. The results of this thesis can be used in the development and testing of person-centred educational interventions for patients undergoing elective hip or knee replacements.

    Delarbeten
    1. Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey
    Öppna denna publikation i ny flik eller fönster >>Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey
    Visa övriga...
    2014 (Engelska)Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, nr 11, s. 1491-1499Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND:

    Patient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled.

    OBJECTIVES:

    To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions.

    DESIGN:

    A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery.

    SETTINGS:

    Two Finnish, three Icelandic and two Swedish hospitals.

    PARTICIPANTS:

    The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women.

    METHODS:

    Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations.

    RESULTS:

    Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected knowledge.

    CONCLUSIONS:

    In order to better support patients by education it is necessary to assess their emotional state, educational level and knowledge expectations before surgery.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2014
    Nyckelord
    Emotions, Empowering knowledge, Hip replacement, Knowledge expectations, Orthopaedic nursing, Patient education, Symptoms
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-109769 (URN)10.1016/j.ijnurstu.2014.03.006 (DOI)000343351900009 ()24751503 (PubMedID)
    Projekt
    Empowering Patient Education
    Tillgänglig från: 2014-08-27 Skapad: 2014-08-27 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    2. The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Öppna denna publikation i ny flik eller fönster >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Visa övriga...
    2014 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, nr 19-20, s. 2896-2908Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

    BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

    DESIGN: Descriptive, prospective survey.

    METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

    RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

    CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

    RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2014
    Nyckelord
    Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
    Projekt
    EEPO
    Tillgänglig från: 2014-03-13 Skapad: 2014-03-13 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
    Öppna denna publikation i ny flik eller fönster >>The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
    Visa övriga...
    2016 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, nr 17-18, s. 2489-2501Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims and objectives. To describe and compare the quality of recovery (QoR) on discharge from hospital between patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors.

    Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with QoR at discharge from hospital.

    Design. A descriptive, comparative study including 12 hospitals in five European countries; Cyprus, Finland, Greece, Iceland and Sweden.

    Methods. Consecutively included patients responded on: Health-Related Quality of Life, and emotions before surgery and at hospital discharge; Quality of Recovery, Patient Satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total 865 patients were included (hip n=413, knee n=452).

    Results. In the dimension of pain, patients undergoing hip replacement had significantly better QoR compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer QoR. Fulfilment of knowledge expectations has a limited effect on QoR. Greater satisfaction with care predicted better QoR.

    Conclusions. Negative preoperative emotions were related to poorer QoR. For both kinds of arthroplasty, greater satisfaction with care was associated with better QoR.

    Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell Publishing Inc., 2016
    Nyckelord
    Fulfilment of knowledge expectations, health-related quality of life, hip replacement, knee replacement, preoperative emotional state, quality of recovery, satisfaction with care
    Nationell ämneskategori
    Omvårdnad Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-125235 (URN)10.1111/jocn.13278 (DOI)000388920400011 ()
    Anmärkning

    At the time of thesis presentation publication was in status: Manuscript

    Tillgänglig från: 2016-02-17 Skapad: 2016-02-17 Senast uppdaterad: 2021-07-06Bibliografiskt granskad
    4. Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
    Öppna denna publikation i ny flik eller fönster >>Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
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    2016 (Engelska)Ingår i: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 23, s. 32-46Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Today’s shorter hospital stays means that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the health care staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be primary caregivers as their relationship with the patient is more interdependent than other family members or caregivers.

    Objectives: The aim was to describe spouse-related factors that were associated with patients’ quality of recovery on discharge from hospital after elective hip or knee replacement.

    Design: The design was prospective, descriptive and comparative with two measurements; before arthroplasty and on discharge.

    Settings: Two Finnish, three Icelandic and two Swedish university or community hospitals.

    Participants: The sample consisted of spouses and patients. The inclusion criteria were: age ≥ 18 years, able to complete the questionnaires, and able to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as; wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years, and 54% of them were females.

    Methods: Self-reported instruments on; expected and received knowledge, access to knowledge, emotional state and quality of recovery were used.

    Results: If the spouses were or had been employed in the social services or healthcare their partner had greater quality of recovery (p=0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p<0.001). Spouses who experienced that nurses had enough time and explained matters concerning their family members’ care and treatment had partners who experienced greater quality of recovery (p=0.011, 0.044).

    Conclusions: Spouses’ emotional state played an important role in the patients’ quality of recovery, with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses’ fulfilment of knowledge expectations was not associated with patients’ recovery.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2016
    Nyckelord
    Access to knowledge, empowering knowledge, emotional state, fulfilment of knowledge expectations, hip replacement, knee replacement, recovery, spousal caregivers
    Nationell ämneskategori
    Omvårdnad Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-125236 (URN)10.1016/j.ijotn.2016.03.001 (DOI)000390590600005 ()
    Anmärkning

    At the time for thesis presentation publication was in status: Manuscript

    Tillgänglig från: 2016-02-17 Skapad: 2016-02-17 Senast uppdaterad: 2020-02-21Bibliografiskt granskad
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  • 312.
    Johansson Stark, Åsa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Ingadottir, Brynja
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Salanterä, Sanna
    Turku University, Finland.
    Sigurdardottir, Arun K
    University of Akureyri, Iceland.
    Valkeapää, Kirsi
    University of Turku, Finland.
    Bachrach-Lindström, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey2014Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, nr 11, s. 1491-1499Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Patient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled.

    OBJECTIVES:

    To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions.

    DESIGN:

    A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery.

    SETTINGS:

    Two Finnish, three Icelandic and two Swedish hospitals.

    PARTICIPANTS:

    The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women.

    METHODS:

    Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations.

    RESULTS:

    Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected knowledge.

    CONCLUSIONS:

    In order to better support patients by education it is necessary to assess their emotional state, educational level and knowledge expectations before surgery.

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  • 313.
    Johansson Stark, Åsa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Ingadottir, Brynja
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Sigurdardottir, Arun K
    University of Akureyri, Iceland.
    Valkeapää, Kirsi
    University of Turku, Finland.
    Bachrach-Lindström, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Fulfilment of patients’ knowledge expectations in connection with hip or knee replacement – a Nordic perspective2014Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To describe and compare the differences between received and expected knowledge in patients undergoing elective hip or knee replacement in three Nordic countries, and to analyse if these differences are related to patients’ characteristics.

    Method: A descriptive, prospective and comparative survey of patients with osteoarthritis treated at two Finnish, three Icelandic and two Swedish hospitals (n=612). Patients answered questionnaires about their knowledge expectations (KEhp) before surgery and about received knowledge (RKhp) at discharge. These two parallel instruments include: bio-physiological, functional, experiential, ethical, social and financial dimensions of knowledge.

    Results: Among the 29% Finnish, 34% Icelandic and 37% Swedish patients (hip: 53%, knee: 47%) were 54% females and the mean age was 65 years. Patients` knowledge expectations were higher, mean: 3.6 (±SD 0.5), than their perception of received knowledge 3.0 (0.7). The difference between expected and received knowledge was larger in Sweden -0.9(0.8) compared with Finland -0.4(0.8) and Iceland -0.5(0.7) (p<0.001) but not statistically different between patients having hip or knee replacement. Patients perceived having received most bio-physiological -0.3(0.6) and functional -0.3(0.6) knowledge but least financial -1.2(1.2) knowledge. A relationship was found between the difference of expected and received knowledge and whether the hospital stay was as expected. For patients undergoing hip replacement this difference was also related to the level of education, for knee replacement patients if they had their first arthroplasty and employment in social or health care.

    Conclusions: Patients expect multidimensional knowledge during hospital stay which was inadequately met. Assessing patients’ knowledge needs could improve patient education.

  • 314.
    Johansson, Ulla M
    et al.
    Centrum för klinisk forskning, Gävleborg.
    Bosaeus, Ingvar
    Enheten för klinisk nutrition, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Larsson, Jörgen
    Clintec, Enheten för kirurgi, ­Karolinska institutet, Huddinge.
    Rothenberg, Elisabet
    Avdelningen för Klinisk Näringslära, Sahlgrenska sjukhuset, Göteborg, Sweden.
    Stene, Christina
    Kirurgiska kliniken, Universitetssjukhuset MAS, Malmö.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Nutritional therapy in elderly care--a forgotten perspective. A questionnaire study shows clear shortages in the care of the elderly2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 40, s. 2538-2542Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It has previously been demonstrated that the use of clinical nutrition in Swedish hospitals did not fulfill European standards. In the present study, a questionnaire-based investigation was performed among nurses working with elderly people living in sheltered housing. Overall, 765 (54.6%) responded. Nearly 90% of the nurses considered themselves responsible for nutritional assessment, although only 36% routinely registered energy intake on patients at risk of undernutrition. More than 60% stated that education regarding clinical nutrition was insufficient. Thus, despite a heavy responsibility in the nutrition care process for nurses, a lack of sufficient knowledge and education was evident. Special efforts should be aimed at a clarified organization as well as education.

  • 315.
    Jonkman, Nini H.
    et al.
    University of Medical Centre Utrecht, Netherlands .
    Westland, Heleen
    University of Medical Centre Utrecht, Netherlands .
    Trappenburg, Jaap C. A.
    University of Medical Centre Utrecht, Netherlands .
    Groenwold, Rolf H. H.
    University of Medical Centre Utrecht, Netherlands .
    Effing-Tijdhof, Tanja W.
    Repatriat Gen Hospital, Australia .
    Troosters, Thierry
    Catholic University of Louvain, Belgium .
    van der Palen, Job
    University of Twente, Netherlands .
    Bourbeau, Jean
    McGill University, Canada .
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Filosofiska fakulteten.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands .
    Schuurmans, Marieke J.
    University of Medical Centre Utrecht, Netherlands .
    Towards tailoring of self-management for patients with chronic heart failure or chronic obstructive pulmonary disease: a protocol for an individual patient data meta-analysis2014Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 4, nr 5, s. 005220-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Self-management interventions in patients with chronic conditions have received increasing attention over the past few years, yet the meta-analyses encountered considerable heterogeneity in results. This suggests that the effectiveness of self-management interventions must be assessed in the context of which components are responsible for eliciting the effect and in which subgroups of patients the intervention works best. The aim of the present study is to identify condition-transcending determinants of success of self-management interventions in two parallel individual patient data meta-analyses of self-management trials in patients with congestive heart failure (CHF) and in patients with chronic obstructive pulmonary disease (COPD). Methods and analysis: Investigators of 53 randomised trials (32 in CHF and 21 in COPD) will be requested to share their de-identified individual patient data. Data will be analysed using random effects models, taking clustering within studies into account. Effect modification by age, sex, disease severity, symptom status, comorbid conditions and level of education will be assessed. Sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination: The de-identified individual patient data are used only for the purpose for which they were originally collected and for which ethical approval has been obtained by the original investigators. Knowledge on the effective ingredients of self-management programmes and identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised self-management interventions for patients with CHF and COPD as well as with other chronic diseases.

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  • 316.
    Järemo, Petter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Eriksson, M.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk kemi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk kemi.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Platelets and acute cerebral infarction2013Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 24, nr 5, s. 407-411Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Stroke is worldwide a leading cause of death and disability. Its etiology is regarded as heterogeneous. Platelets are implicated in its pathophysiology, but our understanding of their specific role is incomplete. Only sparse and conflicting information exists about platelet reactivity and activity in acute stroke. Some scientists take the view that platelets activate in conjunction with acute cerebral infarctions. Others put forward evidence corroborating the contrary notion. Increased soluble P-selectin as a sign of platelet and/or endothelial activity seems to be a feature of the disease. The latter point of view is opposed by other researchers. Due to these conflicting opinions, this study is devoted to platelet characteristics in acute cerebral infarctions. We studied subjects (n = 72; age 74 +/- 10(SD) years; 31 females) having acute stroke. As controls served atrial fibrillation (AF) patients (n = 58; age 69 +/- 7(SD) years; 12 females) subject to electrical cardioversion, a flow cytometer was put to use for measuring platelet reactivity and activity. After agonist provocation, both platelet bound P-selectin and fibrinogen were employed as estimates of platelet reactivity. Dilutions of a thrombin-receptor-activating peptide (TRAP-6) (74 and 57 mmol/l) (P-selectin and fibrinogen) and ADP (8.5 and 1.7 mmol/l) (fibrinogen only) were put to use as platelet agonists. Membrane-bound P-selectin without agonist stimulation served as a measure of in vivo platelet activation. Soluble P-selectin, as determined from a commercial ELISA, was used to assess platelet and/or endothelial activity. In acute stroke neither platelet-bound P-selectin nor fibrinogen after stimulation, i.e. reactivity, differed from AF controls. In contrast, lower platelet activity as judged from surface attached and circulating P-selectin without agonist stimulation proved to be a feature of cerebral infarctions. The p-values were p < 0.001 and p < 0.01, respectively. It is concluded that acute stroke is not associated with platelet reactivity platelets circulate less activated during the disease. It is evident that the mechanisms reflecting platelet reactivity and activity being investigated in this study play minor roles in stroke pathophysiology. New powerful platelet inhibitory drugs are currently introduced. To avoid major bleeding studies on platelet, behavior in acute stroke are necessary before including these medications in stroke treatment protocols.

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    Platelets and acute cerebral infarction
  • 317.
    Järemo, Petter
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Eriksson-Franzen, Marie
    Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Platelets, gender and acute cerebral infarction2015Ingår i: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, ISSN ISSN 1479-5876, Vol. 13, nr 267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    Platelets may well be significant in the pathogenesis of cerebral infarction. Platelets vary substantially according to gender. The scope of our current work is to establish if female and male stroke sufferers differ regarding platelet reactivity.

    Patients and methods

    73 Consecutive individuals stricken by acute ischemic cerebral infarction (31 females, 42 males) participated. All stroke subtypes were included. Platelet counts was determined electronically. Platelet reactivity i.e. the presence of surface-bound fibrinogen following provocation was analyzed with a flow cytometer. ADP (1.7 μmol/L) and a thrombin receptor agonist (TRAP-6) (57 μmol/L) were the agonists used.

    Results

    Female stroke sufferers had higher platelet counts (p = 0.013) but their platelets were less reactive. The p values were (p = 0.038) and (p = 0.016) for ADP and TRAP-6, respectively.

    Conclusion

    The current study demonstrates that women suffering acute cerebral infarction have less reactive platelets. It is concluded that gender affects platelets. Our study indicates that it may be beneficial to individualize platelet inhibition of stroke sufferers according to gender.

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    fulltext
  • 318.
    Järemo, Petter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Buller, Caroline
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Winblad, Bengt
    Karolinska Institute, Huddinge, Sweden.
    Alzheimer's disease and granulocyte density diversity2013Ingår i: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 43, nr 6, s. 545-548Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    The current study investigates circulating eosinophils and neutrophils in Alzheimer's (AD) type dementia with respect to density (kg/L). The existence of β-amyloid plaques in the brain is a feature of AD. Sporadic scientific reports indicate that the disease affects circulating neutrophils. In contrast, numerous publications investigate inflammatory reactions in AD brains. Locally, the plaques evoke a substantial inflammatory response involving activated microglia and astrocytes.

    METHODS:

    Subjects with probable AD (n = 39) were included and compared with elderly individuals (n = 22) lacking apparent memory problems. We sampled 10 mL venous blood in citrate. Granulocytes were separated according to density in linear Percoll™ gradients. Subsequently, the gradients were divided into density subfractions (n = 16). In every fraction, determination of eosinophil and neutrophil counts was carried out.

    RESULTS:

    AD sufferers displayed less granulocytes in fractions nos. 13-15 containing light cells. For these fractions, the P-values proved to be (P < 0·001; not significant; P = 0·03) and (P = 0·01; P = 0·01; not significant), for eosinophils and neutrophils, respectively.

    CONCLUSIONS:

    The present work describes that less circulating light granulocytes are a feature of AD demented individuals. It is to hypothesize that it is a sign of impaired granulocyte turnover and cell damage. It is concluded that AD affects inflammatory cells in the periphery and that the behaviour of granulocytes in dementia is worthwhile further studies.

    Ladda ner fulltext (pdf)
    Alzheimer's disease and granulocyte density diversity
  • 319.
    Järemo, Petter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Buller, Caroline
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Winblad, Bengt
    Karolinska Institutet.
    Low-density platelet populations demonstrate low in vivo activity in sporadic Alzheimer disease2012Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 23, nr 2, s. 116-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Platelets contain a substantial quantity of amyloid-precursor protein (APP) and β-amyloid. However, despite the large importance of APP and β-amyloid to dementia, little is known about platelets in sporadic Alzheimer dementia (AD). Furthermore, platelet heterogeneity influences human pathology and has been described to affect the progression of AD. This study investigated AD platelets with respect to density diversity and in vivo activity associated with density sub-fractions. We included 39 AD patients and used, as controls, 22 elderly individuals without apparent memory disorder. A continuous Percoll™ gradient covering the density span 1.04–1.09 kg/l provided the basis to divide platelets of whole blood into density fractions (n = 16). All platelet populations were evaluated accordingly. Platelet counts were determined electronically. A flow-cytometer was put to use to measure surface-bound fibrinogen as a measure of platelet in vivo activity. Samples obtained from patients diagnosed with sporadic AD contained platelets (fractions numbers 4–16) that circulated with significantly less surface-bound fibrinogen, i.e., their platelet activation in vivo was reduced, compared with controls. In particular, highly significant differences (p < 0.001) were obtained for the six less dense platelet populations (fractions numbers 11–16) when comparing sporadic AD with controls. In contrast, the densest AD platelets in fractions numbers 1–3 did not differ significantly from control cells with respect to in vivo platelet-bound fibrinogen. It is concluded that sporadic AD is characterized by lower density platelet populations that, while circulating, exhibited reduced activation. The clinical significance of this finding is unclear but these results suggest the importance of platelet heterogeneity in dementia as a topic for further investigation.

  • 320.
    Järemo, Petter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Buller, Caroline
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Winblad, Bengt
    Karolinska Institute, Sweden .
    P-selectin paradox and dementia of the Alzheimer type: Circulating P-selectin is increased but platelet-bound P-selectin after agonist provocation is compromised2013Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 73, nr 2, s. 170-174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Knowledge concerning the neurobiological importance of platelets in Alzheimers disease (AD) is sparse. P-selectin, which is located together with beta-amyloid precursor proteins in platelet alpha-granules, is also found in endothelial cells. Upon activation, P-selectin is relocated to cell surfaces where it acts as a receptor. Subsequently, the protein is cleaved from the membrane, to then be circulated. We investigated P-selectin behavior in AD dementia. Methods. We recruited 23 persons diagnosed moderate AD and 17 healthy elders without obvious memory problems. Circulating P-selectin was analyzed using an ELISA technique and flow cytometry was used to measure surface-bound P-selectin. The latter measure was carried out without provocation (platelet activity) and after in vitro agonist stimulation (platelet reactivity). A thrombin-receptor activating peptide (TRAP-6) (74 mu mol/L)) was used as a platelet agonist. Results. Soluble P-selectin was augmented in AD (p = 0.019) but platelet membrane-attached P-selectin did not differ from controls. AD diagnosis was associated with less surface-bound P-selectin after provocation. Significant results were obtained when 74 mu mol/L TRAP-6 was used as a platelet agonist (p = 0.0008). Conclusion. This study describes apparently paradoxical P-selectin reactions in moderate AD. While soluble P-selectin was higher in the disease group, membrane-attached P-selectin without agonist stimulation was no different between the disease and control groups. In contrast, AD was linked to lower platelet reactivity. The current findings encourage further research into this P-selectin paradox and its relevance for AD and, perhaps, other types of dementia as well.

  • 321.
    Järemo, Petter
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk kemi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Richter, Arina
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Elevated platelet reactivity in stable angina pectoris without significant coronary flow obstruction2008Ingår i: Journal of Cardiovascular Medicine, ISSN 1558-2027, Vol. 9, nr 2, s. 129-130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    There are many different causes of angina pectoris without significant coronary flow obstruction in major coronary arteries. Examples include Prinzmetal angina and small vessel atherosclerotic disease.

    METHODS:

    We investigated individuals with stable angina pectoris subject to elective coronary angiography. To keep the study group as homogeneous as possible, patients with diabetes mellitus were excluded. Subjects with normal coronary angiograms (n = 13) or insignificant (< 50%) coronary flow obstruction(s) (n = 4) were grouped together. The remaining cohort (n = 96) with at least one significant (> or = 50%) flow obstruction in at least one major coronary artery served as controls.

    RESULTS:

    Before angiography, platelet activity in vitro on stimulation with a thrombin-receptor activating peptide (TRAP-6) (57 micromol/l and 74 micromol/l) and ADP (1.7 micromol/l and 8.5 micromol/l) was determined. Angina pectoris individuals without significant flow obstruction in major coronary arteries had enhanced platelet reactivity both when stimulated with TRAP-6 and ADP (P < 0.01 for both TRAP-6 concentrations and P < 0.05 for both ADP concentrations, respectively.

    CONCLUSIONS:

    It is concluded that angina pectoris without significant flow impediment in major epicardial arteries is associated with augmented platelet reactivity.

  • 322.
    Järemo, Petter
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk kemi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Richter, Arina
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Letter: Elevated platelet density and enhanced platelet reactivity in stable angina pectoris complicated by diabetes mellitus type II2009Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 124, nr 3, s. 373-374Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The prognosis of coronary heart disease (CHD) has changed for the better. Type II diabetes mellitus (T2DM) complicates CHD and is associated with less favorable prospects and higher rates of coronary recurrence.

    149 individuals below 75 years of age subject to elective coronary angiography to evaluate chest pain were consented. Patients were eligible if they did not have a history of rheumatic disease. 51 individuals treated medically for T2DM were compared with the remaining subjects (n = 98). Blood samples were obtained before elective coronary angiography.A special designed optical apparatus was used to analyze peak platelet density. Platelet bound fibrinogen after provocation reflecting the activation of the GPIIb-IIIa receptor i.e. platelet reactivity was determined with the use of a flow cytometer.

    T2DM is associated with augmented platelet density (p < 0.001).Diabetic platelets displayed enhanced reactivity when stimulating with higher concentrations ADP (8.5 μmol/l) (p < 0.01) and TRAP-6 (74 μmol/l) (p < 0.001).

    DTII patients with stable angina pectoris showed enhanced platelet density, augmented platelet reactivity and increased MPV. Platelets are more reactive in DTII. More aggressive platelets may offer a explanation as to why DTII has an impact upon the prognosis of CHD.

     

  • 323.
    Järemo, Petter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Buller, Caroline
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Post, Claes
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Winblad, Bengt
    Department of Neurobiology, Care Sciences and Society (NVS), KI-Alzheimer’s Disease Research Center, Karolinska Institute, Huddinge; Sweden.
    Alzheimer's disease is characterized by more low-density erythrocytes with increased volume and enhanced β-amyloid x-40 content2011Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 270, nr 5, s. 489-492Artikel i tidskrift (Övrigt vetenskapligt)
  • 324.
    Järemo, Petter
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Milovanovic, Micha
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Richter, Arina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Gender and stable angina pectoris: Women have greater thrombin-evoked platelet activity but similar adenosine diphosphate-induced platelet responses2005Ingår i: Thrombosis and Haemostasis, ISSN 0340-6245, E-ISSN 2567-689X, Vol. 94, nr 1, s. 227-228Övrigt (Övrigt vetenskapligt)
  • 325.
    Jörgensen, Kristian
    et al.
    Leg Kiropraktorers Riksorganisation.
    Rösblad, Birgit
    Leg Sjukgymnasters Riksförbund.
    Liedberg, Gunilla
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Hur utbildas vårdens personal i rörelseorganens sjukdomar?2007Rapport (Övrigt vetenskapligt)
    Abstract [sv]

      

  • 326. Beställ onlineKöp publikationen >>
    Karlsson, Agneta
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Transition towards autonomy and psychological empowerment in self-management, among teenagers with type 1 diabetes2007Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The general aim of this thesis was to study the transition process from dependency towards anatomy and psychological empowerment among teenagers with type 1 diabetes. Thirty-two teenagers (18 female/14 male) aged 13-17 took part in conversational interviews. The interviews followed a semi-structured question guide. Data comprised 31 tape recorded interviews (one informant did not want to be tape recorded). The research design was based on a phenomenological and life world perspective including two different analysis methods.

    The transition towards autonomy among teenagers with type 1 diabetes was elucidated in a phenomenological approach (paper I). Through the teenagers’ narratives about their daily life experiences with type 1 diabetes there emerged the over-riding theme “Hovering between individual actions and support of others”. This theme illustrates the main problem related to diabetes management - duality in dependence and independence. The themes “growth through individual self-reliance” and “growth through confirmation of others” seem to facilitate the transition process from dependency towards autonomy. Experiences of the Empowerment Education Programme (EEP) were studied by a qualitative content analysis (paper II). From the teenagers’ descriptions the over-riding theme was formulated as “Sense of community”, and this covered the categories of social fellow feeling, collaborative learning, and community of interests. A synthesis of the findings illustrates that individual self-reliance, confirmation of others, and sense of community are closely related to individual inner resources, trust in others, and the feeling of belonging, which are all suggested as specific goals of empowerment and fulfilment of psychological empowerment. A model was created to explain the relation between psychological empowerment and growth through individual self-reliance, confirmation of others, and sense of community. Professional nursing care might start from the unique situation and context the individual experiences and exists in. Social meetings with like-minded youth were highly appreciated among the teenagers. The teenagers showed their willingness to transform themselves towards becoming more independent in self-management, and the teenage years may be the right period to empower and coach the teenagers towards autonomy and prepare them for adulthood living with type 1 diabetes.

    Delarbeten
    1. Teenagers with type 1 diabetes - a phenomenological study of the transition towards autonomy in self-management
    Öppna denna publikation i ny flik eller fönster >>Teenagers with type 1 diabetes - a phenomenological study of the transition towards autonomy in self-management
    2008 (Engelska)Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, International Journal of Nursing Studies, Vol. 45, nr 4, s. 562-570Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Becoming autonomous is an important aspect of teenagers’ psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support.

    Objective: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes.

    Design and method: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis.

    Participants: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes.

    Findings: The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme “hovering between individual actions and support of others”. The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme “confirmation of others” showed that parental encouragement increased the certainty of teenagers’ standpoints; peers’ acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers’ self-esteem.

    Conclusion: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

    Nyckelord
    Teenage diabetes, Adolescence, Self-management, Transition, Autonomy, Caring, Phenomenology
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-12935 (URN)10.1016/j.ijnurstu.2006.08.022 (DOI)
    Tillgänglig från: 2008-02-18 Skapad: 2008-02-18 Senast uppdaterad: 2017-12-13
    2. Teenagers' experiences of participation in an Empowerment Education Programme for people with type I diabetes
    Öppna denna publikation i ny flik eller fönster >>Teenagers' experiences of participation in an Empowerment Education Programme for people with type I diabetes
    2007 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikel i tidskrift (Refereegranskat) Submitted
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-12936 (URN)
    Tillgänglig från: 2008-02-18 Skapad: 2008-02-18 Senast uppdaterad: 2017-12-13
    Ladda ner fulltext (pdf)
    FULLTEXT01
    Ladda ner (pdf)
    COVER01
    Ladda ner (pdf)
    POPULARSUMMARY01
  • 327.
    Karlsson, Agneta
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Arman, Maria
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Wikblad, Karin
    Linköpings universitet, Institutionen för vård och välfärd. Linköpings universitet, Hälsouniversitetet.
    Teenagers with type 1 diabetes - a phenomenological study of the transition towards autonomy in self-management2008Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, International Journal of Nursing Studies, Vol. 45, nr 4, s. 562-570Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Becoming autonomous is an important aspect of teenagers’ psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support.

    Objective: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes.

    Design and method: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis.

    Participants: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes.

    Findings: The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme “hovering between individual actions and support of others”. The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme “confirmation of others” showed that parental encouragement increased the certainty of teenagers’ standpoints; peers’ acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers’ self-esteem.

    Conclusion: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

  • 328.
    Karlsson, Agneta
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Viklund, Gunnel
    Department of Medical Sciences Faculty of Medicine, Uppsala University, Uppsala, and Karolinska Institute Department of Woman and Child Health, Stockholm, Sweden.
    Arman, Maria
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Teenagers' experiences of participation in an Empowerment Education Programme for people with type I diabetes2007Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikel i tidskrift (Refereegranskat)
  • 329.
    Karlsson, Marit
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping.
    Hur vill vi dö? Snabbt, smärtfritt, sederad och med sällskap?: Den goda döden och konsekvenser för sjukvården2013Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, nr 1, s. 132-139Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Majoriteten av människor i dagens västerländska samhälle dör en långsam förväntad död till följd av kronisk sjukdom. Under livets sista tid fattas många beslut inom sjukvården, som bidrar till formandet av döendet. Det finns ingen enhetlig beskrivning av vad som utgör en god död, utan detta varierar på grupp- och individnivå. Oomstridda kriterier för en god död är att få dö värdigt och utan lidande, med god livskvalitet och medbestämmande, samt med bevarade sociala relationer. Mer omdiskuterade kriterier för en god död rör personlig acceptans av döden, med kontroll och oberoende, och med fullständigt självbestämmande och uttryckt individualitet. För att sjukvården skall möjliggöra en god död för patienten behövs individualiserad vård baserad på samtal där patienten fått uttrycka sina önskemål.

  • 330.
    Karlsson, Marit
    et al.
    Karolinska institutet.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum.
    Strang, Peter
    Karolinska Institute, Stockholm.
    Correction: Dying with dignity according to Swedish medical students (vol 14, pg 334, 2006)2011Ingår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 19, nr 7, s. 1065-1065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    n/a

  • 331.
    Karlsson, Marit
    et al.
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum. Linköpings universitet, Hälsouniversitetet.
    Strang, Peter
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Dying cancer patients' own opinions on euthanasia: An expression of autonomy? A qualitative study.2012Ingår i: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 26, nr 1, s. 34-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Deliberations on euthanasia are mostly theoretical, and often lack first-hand perspectives of the affected persons. METHOD: Sixty-six patients suffering from cancer in a palliative phase were interviewed about their perspectives of euthanasia in relation to autonomy. The interviews were transcribed verbatim and analysed using qualitative content analysis with no predetermined categories. RESULTS: The informants expressed different positions on euthanasia, ranging from support to opposition, but the majority were undecided due to the complexity of the problem. The informants' perspectives on euthanasia in relation to autonomy focused on decision making, being affected by (1) power and (2) trust. Legalization of euthanasia was perceived as either (a) increasing patient autonomy by patient empowerment, or (b) decreasing patient autonomy by increasing the medical power of the health care staff, which could be frightening. The informants experienced dependence on others, and expressed various levels of trust in others' intentions, ranging from full trust to complete mistrust. CONCLUSIONS: Dying cancer patients perceive that they cannot feel completely independent, which affects true autonomous decision making. Further, when considering legalization of euthanasia, the perspectives of patients fearing the effects of legalization should also be taken into account, not only those of patients opting for it.

  • 332.
    Karlsson, Marit
    et al.
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping. Linköpings universitet, Hälsouniversitetet.
    Strang, Peter
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives.2012Ingår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, nr 5, s. 1065-1071Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. METHODS: Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. RESULTS: The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. CONCLUSIONS: Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.

  • 333.
    Kato, Naoko
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. University of Tokyo, Japan JSPS Postdoctoral Fellow for Research Abroad, Tokyo, Japan .
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Ben Gal, Tuvia
    Rabin Medical Center, Petah Tikva, Israel; Tel Aviv University, Israel .
    Learning self-care after left ventricular assist device implantation2014Ingår i: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 11, nr 3, s. 290-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The number of heart failure (HF) patients living with a left ventricular assist device (LVAD) as destination therapy is increasing. Successful long-term LVAD support includes a high degree of self-care by the patient and their caregiver, and also requires long-term support from a multidisciplinary team. All three components of self-care deserve special attention once an HF patient receives an LVAD, including activities regarding self-care maintenance (activities related both to the device and lifestyle), self-care monitoring (e.g., monitoring for complications or distress), and self-care management (e.g., handling alarms or coping with living with the device). For patients to perform optimal self-care once they are discharged, they need optimal education that focuses on knowledge and skills through a collaborative, adult learning approach.

  • 334.
    Keady, John
    et al.
    University of Manchester, England .
    Jones, Lesley
    Greater Manchester West Mental Health NHS Fdn Trust, England .
    Ward, Richard
    University of Stirling, Scotland .
    Koch, Susan
    Helen Macpherson Smith Institute Community Heatlh, Australia .
    Swarbrick, Caroline
    University of Manchester, England .
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Davies-Quarrell, Vivienne
    Glen Devon, Wales .
    Williams, Sion
    Bangor University, Wales .
    Introducing the bio-psycho-social-physical model of dementia through a collective case study design2013Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, nr 19-20, s. 2768-2777Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives To provide evidence for the development of a physical domain attached to the well-known bio-psycho-social model of dementia. The objectives were to develop a set of international case studies that followed a trajectory approach, from prevention to end-of-life care. less thanbrgreater than less thanbrgreater thanBackground In the UK the bio-psycho-social model has informed the shape of the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence dementia guideline. However, limited attention has been paid to outlining and describing a physical domain of dementia, a discrepancy that informed the rationale for this study. less thanbrgreater than less thanbrgreater thanDesign A collective case study design was used to address the research aim and objectives. less thanbrgreater than less thanbrgreater thanMethods Case studies from along the trajectory of dementia were provided by an international team of contributors from an inter-disciplinary background comprising nursing (general and mental health), social work and social science. less thanbrgreater than less thanbrgreater thanResults The teams synthesis and analysis of the six case studies generated five repeating themes with each theme becoming components of a physical domain of dementia. The five identified physical components were: (1) physical well-being, (2) physical health and examination, (3) physical care, (4) physical treatment and (5) physical environment. less thanbrgreater than less thanbrgreater thanConclusions The development of a bio-psycho-social-physical model of dementia presents a holistic and culturally sensitive approach to understanding the experience of living with dementia, and to providing care and support in a variety of situations and contexts. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The physical domain of dementia has particular relevance to nursing and nursing practice, such as providing physical care at the end-of-life. The interplay between the biological-psychological-social-physical domains of dementia and the trajectory of dementia could form the basis of clinical decision-making and practice.

  • 335.
    Kielhofner, Gary
    et al.
    University of Illinois at Chicago, USA.
    Forsyth, Kirsty
    Queen Margaret University College, Edinburgh, Scotland.
    Clay, Christine
    Chicago Lighthouse for The Blind, USA.
    Ekbladh, Elin
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hemmingsson, Helena
    Karolinska Institutet, Stockholm.
    Keponen, Riita
    Helsinki Polytechnic Stadia; Finland.
    Olson, Linda
    Rusch University, Chicago, USA.
    Talking with clients: assessments that collect information2008Ingår i: Model of human occupation: theory and application / [ed] Gary Kielhofner, Philadelphia, USA: Lippincott Williams & Wilkins , 2008, 4, s. 262-287Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

      Model of Human Occupation, Fourth Edition offers a complete and current presentation of the most widely used model in occupational therapy, and delivers the latest in MOHO theory, research, and application to practice. This authoritative text explores what motivates individuals, how they select occupations and establish everyday routines, how environment influences occupational behavior, and more. NEW TO THIS EDITION: Case Vignettes that illustrate key concepts that students need to know Case Studies that help students apply the model to practice Chapter on evidence based practice (ch. 25) Chapter on World Health Organization and AOTA practice framework and language links the MOHO model to two widely used frameworks (ch. 27) Photographs of real patients help bring the concepts and cases to life

  • 336.
    Kjellberg, Anette
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Being a citizen2002Ingår i: Disability & Society, ISSN 0968-7599, E-ISSN 1360-0508, Vol. 17, nr 2, s. 187-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There has been a striving in Sweden, ideologically and legally, since the 1960s to develop and extend citizenship to persons with learning disabilities. This article had the purpose to capture and describe how persons with learning disabilities conceive citizenship and opportunities to participate in the societal arena. Twenty-three persons with learning disabilities were interviewed two times. Qualitative analysis focused on three themes: areas of interest, voting and significant persons. The analysis displayed that the informants' conceptions about citizenship differed in relation to environmental contexts. Significant persons are discussed as having considerable importance when exercising citizenship.

  • 337.
    Kjellberg, Anette
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    From patient to participatory citizen: Literature review of disability policy on participation and access in relation to occupational therapy practice2010Ingår i: WFOT Bulletin, ISSN 1447-3828, Vol. 61, s. 32-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to analyse Swedish laws and steering documents concerning disability policy on participation and accessibility in relation to occupational therapy practice. An analysis of documents that have influenced Swedish disability policy was performed based mainly on Swedish documents but also including key international documents. These documents can be used to support and guide the occupational therapists’ work. People with disabilities have the right to have an accessible and participatory life but an evaluation of the national goals for people with disabilities in Sweden showed that the goals had not been fully reached. Occupational therapists have knowledge and an obligation to work with participation and accessibility issues and need to expand their interventions from the level of direct patient treatment to a societal level to better enable people with disabilities to be participatory citizens. This paper may inform occupational therapists in other countries the value of analyzing their government’s laws and documents to evaluate their stance on access and participation and how that effects the work of occupational therapy.

  • 338.
    Kjellberg, Anette
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    More or less independent2002Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 24, nr 16, s. 828-840Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to describe how persons with learning disabilities conceived their opportunities to participate in decisions in different environmental settings. Further, the study focused on factors that persons with learning disabilities conceived what facilitated or hindered their participation in decisions in everyday life. Method: Qualitative interviews were performed with 23 persons with mild to moderate learning disabilities. The youngest was 22 years and the oldest 63. Data were categorized in three levels of decision making, described as independent, interdependent and dependent. Results: The participants were presented in five profiles depending on level of decision and in relation to the environmental arenas work and leisure. Most conceptions were categorized as dependent or interdependent regardless of arena. Few examples of independence were given. Factors that facilitated or hindered participation in decisions varied: national legislation, attitudes, and forms of daily routines and activities. Conclusions: This study showed a gap between official ideologies of every citizen's rights and the studied participants' conceptions of how they participate in decisions in everyday life. As a consequence of this, professionals have to develop methods promoting decision-making as conceived by the clients.

  • 339.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Transition to higher education and work for young adults with neuropsychiatric disabilities2012Konferensbidrag (Övrigt vetenskapligt)
  • 340.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Övergång till högre studier och arbetsliv för unga vuxna med neuropsykiatriska diagnoser2012Konferensbidrag (Övrigt vetenskapligt)
  • 341.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Övergången från skola till högre studier och arbete för unga vuxna med ADHD och Aspergers syndrom.2013Konferensbidrag (Refereegranskat)
  • 342.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Bolic, Vedrana
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Utilization of an ICF-based assessment from occupational therapists' perspectives2012Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, nr 3, s. 274-281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The International Classification of Functioning, Disability and Health (ICF) is intended to provide a framework for practitioners. A client-centred ICF-based assessment (ICF-A) was developed to be used by occupational therapists in problem identification. The aim was to evaluate the ICF-based assessment (ICF-A) focusing on the examination of its utility on the basis of occupational therapists' perspectives regarding clinical relevance and potential for implementation. Eleven occupational therapists, most of whom worked in hospitals, performed in total 99 ICF-A based assessments and completed three self-reported questionnaires related to the utility of the ICF-A, resulting in a total of 121 questionnaires. Data were analysed using descriptive statistics and directed content analysis. The results from this initial testing of ICF-A showed that its clinical relevance was considered low since ICF-A included too many categories. In addition, the time needed to perform the assessments decreased during the 10 assessment occasions. Furthermore, concerning its implementation potential, the client-centred approach in the ICF-A was rated as weak. The target group did not benefit from using ICF-A in a hospital context. Hence, an investigation of its utility among occupational therapists in community and primary care will be the next step in the development of the ICF-A.

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  • 343.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Bringzén, KennethIKP .Eklöf, DavidIKP .Nåbo, MatsIKP .
    Design for all: Inter-professional integration among students from two faculties. I Celebrating the Past by Expanding the Future 1986-2006.2006Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
    Abstract [en]

      

  • 344.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Hellberg, Kristina
    Linnéuniversitetet, Inst. för pedagogik, Speciallärar- specialprogrammen.
    Transition till vuxenlivet2016Ingår i: Arbetsterapi för barn och ungdom / [ed] Ann-Christin Eliasson, Helene Lidström, Marie Peny-Dahlstrand, Lund: Studentlitteratur AB, 2016, 1, s. 93-104Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 345.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hellberg, Kristina
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Filosofiska fakulteten.
    Övergångsprocessen från skola till vidare studier och arbete. Intervjuer med unga vuxna med ADHD och Aspergers syndrom2012Konferensbidrag (Övrigt vetenskapligt)
  • 346.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Citizenship and Voting: Experiences of Persons With Intellectual Disabilities in Sweden2013Ingår i: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 10, nr 4, s. 326-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Sweden, citizenship and participation in society have been emphasized as important for persons with intellectual disabilities for over four decades. The aim of the study was to describe, from a longitudinal perspective, how persons with intellectual disabilities experience citizenship and voting. The characteristics of becoming and being a voter were also identified. Thirteen women and seven men, aged 22-55 years on the first interview occasion in 1998, were interviewed three times more in regard to general elections in Sweden during the period 1998-2006. A constant comparative method was used in the data analysis. Two-thirds of the participants voted in at least one of the three elections and a group of seven people did not vote at all. Age and significant persons were the most crucial factors for voting. The characteristics of a voter were having the idea and belief that one should vote as a citizen and having experience of voting so that one knew how to do it. In both these cases, significant persons and age were of importance. The authors suggest that the development of Swedish social policy may have influenced the voting behavior as people born during the 1940s and 1950s voted more often than people born during the 1960s and 1970s. Additionally, their social networks may enable persons with intellectual disabilities to make full use of their right to exercise political citizenship and to vote.

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  • 347.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Holstein, Jane
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Design för alla - en utmaning för arbetsterapeutstudenter.2013Konferensbidrag (Refereegranskat)
  • 348.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Kåhlin, Ida
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Samhälle, mångfald, Identitet (SMI). Linköpings universitet, Filosofiska fakulteten.
    Alfredsson Ågren, Kristin
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Arbetsterapi för vuxna personer med utvecklingsstörning en litteraturgenomgång: Tidskriften arbetsterapeuten2010Övrigt (Övrigt vetenskapligt)
  • 349.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Kåhlin, Ida
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, NISAL - Nationella institutet för forskning om äldre och åldrande. Linköpings universitet, Filosofiska fakulteten.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Taylor, Renée
    Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA.
    The myth of participation in occupational therapy: reconceptualizing a client-centred approach2012Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, nr 5, s. 421-427Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.

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  • 350.
    Kjellberg, Anette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Taylor, Renee
    Dep. of Occcupational Therapy, University of Illinois, Chicago, USA.
    Sandell, Caroline
    Östergötlands Läns Landsting.
    Increasing participation in occupational therapy: Findings from a neuropsychiatric program2012Konferensbidrag (Övrigt vetenskapligt)
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