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  • 8601.
    Zilg, B.
    et al.
    Karolinska Institute, Sweden.
    Alkass, K.
    Karolinska Institute, Sweden.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Druid, H.
    Karolinska Institute, Sweden.
    Interpretation of postmortem vitreous concentrations of sodium and chloride2016In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 263, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Vitreous fluid can be used to analyze sodium and chloride levels in deceased persons, but it remains unclear to what extent such results can be used to diagnose antemortem sodium or chloride imbalances. In this study we present vitreous sodium and chloride levels from more than 3000 cases. We show that vitreous sodium and chloride levels both decrease with approximately 2.2 mmol/L per day after death. Since potassium is a well-established marker for postmortem interval (PMI) and easily can be analyzed along with sodium and chloride, we have correlated sodium and chloride levels with the potassium levels and present postmortem reference ranges relative the potassium levels. We found that virtually all cases outside the reference range show signs of antemortem hypo- or hypernatremia. Vitreous sodium or chloride levels can be the only means to diagnose cases of water or salt intoxication, beer potomania or dehydration. We further show that postmortem vitreous sodium and chloride strongly correlate and in practice can be used interchangeably if analysis of one of the ions fails. It has been suggested that vitreous sodium and chloride levels can be used to diagnose drowning or to distinguish saltwater from freshwater drowning. Our results show that in cases of freshwater drowning, vitreous sodium levels are decreased, but that this mainly is an effect of postmortem diffusion between the eye and surrounding water rather than due to the drowning process, since the decrease in sodium levels correlates with immersion time. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 8602.
    Zilg, B
    et al.
    Karolinska Institute.
    Alkass, K
    Karolinska Institute.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Druid, H
    Karolinska Institute.
    Postmortem identification of hyperglycemia2009In: FORENSIC SCIENCE INTERNATIONAL, ISSN 0379-0738, Vol. 185, no 1-3, p. 89-95Article in journal (Refereed)
    Abstract [en]

    The detection of diabetic coma postmortem requires accurate biochemical analysis. Due to continuous consumption of glucose by surviving cells postmortem, blood glucose levels decrease rapidly. Therefore, vitreous fluid has been used as a substitute in forensic practice, since it has a very low cell count, It has been repeatedly reported that the sum value of vitreous glucose and lactate should be used to estimate the original antemortem blood glucose level, based on the assumption that pre-existing glucose is gradually converted to lactate under anaerobic conditions during agonal phase and the early postmortem period. in this Study, we applied a strategy including consistent sampling of vitreous fluid from the centre of both eyes of deceased subjects as soon as possible after arrival at the morgue, and immediate bedside analysis using a blood gas instrument. In total, 3076 cases were included during 2004-2006. We found that, after an initial drop of vitreous glucose during the very early postmortem period, the levels stayed stable for appreciable time postmortem. Analysis of a second sample collected at autopsy 1-3 days later gave similar results (R-2 = 0.90). In contrast, the vitreous lactate levels showed a steady increase. This implies that the sum value of glucose and lactate increases with postmortem time, as reflected by vitreous potassium level. In fact, a statistically significant difference in the SUM Value was seen between subjects with potassium below 10 mmol/L (n = 1086) and above 20 mmol/L (n = 531), p < .001. In addition, in this large material, we did not identify a single case with circumstantial indication of hyperglycemia that only showed high vitreous lactate. We therefore suggest that vitreous glucose alone Should be used to diagnose hyperglycemia postmortem and that the limit of 10 mmol/L should have a good specificity for diabetic coma, which theoretically would equal an original blood glucose value of about 26 mmol/L. As to the methodology, we found that sonication, centrifugation and addition of fluoride to the samples are unnecessary procedures when using a blood gas instrument. The strategy resulted in a doubling of the number of diabetic coma identified at our department compared to preceding period when analysis only was performed on selected cases.

  • 8603.
    Zilg, B.
    et al.
    Karolinska Institute, Sweden.
    Bernard, S.
    University of Lyon 1, France.
    Alkass, K.
    Karolinska Institute, Sweden.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Druid, H.
    Karolinska Institute, Sweden.
    A new model for the estimation of time of death from vitreous potassium levels corrected for age and temperature2015In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 254, p. 158-166Article in journal (Refereed)
    Abstract [en]

    Analysis of potassium concentration in the vitreous fluid of the eye is frequently used by forensic pathologists to estimate the postmortem interval (PMI), particularly when other methods commonly used in the early phase of an investigation can no longer be applied. The postmortem rise in vitreous potassium has been recognized for several decades and is readily explained by a diffusion of potassium from surrounding cells into the vitreous fluid. However, there is no consensus regarding the mathematical equation that best describes this increase. The existing models assume a linear increase, but different slopes and starting points have been proposed. In this study, vitreous potassium levels, and a number of factors that may influence these levels, were examined in 462 cases with known postmortem intervals that ranged from 2 h to 17 days. We found that the postmortem rise in potassium followed a non-linear curve and that decedent age and ambient temperature influenced the variability by 16% and 5%, respectively. A long duration of agony and a high alcohol level at the time of death contributed less than 1% variability, and evaluation of additional possible factors revealed no detectable impact on the rise of vitreous potassium. Two equations were subsequently generated, one that represents the best fit of the potassium concentrations alone, and a second that represents potassium concentrations with correction for decedent age and/or ambient temperature. The former was associated with narrow confidence intervals in the early postmortem phase, but the intervals gradually increased with longer PMIs. For the latter equation, the confidence intervals were reduced at all PMIs. Therefore, the model that best describes the observed postmortem rise in vitreous potassium levels includes potassium concentration, decedent age, and ambient temperature. Furthermore, the precision of these equations, particularly for long PMIs, is expected to gradually improve by adjusting the constants as more reference data are added over time. A web application that facilitates this calculation process and allows for such future modifications has been developed. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 8604.
    Zimdahl Kahlin, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Helander, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences.
    Skoglund, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Mårtensson, Lars-Göran
    Linköping University, Department of Physics, Chemistry and Biology, Chemistry. Linköping University, Faculty of Science & Engineering.
    Lindqvist Appell, Malin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Comprehensive study of thiopurine methyltransferase genotype, phenotype, and genotype-phenotype discrepancies in Sweden2019In: Biochemical Pharmacology, ISSN 0006-2952, E-ISSN 1356-1839, Vol. 164, p. 263-272Article in journal (Refereed)
    Abstract [en]

    Thiopurines are widely used in the treatment of leukemia and inflammatory bowel diseases. Thiopurine metabolism varies among individuals because of differences in the polymorphic enzyme thiopurine methyltransferase (TPMT, EC 2.1.1.67), and to avoid severe adverse reactions caused by incorrect dosing it is recommended that the patients TPMT status be determined before the start of thiopurine treatment. This study describes the concordance between genotyping for common TPMT alleles and phenotyping in a Swedish cohort of 12,663 patients sampled before or during thiopurine treatment. The concordance between TPMT genotype and enzyme activity was 94.5%. Compared to the genotype, the first measurement of TPMT enzyme activity was lower than expected for 4.6% of the patients. Sequencing of all coding regions of the TPMT gene in genotype/phenotype discrepant individuals led to the identification of rare and novel TPMT alleles. Fifteen individuals (0.1%) with rare or novel genotypes were identified, and three TPMT alleles (TPMT*42, *43, and *44) are characterized here for the first time. These 15 patients would not have been detected as carrying a deviating TPMT genotype if only genotyping of the most common TPMT variants had been performed. This study highlights the benefit of combining TPMT genotype and phenotype determination in routine testing. More accurate dose recommendations can be made, which might decrease the number of adverse reactions and treatment failures during thiopurine treatment.

    The full text will be freely available from 2020-04-18 07:47
  • 8605.
    Zinner, Christoph
    et al.
    University of Wurzburg, Germany; Mid Sweden University, Sweden.
    Morales-Alamo, David
    University of Las Palmas Gran Canaria, Spain; University of Las Palmas Gran Canaria, Spain.
    Ortenblad, Niels
    Mid Sweden University, Sweden; University of Southern Denmark, Denmark.
    Larsen, Filip J.
    Swedish School Sport and Health Science, Sweden.
    Schiffer, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Willis, Sarah J.
    Mid Sweden University, Sweden.
    Gelabert-Rebato, Miriam
    University of Las Palmas Gran Canaria, Spain; University of Las Palmas Gran Canaria, Spain.
    Perez-Valera, Mario
    University of Las Palmas Gran Canaria, Spain; University of Las Palmas Gran Canaria, Spain.
    Boushel, Robert
    University of British Columbia, Canada.
    Calbet, Jose A. L.
    University of Las Palmas Gran Canaria, Spain; University of Las Palmas Gran Canaria, Spain; University of British Columbia, Canada.
    Holmberg, Hans-Christer
    Mid Sweden University, Sweden; University of British Columbia, Canada; UiT Arctic University of Norway, Norway.
    The Physiological Mechanisms of Performance Enhancement with Sprint Interval Training Differ between the Upper and Lower Extremities in Humans2016In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 7, no 426Article in journal (Refereed)
    Abstract [en]

    To elucidate the mechanisms underlying the differences in adaptation of arm and leg muscles to sprint training, over a period of 11 days 16 untrained men performed six sessions of 4-6 x 30-s all-out sprints (SIT) with the legs and arms, separately, with a 1-h interval of recovery. Limb-specific VO(2)peak, sprint performance (two 30-s Wingate tests with 4-min recovery), muscle efficiency and time-trial performance (TT, 5-min all-out) were assessed and biopsies from the m. vastus lateralis and m. triceps brachii taken before and after training. VO(2)peak and Wmax increased 3-11% after training, with a more pronounced change in the arms (P amp;lt; 0.05). Gross efficiency improved for the arms (+8.8%, P amp;lt; 0.05), but not the legs (-0.6%). Wingate peak and mean power outputs improved similarly for the arms and legs, as did TT performance. After training, VO2 during the two Wingate tests was increased by 52 and 6% for the arms and legs, respectively (P amp;lt; 0.001). In the case of the arms, VO2 was higher during the first than second Wingate test (64 vs. 44%, P amp;lt; 0.05). During the TT, relative exercise intensity, HR, VO2, VCO2, V-E, and V-t were all lower during arm-cranking than leg-pedaling, and oxidation of fat was minimal, remaining so after training. Despite the higher relative intensity, fat oxidation was 70% greater during leg-pedaling (P = 0.017). The aerobic energy contribution in the legs was larger than for the arms during the Wingate tests, although VO2 for the arms was enhanced more by training, reducing the O-2 deficit after SIT. The levels of muscle glycogen, as well as the myosin heavy chain composition were unchanged in both cases, while the activities of 3-hydroxyacyl-CoA-dehydrogenase and citrate synthase were elevated only in the legs and capillarization enhanced in both limbs. Multiple regression analysis demonstrated that the variables that predict TT performance differ for the arms and legs. The primary mechanism of adaptation to SIT by both the arms and legs is enhancement of aerobic energy production. However, with their higher proportion of fast muscle fibers, the arms exhibit greater plasticity.

  • 8606.
    Zuzak, Tycho J,
    et al.
    University of Childrens Hospital Essen, Germany .
    Bonkova, Johanna
    Soc Anthroposoph Med, Czech Republic .
    Careddu, Domenico
    Italian Soc Nat Medical SIMN, Italy .
    Garami, Miklos
    Semmelweis University, Hungary .
    Hadjipanayis, Adamos
    Larnaca Hospital, Cyprus .
    Jazbec, Janez
    University of Medical Centre, Slovenia .
    Merrick, Joav
    QOL Research Centre, Denmark .
    Miller, Joyce
    Bournemouth University, England .
    Ozturk, Candan
    Dokuz Eylul University, Turkey .
    Persson, Ingrid
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Petrova, Guenka
    Medical University of Sofia, Bulgaria .
    Saz Peiro, Pablo
    Fac Med, Spain .
    Schraub, Simon
    University of Strasbourg, France .
    Simoes-Wuest, A Paula
    Norwegian University of Science and Technology, Norway .
    Steinsbekk, Aslak
    Norwegian University of Science and Technology, Norway .
    Stockert, Karin
    Medical University of Sofia, Bulgaria .
    Stoimenova, Assena
    Medical University of Sofia, Bulgaria .
    Styczynski, Jan
    Nicholas Copernicus University, Poland .
    Tzenova-Savova, Alexandra
    Medical University of Sofia, Bulgaria .
    Ventegodt, Soren
    QOL Research Centre, Denmark .
    Vlieger, Arine M:
    St Antonius Hospital, Netherlands .
    Laengler, Alfred
    Gemeinschaftskrankenhaus Herdecke, Germany .
    Use of complementary and alternative medicine by children in Europe: Published data and expert perspectives2013In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 21, p. S34-S47Article in journal (Refereed)
    Abstract [en]

    Introduction: Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children. less thanbrgreater than less thanbrgreater thanMethods: A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated. less thanbrgreater than less thanbrgreater thanResults: Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10-90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5-90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions. less thanbrgreater than less thanbrgreater thanConclusion: This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.

  • 8607.
    Ängarne-Lindberg, Teresia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Young adults with childhood experience of parental divorce: Disappointment and contentment2009In: Journal of Divorce and Remarriage, ISSN 1050-2556, E-ISSN 1540-4811, Vol. 50, no 3, p. 172-184Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to use in-depth interviews to identify and describe experiences of parental divorce among adult children whose parents divorced 15 years earlier. Ten out of 76 interviews were recorded and transcribed verbatim, and data were analyzed using qualitative content analysis. Two categories of experiences were identified: disappointment and contentment. Two subcategories of disappointment were distinguished: disappointment toward mother, father, or both, and disappointment with relatives and other surrounding persons. Four subcategories of contentment were distinguished: contentment in the belief that the members of the original family received a good or even better life after the divorce, contentment with how the divorce was handled by the parents, contentment and inner strength as a part of the child's own personality, and contentment with receiving adequate help during and after the parental divorce.

  • 8608.
    Ängerud, Karin H
    et al.
    Umeå University, Sweden.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Isaksson, Rose-Marie
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Department of Research, Norrbotten County Council, Sweden.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 3, p. 201-207Article in journal (Refereed)
    Abstract [en]

    AIM: In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

    METHODS AND RESULTS: This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001).

    CONCLUSION: Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and when to decide if there is a need for an ambulance.

  • 8609.
    Ågren, Axel
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Äldres ensamhet i media: mellan "epidemi" och individuell upplevelse2019In: Mind, ISSN 2002-4282, no 2, p. 4p. 36-39Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Ensamhet är idag en fråga som berör och får stor uppmärksamhet i massmedia. I ny forskning riktas blicken mot hur äldres ensamhet beskrivs i svensk dagspress idag, vilken bland annat visat att ensamhet främst kopplas till äldre samt att fokus ligger vid äldreomsorg och inte ensamhet i sig.

  • 8610.
    Ågren, Axel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences. Ensommes gamle vaern, Danmark..
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Who is designated responsibility for reducing loneliness among older people?2018In: Lessons of a lifetime, Oslo, 2018Conference paper (Other academic)
  • 8611.
    Ågren, S
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Heart failure in the family - design and methodology of a randomised study evaluating education and psychosocial support to patients and their caregivers.2005Conference paper (Other academic)
  • 8612.
    Ågren, Sophia
    et al.
    Linköping University, Department of Medical and Health Sciences.
    Ågren, Pauline
    Linköping University, Department of Medical and Health Sciences.
    Sexuell hälsa hos kvinnor med ADHD: en strukturerad intervjustudie via Facebook2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background The number of people diagnosed with ADHD increases. In order to apply person-centered care, knowledge and understanding of how women with ADHD experience their sexual health, is required. Midwives meets women of all ages and should apply person-centered care in the meeting with all woman.

    Aim To describe experiences of sexual health among women with ADHD. Study design A qualitative study with inductive approach. A structured interview form was answered by 267 women. They were recruited via the Facebook group "ADHD Sverige". The data collection was analyzed by Hsieh and Shannon's (2005) conventional content analysis. Results The analysis resulted in two categories, Sexual Satisfaction and Sex that Causes Harm. The categories describe the factors that, according to the women's experiences, influenced their sexual health. Conclusions The women described the sexual desire as an important aspect of their sexual health. Mental illness and/or drug treatment was said to be a cause of impaired sexual desire in women. The women who were in a relationship stated that good communication and gender equality promoted their sexual health. Furthermore, sexual illness proved to be related to reduced self-esteem. The midwife should keep this in mind in order to be able to acquire a complete sexual anamnesis, thus identifying risk factors for sexual illness.

  • 8613.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Supportive care for patients with heart failure and their partners: A descriptive and interventional study2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Having the support of a partner is essential for both health related quality of life and survival in heart failure patients. However, caring for a patient with heart failure may affect the health related quality of life, well‐being and cause a burden for the partner. The partner is expected to be responsible for the care, which may have consequences for the heart failure patient’s long‐term health and well‐being. Further research to determine health related quality of life, well‐being, caregiver burden and needs of partners is warranted as well as studies evaluating interventions targeting patient‐partner dyads.

    Aim: The overall aim was to describe how the life situation of patient‐partner dyads was influenced by heart failure and to determine the effects of an intervention of follow‐up with education and psychosocial support for patient‐partner dyads.

    Design and methods: The thesis is based on three quantitative studies and one qualitative study. The first two studies were descriptive and included 135 dyads (patient‐partner) (I, II) and the randomised intervention study included a total of 155 dyads (IV). The qualitative study had a grounded theory approach. Thirteen partners were interviewed and data analysed using constant comparative method (III).

    Results: Caregiver burden was perceived as moderate in 30% of the partners and the rest experienced a low caregiver burden. The patients’ physical component score of SF‐36, partners’ mental component score of SF‐36 and perceived control explained 39% of the caregiver burden (I). Patients had lower health related quality of life compared to their partners in all dimensions except in the mental health domain of SF‐36 and lower qualityadjusted life year weights compared to their partners. Mental health scores were lower in partners compared to age and gender‐matched references. All other health related quality of life scores and the quality‐adjusted life year weights were comparable between the partners and the reference group. Patients had more depressive symptoms than their partners. There was no difference in the level of perceived control or knowledge about chronic heart failure between patients and partners (II). During grounded theory analysis confirmation was identified as describing the core category of the partners’ individual needs. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among partners (III). At the three month follow‐up the dyad‐intervention had improved perceived control in patients, but not in the partners. There were no other significant differences in the control and intervention group with regard to the dyads’ health related quality of life and symptoms of depression. There were also no differences in the patients’ self‐care behaviour and partners’ experiences of caregiver burden (IV).

    Conclusions and implications: Partners to patients with chronic heart failure are at risk of decreased mental well‐being. One third of the partners experienced a moderate caregiver burden and was therefore at a higher risk of poor mental health and decreased perceived control. During short‐term follow‐up the intervention with education and psychosocial support to dyads (patient‐partner) improved the level of perceived control in the chronic heart failure patient group. By identifying partnersʹ needs for security, rest for mind and body, and inner strength, healthcare professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions targeting dyads have been limited in previous research. Partners need to be prepared regarding the disease process, the daily regimen, hopes for the future and responsible care providers. They also need to be confirmed because they are vital to the patients’ recovery. Further, the effects of the intervention study should also include a long‐term follow‐up as well as an evaluation of the health‐economic perspective including direct and indirect costs of care.

    List of papers
    1. Do partners of patients with chronic heart failure experience caregiver burden?
    Open this publication in new window or tab >>Do partners of patients with chronic heart failure experience caregiver burden?
    2010 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 4, p. 254-262Article in journal (Refereed) Published
    Abstract [en]

    Aim: To describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure.

    Background: Care and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health.

    Methods: Data for this descriptive cross sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden.

    Results: The 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients’ Physical component score of SF-36 (p< 0.001), partners’ Mental component score of SF-36 (p< 0.001) and perceived control (p<0.01) accounted for 39% of the variance in caregiver burden.

    Conclusion: Caregiver burden was lower when the mental health of the partner and the physical health of the patient were better and the partner experienced higher control over the heart disease. A partner-centered approach to educate and support partners of patients with heart failure is essential to improve the life situation for patient-partner dyads.

    Place, publisher, year, edition, pages
    Amsterdam, Netherlands: Elsevier, 2010
    Keywords
    Caregiver burden, depression, health-related quality of life, heart failure, partner, nursing 1
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56227 (URN)10.1016/j.ejcnurse.2010.03.001 (DOI)000284683700009 ()
    Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
    2. The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life
    Open this publication in new window or tab >>The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life
    2011 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed) Published
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

    Place, publisher, year, edition, pages
    Aspen Publishers, 2011
    Keywords
    Heart failure, partner, health-related quality of life, quality-adjusted life year, knowledge
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56228 (URN)10.1097/JCN.0b013e3181ec0281 (DOI)000285138300015 ()
    Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12
    3. Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure
    Open this publication in new window or tab >>Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure
    Show others...
    2009 (English)In: HEART and LUNG, ISSN 0147-9563, Vol. 38, no 4, p. 284-291Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses needs are important because they are vital to the patients recovery.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20176 (URN)10.1016/j.hrtlng.2008.10.002 (DOI)
    Available from: 2009-09-01 Created: 2009-08-31 Last updated: 2013-09-03Bibliographically approved
    4. Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners
    Open this publication in new window or tab >>Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners
    2012 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 5, p. 359-366Article in journal (Refereed) Published
    Abstract [en]

    Background: Chronic heart failure (HF) may cause great suffering for both patients and their partners. High marital quality with sufficient emotional support has been found to influence long-term survival in patients with chronic HF. However, emotional reactions of burden, stress and depression have been found to be associated with the partner’s new role. Psychosocial support, and patients-partner education is usually not included in standard chronic HF care despite recommendations in international guidelines.

    Aim: To evaluate the effects of an integrated dyad care programme with education and psychosocial support to patients with chronic HF and their partners during a post-discharge period of 3 months after acute deterioration of chronic HF.

    Methods: A randomised, controlled design with a follow up assessment after 3 months was used. The dyads in the control group received care as usual. The experimental group participated in an integrated care intervention, delivered in three modules through nurse-led face-to-face counselling, a computer-based CD-ROM program and other written teaching materials.

    Results: The intervention improved perceived control (P<0.05) in patients, but not in the partners. There were no other significant differences between the groups with regard to the dyads’ health related quality of life and depressive symptoms, patients’ self-care behaviour and partners’ experiences of caregiver burden.

    Conclusion: This is the first major randomised study evaluating a programme focusing on the development of problem solving skills to assist the dyads in managing heart failure. The intervention significantly improved the level of perceived control in the patient group.

    Keywords
    Chronic heart failure, family, perceived control, quality of life, intervention, nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56231 (URN)10.1016/j.cardfail.2012.01.014 (DOI)000304078700002 ()
    Note
    funding agencies|Linkoping University||Swedish Research Council||Swedish Institute for Health Sciences||Heart and Lung Foundation||Heart and Lung Disease National Association||Lions Research Foundation||Health Sciences Centre||Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
  • 8614.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Psychoeducational support to post cardiac surgery heart failure patients and their partners: A randomised pilot study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 1, p. 10-18Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Postoperative heart failure is a serious complication that changes the lives of both the person who is critically ill and family in many ways. The purpose of this study was to evaluate the effects of an intervention in postoperative heart failure patient-partner dyads regarding health, symptoms of depression and perceived control.

    RESEARCH METHODOLOGY/DESIGN: Pilot study with a randomised controlled design evaluating psychosocial support and education from an interdisciplinary team.

    SETTING: Patients with postoperative heart failure and their partners.

    MAIN OUTCOME MEASURES: SF-36, Beck Depression Inventory, Perceived Control at baseline, 3 and 12 months.

    RESULTS: A total of 42 patient-partner completed baseline assessment. Partners in the intervention group increased health in the role emotional and mental health dimensions and patients increased health in vitality, social function and mental health dimensions compared with the control group. Patients' perceived control improved significantly in the intervention group over time.

    CONCLUSION: Psychoeducational support to post cardiac surgery heart failure dyads improved health in both patients and partners at short term follow-up and improved patients' perceived control at both short and long-term follow-up. Psychoeducational support appears to be a promising intervention but the results need to be confirmed in larger studies.

  • 8615.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Eriksson, Anna
    Hälsostödjande samtal2015Conference paper (Other academic)
    Abstract [en]

    Families who have a seriously ill family member in an intensive care unit face a demanding situation,threatening the normal functioning of the family. The burden onfamilies can be reduced by usingavailable resources, cohesiveness, supportive communication, flexibility and othersocial resources outsidethe family.If health promoting conversationsoffered to the family's ownabilities is strengthened, thisshould result in health promoting values to the family. In order to gain a better understanding of familyadaptation, we must not only see the family as a unit but also acknowledge the experiences of eachmember of the family.

    To investigate outcomes of the nurse led intervention, “Health promoting conversations with families” on family functioning and wellbeing in families with a member who has had critical illness.

    The study is a RCT study using a pre-test, post-test intervention and control group design. The inclusioncriteria will be: Patients over the age of 18, a minimum of 72 hours at the intensive care unit, and at leastone family member (>15 years) to each patient interested in participating. Within the study, quantitativeand qualitative data will be collected and analysed with descriptive and analytical statistical methods ofthe quantitative data and content analysis of the qualitative data.

    The conversations were considered to be healing and learning, because the family members can completememory loss from other family members' stories. Families showed a tendency to less stress and morehope, better mental health but poorer physical health in a pilot study. The project highlights knowledgeabout the health benefits of conversations about families where a family member has suffered from poorhealth. The health promoting conversations has a structure that makes conversations relatively easy toimplement in everyday healthcare and will be beneficial for many patients with critical illness and theirfamilies.

  • 8616.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Eriksson, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Orwelius, Lotti
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    The health promoting conversations intervention for families with a critically ill relative: A pilot study2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 50, p. 103-110Article in journal (Refereed)
    Abstract [en]

    Background: After intensive care unit treatment, patients often have prolonged impairments that affect their physical, cognitive and mental health. Family members can face overwhelming and emotionally challenging situations and their concerns and needs must be addressed. Objective: We investigated the outcomes of pilot randomised control trial, a nurse-led family intervention, Health Promoting Conversations, which focused on family functioning and wellbeing in families with a critically ill member. Study design: This randomised controlled pilot study used a pre-test, post-test design with intervention and control groups to investigate the outcomes of the nurse-led intervention in 17 families. Outcome measures: The Health Promoting Conversations intervention was evaluated using validated instruments that measure family functioning and family wellbeing: the General Functioning sub-scale from the McMaster Family Assessment Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical Outcome Short-Form Health Survey. Descriptive and analytical statistical methods were used to analyse the data. Results: After 12 months, the intervention group reported better family functioning than the control group. The intervention group also had better social functioning and mental health after 12 months. Conclusion: This intervention may improve family wellbeing by improving family function, reducing stress, and promoting better mental health. (C) 2018 Elsevier Ltd. All rights reserved.

  • 8617.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    A comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge in patients with heart failure and their partners.2009In: Esc congress, Barcelona, 2009Conference paper (Refereed)
  • 8618.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Caregiver burden experienced by partners to heart failure patients.2009In: Heart Failure, Nice, 2009Conference paper (Refereed)
  • 8619.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    University of California Los Angeles.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Dyads affected by chronic heart failure, a randomised study evaluating the effects of education and psychosocial support in EUROPEAN HEART JOURNAL, vol 31, issue , pp 945-9462010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 945-946Conference paper (Refereed)
    Abstract [en]

    n/a

  • 8620.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Health-related quality of life, symptoms of depression, perceived control and self-estimated knowledge in patient-partner dyads dealing with chronic heart failure.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP, 2009Conference paper (Refereed)
  • 8621.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Heart failure in patient-partner dyads - a comparison of the partner group and an age-and-gender-matched reference population in HRQL.2009In: Heart Failure Congress, Nice., 2009Conference paper (Refereed)
  • 8622.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Informal caregiving of heart failure in patient-partner dyads - a comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge.2009In: ESC Congress Barcelona., 2009Conference paper (Refereed)
  • 8623.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of heart failure in patient-partner dyads - a comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge.2009In: Heart Failure, Nice., 2009Conference paper (Refereed)
  • 8624.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Davidson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life2011In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 8625.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing, University of California, Los Angeles, USA.
    Davidsson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads - a comparative study addressing issues of health-related quality of life2009Conference paper (Other academic)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 8626.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California Los Angeles .
    Hjelm, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dyada affected by chronic heart failure - a randomised study evaluating effects of education and psychosocial support on patients and their partners.2010Conference paper (Refereed)
  • 8627.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California, Los Angeles.
    Hjelm, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dyads affected by chronic heart failure - a randomised study evaluating effects of education and psychosocial support on patients and their partners.2010Conference paper (Refereed)
  • 8628.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners2012In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 5, p. 359-366Article in journal (Refereed)
    Abstract [en]

    Background: Chronic heart failure (HF) may cause great suffering for both patients and their partners. High marital quality with sufficient emotional support has been found to influence long-term survival in patients with chronic HF. However, emotional reactions of burden, stress and depression have been found to be associated with the partner’s new role. Psychosocial support, and patients-partner education is usually not included in standard chronic HF care despite recommendations in international guidelines.

    Aim: To evaluate the effects of an integrated dyad care programme with education and psychosocial support to patients with chronic HF and their partners during a post-discharge period of 3 months after acute deterioration of chronic HF.

    Methods: A randomised, controlled design with a follow up assessment after 3 months was used. The dyads in the control group received care as usual. The experimental group participated in an integrated care intervention, delivered in three modules through nurse-led face-to-face counselling, a computer-based CD-ROM program and other written teaching materials.

    Results: The intervention improved perceived control (P<0.05) in patients, but not in the partners. There were no other significant differences between the groups with regard to the dyads’ health related quality of life and depressive symptoms, patients’ self-care behaviour and partners’ experiences of caregiver burden.

    Conclusion: This is the first major randomised study evaluating a programme focusing on the development of problem solving skills to assist the dyads in managing heart failure. The intervention significantly improved the level of perceived control in the patient group.

  • 8629.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Evangelista, Lorraine S.
    UC Irvine Program Nursing Science, CA USA .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 15-16, p. 2347-2353Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners.

    Background.  There are few studies evaluating cost-effectiveness of interventions among HF patient–partner dyads.

    Methods.  Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D.

    Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners.

    Conclusion.  The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved.

    Relevance to clinical practice.  The study shows trends of a cost-effective education and psychosocial care of HF patient–partner dyads.

  • 8630.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California, Los Angeles.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Do partners of patients with chronic heart failure experience caregiver burden?2010Conference paper (Refereed)
  • 8631.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Do partners of patients with chronic heart failure experience caregiver burden?2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 4, p. 254-262Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure.

    Background: Care and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health.

    Methods: Data for this descriptive cross sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden.

    Results: The 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients’ Physical component score of SF-36 (p< 0.001), partners’ Mental component score of SF-36 (p< 0.001) and perceived control (p<0.01) accounted for 39% of the variance in caregiver burden.

    Conclusion: Caregiver burden was lower when the mental health of the partner and the physical health of the patient were better and the partner experienced higher control over the heart disease. A partner-centered approach to educate and support partners of patients with heart failure is essential to improve the life situation for patient-partner dyads.

  • 8632.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing, University of California, Los Angeles, USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners2011Conference paper (Other academic)
  • 8633.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure2009In: HEART and LUNG, ISSN 0147-9563, Vol. 38, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses needs are important because they are vital to the patients recovery.

  • 8634.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Addressing spouses' unique needs after cardiac surgery when recovery is complicated by heart failure2009Conference paper (Other academic)
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses’ needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses’ needs are important because they are vital to the patients’ recovery.

  • 8635.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Psychosocial impact in family members before and up to two years after heart or lung transplantation.2015Conference paper (Other academic)
  • 8636.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    The Unsteady Mainstay of the Family: Adult Children’s Retrospective View on Social Support in Relation to Their Parent’s Heart Transplantation2015Conference paper (Other academic)
  • 8637.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiothoracic Surgery/THAI, Skåne University Hospital and Medical Services, Lund, Sweden.
    Rönning, Helén
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    The Unsteady Mainstay of the Family: Now Adult Children's Retrospective View on Social Support in Relation to Their Parent's Heart Transplantation.2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2014, article id 541241Article in journal (Refereed)
    Abstract [en]

    The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).

  • 8638.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjöberg, Trygve
    Skånes universitetssjukhus, Lund.
    Ekmehag, Björn
    Akademiska sjukhuset, Uppsala.
    Wiborg, Maj-Britt
    Skånes universitetssjukhus, Lund.
    Ivarsson, Bodil
    Avdelningen för thoraxkirurgi, Institutionen för kliniska vetenskaper, Lunds universitet; Medicinsk service, Region Skåne.
    Patients' self-perceived health, coping, anxiety, depression and stress before and up to 2 years after a heart or lung transplantation.2015Conference paper (Other academic)
    Abstract [en]

    Background: Psychosocial factors are important aspects for patients before, on waiting list, and after a heart or lung transplantation.

    Aim: To illuminate patients' self-­‐perceived health, coping, anxiety, depression and stress before and up to 2 years after heart or lung transplantation.

    Method: Fifty-­‐four adult patients (28 cardiac and 26 lung) were included. They responded to questionnaires about quality of life, coping, anxiety, depression and stress when they were accepted for the transplant waiting list, then 6 months, 1 year and 2 years after a heart or lung transplantation. 

    Result: Mean waiting time was 37 weeks for cardiac patients and 29 weeks for lung patients. The patients had a lower coping ability and self-­‐perceived health at baseline and showed an improvement over time after the transplantation. Excluding pain, which increased and persisted over time after the transplantation, especially for the lung patients. Twenty-­‐three percent of all patients showed clinically anxiety before transplantation compared to 0-­‐8 % after transplantation. However, both before and after, clinical depression was significantly less frequent. Nearly half (44 %) of the patients scored medium or high level of intrusion stress and 38% of avoidance stress before the transplantation, which declined gradually over the years.

    Conclusion: Transplantation has led to positive psychosocial effects at 6 months, 1 year and 2 years after the heart or lung transplantation for most of the patients. The healthcare professionals must ensure to be aware of the challenges faced by their patients in daily living, not only the symptoms of their severe chronic disease but also psychosocial factors mainly before but even after a heart or lung transplantation. Patients have an underlying serious, chronic disease where severe long-­‐term life-­‐threatening complications suddenly can occur

  • 8639.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Department of Cardiothoracic Surgery, Lund University, Lund, Sweden.
    Sjöberg, Trygve
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Ekmehag, Björn
    Uppsala University, Sweden; Uppsala University Hospital, Sweden.
    Wiborg, Maj-Britt
    Caring Science, Uppsala University, Sweden; Uppsala University Hospital, Uppsala, Sweden; Department of Cardiology, Skåne University Hospital Lund, Lund, Sweden.
    Ivarsson, Bodil
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Psycho-social aspects before and up to 2 years after heart or lung transplantation - experience of patients and their next of kin.2017In: Clinical Transplantation, ISSN 0902-0063, E-ISSN 1399-0012, Vol. 31, no 3, article id e12905Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychosocial factors are important for patients undergoing heart (HTx) or lung (LTx) transplantation, and for their next of kin (NoK).

    AIM: To describe health-related quality of life (patients only), anxiety, depression, stress, coping ability and burden (NoK only) for patients and their NoK before and up to 2 years after HTx or LTx.

    DESIGN: Adult patients (28 heart and 26 lung) and their appointed NoK were surveyed with questionnaires about specific psychosocial topics when they were accepted for the transplantation waiting list and 6 months, 1 year, and 2 years after transplantation.

    FINDINGS: Patients' coping ability and self-perceived health were low at baseline and improved over time after the transplantation. However, lung patients took longer time to recover in terms of health-related quality of life, depression, and stress than heart patients. Similarly, NoK of lung patients experienced a higher burden and more stress 1 year after transplantation than NoK of heart patients.

    CONCLUSIONS: Healthcare professionals should be aware of the psychosocial challenges patients and their NoK face in daily living and provide support both before and after heart or lung transplantation. Especially, given that these patients have a serious, chronic, underlying disease. This article is protected by copyright. All rights reserved.

  • 8640.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Luttik, Marie Louise A.
    Hanze University of Appl Science, Netherlands.
    Caregiving tasks and caregiver burden; effects of an psycho-educational intervention in partners of patients with post-operative heart failure2015In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 4, p. 270-275Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of a psycho-educational intervention on caregiver burden in partners of patients with postoperative heart failure. Background: Since partners of cardiac surgery patients play a significant role in the patients recovery, it is important to address their needs during hospitalization and after discharge. Methods: Forty-two patients with postoperative heart failure and their partners participated in a randomized controlled pilot study. Dyads in the intervention group received psycho-educational support from a multidisciplinary team. Dyads in the control group received usual care. Results: No significant differences were found in the performance of caregiving tasks and perceived caregiver burden in the control versus the intervention group. Conclusion: A pilot study exploring the effects of a psycho-educational intervention in patients and their partners did not reveal significant effects with regard to reduced feelings of burden in partners. Alleviating caregiver burden in partners may need a more intense or specific approach. (C) 2015 Elsevier Inc. All rights reserved.

  • 8641.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens University Hospital, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
    Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients2017In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 1929-1939Article in journal (Refereed)
    Abstract [en]

    Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.

  • 8642.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, NU Hospital Group, Trollhättan, Sweden.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlson, Bjorn W.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden2019In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 577-586Article in journal (Refereed)
    Abstract [en]

    Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

    Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

    Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

    Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

  • 8643.
    Åhlund, Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Physical Performance Impairments and Limitations Among Hospitalized Frail Older Adults2018In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 41, no 4, p. 230-235Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Early rehabilitation is important for frail older adults due to reduced reserve capacity and physical fitness. To facilitate individualized rehabilitation programs, we need tools to make it possible to assess physical fitness in relation to frailty, instead of chronological age. The purpose of this study was, in a Swedish context, to describe measures of physical fitness in hospitalized frail older adults in relation to their degree of frailty. Methods: This was a cross-sectional study. A total of 408 frail older adults, mean age 86.6 years (75-99 years), in need of emergency medical inpatient care, were included in the NAL-Uddevalla (NU) hospital group in Sweden. During the hospital stay, physical fitness was assessed using 4 different tests: hand-grip strength, the Timed Up and Go Test, 5-time sit-to-stand test, and 6-minute walk test. In the analyses, the physical fitness outcomes were related to the degree of frailty using the FRail Elderly Support ResearcH group screening instrument and previously used cutoffs or age-related reference values for older adults. Results and Discussion: This study showed that most hospitalized frail older adults perform far lower than previously described age-related reference values relating to physical fitness. An increased degree of frailty contributes to reduced physical fitness in tests assessing strength and endurance. Conclusions: A frail-related screening instrument may be useful in the evaluation of physical fitness in hospitalized frail older adults and may facilitate the development of realistic, individualized rehabilitation programs beneficial to an early start on the emergency medical ward.

  • 8644.
    Åhman, Rasmus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Forsberg Siverhall, Pontus
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Snygg, Johan
    Sahlgrens Univ Hosp, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Enlund, Gunnar
    Uppsala Univ Hosp, Sweden.
    Björnström, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 15695Article in journal (Refereed)
    Abstract [en]

    Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated exposures and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7-8.6%) and 23.6% at 365 days (95% CI 22.9-24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p amp;lt; 0.001), male gender (aHR 1.45, p amp;lt; 0.001), ASA-PS-class (ASA 1amp;2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p amp;lt; 0.001) and PACU-LOS (aHR 1.01, p amp;lt; 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p amp;lt; 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.

  • 8645.
    Åkerman, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Casas, Rosaura
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Tavira Iglesias, Beatriz
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Skoglund, Camilla
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0191067Article in journal (Refereed)
    Abstract [en]

    Micro RNAs (miRNAs) are promising disease biomarkers due to their high stability. Their expression in serum is altered in type 1 diabetes, but whether deviations exist in individuals with high risk for type 1 diabetes remains unexplored. We therefore assessed serum miRNAs in high-risk individuals (n = 21) positive for multiple islet autoantibodies, age-matched healthy children (n = 17) and recent-onset type 1 diabetes patients (n = 8), using Serum/Plasma Focus microRNA PCR Panels from Exiqon. The miRNA levels in the high-risk group were similar to healthy controls, and no specific miRNA profile was identified for the high-risk group. However, serum miRNAs appeared to reflect glycemic status and ongoing islet auto-immunity in high-risk individuals, since several miRNAs were associated to glucose homeostasis and autoantibody titers. High-risk individuals progressing to clinical disease after the sampling could not be clearly distinguished from non-progressors, while miRNA expression in the type 1 diabetes group deviated significantly from high-risk individuals and healthy controls, perhaps explained by major metabolic disturbances around the time of diagnosis.

  • 8646.
    Åman, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Joakim, Behrendtz
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Anestesipersonalens peri-operativa omvårdnad av överviktiga och obesa barn2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Children are a group of patients that require special knowledge from the anesthesia staff, both general and specific. Theoretical knowledge and practical experience is necessary to adequately care for the child as it anatomically, physiologically and mentally may differ from adult patients.

    A growing problem in the pediatric population is overweight and obesity. From a stagnation in the early 2000s the prevalence of overweight and obesity among children in the world are again increasing.The purpose of this study was to examine peri-operative care of overweight and obese children.

    Systematic searches were done in PubMed, CINAHL and Scopus. After the quality audit according to SBU, twelve articles were included for analysis.

    Results suggest that overweight and obese children have a higher risk of respiratory peri-operative complications. The risk of hospital admission after outpatient surgery was also greater in this group as well as higher costs for health care.

    Overweight and obese children are complex subjects with more frequent peri-operative risk factors than normal-weight children. This group requires special knowledge of the anesthesia staff. More studies are required to secure evidence in anesthetic care for overweight and obese children.

  • 8647.
    Årestedt, Kristofer
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus Univ, Sweden.
    Alvariza, Anette
    Ersta Skondal Bracke Univ Coll, Sweden; Dalens Hosp, Sweden.
    Boman, Kurt
    Res Unit, Sweden; Umea Univ, Sweden.
    Ohlen, Joakim
    Univ Gothenburg, Sweden.
    Goliath, Ida
    Karolinska Inst, Sweden.
    Håkanson, Cecilia
    Ersta Skondal Bracke Univ Coll, Sweden; Sophiahemmet Univ, Sweden.
    Furst, Carl Johan
    Lund Univ, Sweden; Reg Skåne, Sweden.
    Brännstrom, Margareta
    Umeå Univ, Sweden.
    Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study2018In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 21, no 3, p. 361-367Article in journal (Refereed)
    Abstract [en]

    Background: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed. Objective: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals. Design: This is a national register study. Setting/Subjects: The study included 3981 patients with diagnosed heart failure as the underlying cause of death. Measurements: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies. Results: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory. Conclusion: The results indicate inadequate palliative care for patients with heart failure during their last week of life.

  • 8648.
    Årestedt, Kristofer
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Linnaeus University, Sweden .
    Saveman, Britt-Inger
    Umeå University, Sweden .
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Blomqvist, Kerstin
    Kristianstad University, Sweden .
    Social support and its association with health-related quality of life among older patients with chronic heart failure2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    Background: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure. less thanbrgreater than less thanbrgreater thanAims: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity. less thanbrgreater than less thanbrgreater thanMethods: Data were collected in a sample of 349 patients (andgt;= 65 years) with chronic heart failure. Patients HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors. less thanbrgreater than less thanbrgreater thanResults: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions. less thanbrgreater than less thanbrgreater thanConclusion: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.

  • 8649.
    Årestedt, Kristofer
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Linnaeus University, Kalmar, Sweden .
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Flemme, Inger
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Moser, Debra K
    University Kentucky, Lexington, KY, USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 4, p. 317-325Article in journal (Refereed)
    Abstract [en]

    Background:The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed.Objective:The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners.Methods:A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach's alpha were used to validate the CAS.Results:The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74-0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex.Conclusions:The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred.

  • 8650. Årestedt, L.
    et al.
    Martinsson, Caroline
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Uhlin, F.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
    Patient participation in dialysis care: a qualitative study of patients’ and health professionals’ perspectivesIn: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed)
170171172173174175 8601 - 8650 of 8714
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