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  • 1.
    Amin, M. Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, M.
    Karolinska Institutet.
    Runeson, B.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mehlum, L.
    National Centre for Suicide Research and Prevention, Oslo, Norway.
    Holmes, E.
    Karolinska Institutet.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    The risk of suicidal behaviour in refugees and other immigrants to Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 191-191Article in journal (Other academic)
  • 2. Barkestad, Eva
    et al.
    Andersson, Ingrid
    Gustafsson, Ingrid
    Hyllienmark, Petra
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences.
    Stevens, Lena
    The Swedish Red Cross University College, Department of Health Sciences.
    Säkra kunskap och kvalitet: utmaningar för framtidens anestesi och intensivvårdssjuksköterska2017In: Ventilen, ISSN 0348-6257, no 4, p. 16-18Article in journal (Other (popular science, discussion, etc.))
  • 3.
    Bexelius, T.
    et al.
    Karolinska Institutet.
    Lachmann, Hanna
    The Swedish Red Cross University College, Department of Health Sciences.
    Järnbert-Pettersson, H.
    Karolinska Institutet.
    Kalén, S.
    Karolinska Institutet.
    Möller, R.
    Karolinska Institutet.
    Ponzer, S.
    Karolinska Institutet.
    Stress among medical students during clinical courses: a longitudinal study using contextual activity sampling system2019In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 10, p. 68-74Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate medical students’ experiences of stress and other emotions related to their professional roles, as defined by the CanMEDS framework, by using the Contextual Activity Sampling System (CASS).

    Methods: Ninety-eight medical students agreed to participate of whom 74 completed this longitudinal cohort study. Data was collected between 6th and 8th term via CASS methodology: A questionnaire was e-mailed to the participants every 3rd week (21questionnaires/measurements) during clinical rotations and scientific project work term. Emotions were measured by a 7-point Likert scale (e.g., maximum stress = 7). Answers were registered through mobile technology. We used a linear mixed-model regression approach to study the association between stress over time in relation to socio-demographic and learning activities related to CanMEDS roles.

    Results: Participants completed 1390 questionnaires. Mean stress level over all time points was 3.6. Stress was reported as highest during the scientific project term. Learning activities related to ‘Communicator,’ ‘Collaborator,’ ‘Scholar,’ ‘Manager’ and ‘Professional’ were associated with increased stress, e.g. ’Scholar’ increased stress with 0.5 points (t=3.91, p<0.001). A reduced level of stress was associated with ’Health Advocate’ of 0.39 points (t=-2.15, p=0.03). No association between perceived stress and demographic factors, such as gender or age was found.

    Conclusions: An association between different learning activities related to CanMEDS Roles and feelings of stress were noted. The CASS methodology was found to be useful when observing learning experiences and might support educational development by identifying course activities linked to stress.

  • 4.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Material Wear of Medical Technical Products: Impact on patient safety2018Conference paper (Refereed)
    Abstract [en]

    The use of a central venous catheters (CVC) always involves an increased risk of infection and thrombotic complications, subsequently increasing patient suffering, prolonged care and health care related costs. One contributing cause of infection is that the surface of the catheter is quickly colonized by bacteria, forming a biofilm, hard to reach by and/or resistant to antibiotics and the patient’s immune defense system. Catheter related thrombosis may also promote colonization of microbes on the fibrin sheet at the surface, and at the same time impact on CVC functionality by lumen occlusion or, in a rare worst-case scenario – cause life threatening embolic events. Coatings with silver or metal alloys can reduce the risk for complications. Our research group have previously identified a correlation between material degradation in medical devices used in patients and exposure time and infections. This talk will discuss the impact of material degradation of different types of CVCs used for patients undergoing chemotherapy against breast cancer.  The results from an evaluation study of a anti infectious noble metal alloy coated CVC compared with an uncoated CVC for tolerability (Adverse Events, AEs), performance and noble metal durability on the surface will also be discussed.

  • 5.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. KI.
    Fossum, Maren
    NTNU.
    Aune, Ragnhild
    NTNU.
    Cytostatika-inducerad materialnedbrytning av subkutana venportar: En preliminär jämförande in-vitro och in-vivostudie2017Conference paper (Refereed)
  • 6.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Johansson, Dorota
    Bactiguard, Stockholm.
    Bergström, Linda
    Bactiguard, Stockholm.
    Strekalovsky, Anton
    Karolinska University Hospital.
    Sanchez, Javier
    Karolinska Institutet / Bactiguard, Stockholm.
    Frostell, Claes
    Karolinska Institutet.
    Kalman, Sigridur
    Karolinska University Hospital / Karolinska Institutet.
    Evaluation of central venous catheters coated with a noble metal alloy - A randomized clinical pilot study of coating durability, performance and tolerability2018In: Journal of Biomedical Materials Research. Part B - Applied biomaterials, ISSN 1552-4973, E-ISSN 1552-4981, Vol. 106, no 6, p. 2337-2344Article in journal (Refereed)
    Abstract [en]

    The use of Central Venous Catheters (CVCs) commonly results in complications. Coatings with silver or metal alloys can reduce the risk associated with the use of CVC. We have evaluated the durability of a noble metal coated CVC (the Bactiguard Infectious Protection, BIP CVC) and compared with an uncoated CVC for clinical tolerability (Adverse Events, AEs) and performance, in order to create a baseline for a large future study. Patients undergoing major surgery, randomised at a 2:1 ratio to BIP CVC (n = 22) or standard CVC (n = 12), were catheterized 9 - 12 days, respectively. Adverse events, microbial colonization and metal release were measured.

    FINDINGS: There were no AEs in the BIP CVC-group, but 5 AEs occurred in 4 patients (1 patient had 2 AEs) in the standard CVC-group, p = 0.011 (whereof 3 were catheter related). The BIP CVC showed an initial release of coating metals in blood (gold, silver and palladium), which rapidly decreased and were far below Permitted Paily Exposure (PDE) for chronical use. The levels of silver concentration were far below those needed to develop microbial resistance. The performance was equal, and there was no difference concerning microbial colonization, for the two CVCs.

    CONCLUSION: In this pilot study the BIP CVC had significantly lower AEs and showed a comparable performance to the standard CVC. The coating was durable throughout the study length (up to 16 days) and toxicological evaluation showed good safety margins. Larger studies are needed.

  • 7.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Johansson, Dorota
    Bactiguard.
    Sanchez, Javier
    Karolinska Institutet / Bactiguard.
    Frostell, Claes
    Karolinska Institutet.
    Bergström, Linda
    Bactiguard.
    Kalman, Sigridur
    Karolinska Institutet.
    Evaluation of Tolerability and Performance of BIP Central Venous Catheter with a noble metal alloy coating: A Clinical Tolerability Study2017Conference paper (Refereed)
  • 8.
    Bränström, Richard
    et al.
    Yale School of Public Health, New Haven, USA / Karolinska Institutet.
    Hatzenbuehler, Mark L
    Columbia University, New York, USA.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Pachankis, John E
    Yale School of Public Health, New Haven, USA.
    Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 6, p. 591-599Article in journal (Refereed)
    Abstract [en]

    In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.

  • 9.
    Burström, Åsa
    et al.
    Karolinska Institutet / Astrid Lindgren Children's Hospital.
    Acuna Mora, Mariela
    University of Gothenburg / KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Öjmyr-Joelsson, Maria
    Karolinska Institutet / Astrid Lindgren Children's Hospital.
    Sparud-Lundin, Carina
    University of Gothenburg.
    Rydberg, Annika
    Umeå University.
    Hanseus, Katarina
    Skåne University Hospital.
    Frenckner, Björn
    Karolinska Institutet / Astrid Lindgren Children's Hospital.
    Nisell, Margret
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Moons, Philip
    University of Gothenburg / KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Bratt, Ewa-Lena
    University of Gothenburg / The Queen Silvia Children's Hospital.
    Parental Uncertainty About Transferring Their Adolescent with Congenital Heart Disease to Adult Care2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 5, no 2, p. 380-387Article in journal (Refereed)
    Abstract [en]

    AIMS: To study parent's levels of uncertainty related to the transfer from pediatric to adult care in adolescents with Congenital Heart Disease (CHD) and to identify potentially correlating factors.

    BACKGROUND: Parents acknowledge that during transition they struggle with finding ways of feeling secure in handing over the responsibility and letting go of control. Well-prepared and informed parents who feel secure are most likely better skilled to support their adolescent and to hand over the responsibility.

    DESIGN: A cross-sectional study.

    METHODS: Overall, 351 parents were included (35% response rate). Parental uncertainty was assessed using a Linear Analogue Scale (0-100). Data was collected between January - August 2016. Potential correlates were assessed using the readiness for transition questionnaire and sociodemographic data.

    RESULTS: The mean parental uncertainty score was 42.5. Twenty-four percent of the parents had a very low level of uncertainty (score 0-10) and 7% had a very high level (score 91-100). Overall, 26% of the mothers and 36% of the fathers indicated that they had not started thinking of the transfer yet. The level of uncertainty was negatively associated with the level of perceived overall readiness. Adolescents' age, sex, CHD complexity and parental age were not related to uncertainty.

    CONCLUSION: A wide range in the levels of uncertainty was found. Parents who were less involved in the care, or perceived their adolescent as readier for the transition, felt less uncertain. Still, thirty percent of the parents had not started to think about the transfer to adult care. This article is protected by copyright. All rights reserved.

  • 10.
    Burström, Åsa
    et al.
    Karolinska Institutet / Astrid Lindgren Children’s Hospital.
    Acuña Mora, Mariela
    University of Gothenburg.
    Öjmyr-Joelsson, Maria
    Karolinska Institutet / Astrid Lindgren Children’s Hospital.
    Sparud-Lundin, Carina
    University of Gothenburg.
    Rydberg, Annika
    Umeå University.
    Hanseus, Katarina
    Skåne University Hospital.
    Frenckner, Björn
    Karolinska Institutet / Astrid Lindgren Children’s Hospital.
    Nisell, Margret
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Moons, Philip
    University of Gothenburg / KU Leuven, Belgium.
    Bratt, Ewa-Lena
    Universisty of Gothenburg / The Queen Silvia Children’s Hospital.
    Ready for Transfer to Adult Care? A Triadic Evaluation of Transition Readiness in Adolescents With Congenital Heart Disease and Their Parents2019In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549XArticle in journal (Refereed)
    Abstract [en]

    Transfer to adult care for adolescents with chronic conditions ought to be determined by transition readiness. The aims of this study were (a) to describe the level of readiness for transition in adolescents with congenital heart disease, (b) to compare adolescents' assessment of transition readiness with their parents' assessments, and (c) to study potential correlates of transition readiness. A total of 157 triads of adolescents aged 14 to 18 years and their parents completed the Readiness for Transition Questionnaire. Adolescents scored higher on overall readiness than their parents. Multivariable analyses revealed that higher levels of adolescents' overall readiness were associated with a less threatening view of the illness, a higher level of empowerment, and with higher mothers' and fathers' overall readiness scores. Adolescents' responsibility scores were positively associated with age and parental adolescent responsibility scores. Parental involvement scores were negatively associated with adolescents' age and positively with the mothers' parental involvement scores. By using a triadic evaluation, the results of the present study significantly extend what is currently known about this population.

  • 11.
    Chatchumni, Manaporn
    et al.
    Rangsit University, Pathumthani, Thailand.
    Namvongprom, Ampaporn
    Rangsit University, Pathumthani, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Mazaheri, Monir
    The Swedish Red Cross University College, Department of Health Sciences. Tehran University of Medical Sciences, Tehran, Iran.
    Engagement and availability in shaping nurses’ management of postoperative pain: a qualitative study2018In: Electronic Physician, ISSN 2008-5842, Vol. 10, no 8, p. 7235-7242Article in journal (Refereed)
    Abstract [en]

    Background: Studies reporting inadequate nursing care for patients indicate that nurses are negatively affected in such situations, and research is needed to study nursing care in postoperative situations. Objective: To describe situations of postoperative pain management in a surgical ward in Thailand. Methods: A qualitative approach using the Critical Incident Technique was chosen to investigate situations of postoperative pain management from the perspective of surgical nurses in Thailand. Data were collected through multiple semi-structured interviews with nine nurses over a five-week period. Results: The situations of surgical nurses described three elements that heavily influenced the quality of postoperative pain management: engagement in a trustful nurse-patient relationship, availability of pain medication and nursing care when needed, and imbalance between meeting the patient’s needs and completing routine nursing duties. Conclusion: The results help to expand our understanding of how Thai nurses manage pain in postoperative situations and indicate areas that could be improved in terms of how nurses respond to patients’ pain. Nurses challenge existing guidelines and facilitate development of new nursing guidelines and/or policies in pain management.

  • 12.
    Chatchumni, Manaporn
    et al.
    The Swedish Red Cross University College. Rangsit University, Pathumthani, Thailand.
    Namvongprom, Ampaporn
    Rangsit University, Pathumthani, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Mazaheri, Monir
    The Swedish Red Cross University College, Department of Health Sciences.
    Exploring the different management structures in nurses responses and treating of patients’ postoperative pain: A qualitative triangulation study2019In: Electronic Physician, ISSN 2008-5842, Vol. 11, no 2, p. 7536--7543Article in journal (Refereed)
    Abstract [en]

    Background: Nurses’ roles are an important aspect of their approaches to pain management and monitoring in the post-operative phase of recovery in a surgical ward. A barrier to successful pain management may be the nurse’s perceptions of the patient in pain, which are confounded by the patterns of communication within individual contexts. We need to study, grasp and understand the complexities of the pain management practice within the context of the surgical ward in order to be able to improve the practices and design appropriate interventions to help patients in need. Objective: The purpose of this study was to explore nurses’ postoperative pain management practices. Methods: This qualitative triangulation study was conducted in a surgical ward at a public hospital in Bangkok (Thailand) from 2012 to 2015. We applied four qualitative methods in the study: 1) observations in a postoperative pain management setting (100 hours); 2) in-depth interviews (12 nurses), 3) three focus group discussions (18 nurses), and 4) narratives relating to 69 critical incidents gathered during recurrent visits over a period of ten weeks (9 nurses). Content analysis, as outlined in grounded theory, was applied. Results: The 40 nursing staff made their observations of the participants by conducting go-along interviews while they worked in the surgical field. The group of nurses comprised of 20 females and 4 males, age-ranged between 21-49 years of age, and their nursing experience ranged from 1-28 years. From our analysis, nurses verified patients’ pain by using double- and triple-control methods to document and record it, thus managing pain by administrative procedures rather than being proactive in providing pain relief. Therefore, communication and information about the patients’ pain and subsequent treatment of postoperative pain caused delays that may hamper the adequate use of available analgesics for pain relief. Levels of experience in communicating between nurses, other professionals, and patients were a main cause of delays in treating and managing pain. Conclusion: The complex communication system that would improve the communication ways leads to better standards of practice and quality of care.

  • 13.
    Christidis, Maria
    The Swedish Red Cross University College, Department of Health Sciences. Stockholm University.
    Vocational knowing in subject integrated teaching: A case study in a Swedish upper secondary health and social care program2019In: Learning, Culture and Social Interaction, ISSN 2210-6561, E-ISSN 2210-657X, Vol. 21, p. 21-33Article in journal (Refereed)
    Abstract [en]

    The aim of this case study was to investigate what vocational knowing was made available in subject-integrated teaching of four vocational subjects in a Swedish Health and Social Care Program (HSCP). The study was composed of two separate data collections, both ethnographic. The first data collection was performed in autumn 2012 on a theme unit called VIPS, with a group of students (16+), in a Swedish HSCP. Data comprised observations, field notes, and audio recordings of planning and teaching of the theme unit, informal discussions with teachers and students, handouts, a theme booklet, and student assignments. The second data collection was performed during spring 2018 in which life-history interviews focused on documentation were conducted with the teachers involved in the theme unit from 2012. Data comprised audio recordings and time lines. A theoretical framework and analytical work were performed with concepts from Cultural Historical Activity Theory, and from New Literacy Studies. The results indicate that the object in the teaching activity comprised vocational knowing in three areas: psychosis, ethics, and communication, and vocational literacy. Vocational contextualization of teaching was a necessary component that made available vocational knowing that contributed to the students' professional development.

  • 14.
    Christidis, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Lindberg, Viveca
    Göteborgs universitet.
    Lärares samverkan för yrkeskunnande: Engl. translation: Teachers’ Cooperation for Vocational Knowing2017In: Yrkesdidaktikens mångfald / [ed] Andreas Fejes, Viveca Lindberg, Gun-Britt Wärvik, Stockholm: Lärarförlaget , 2017, 1Chapter in book (Other (popular science, discussion, etc.))
    Abstract [en]

    Based on a study of curriculum integration in Swedish upper secondary education, at a Health and Social Care Programme (Christidis, 2014), the issue of this chapter is how general subjects can contribute to vocational knowing in the interaction between teachers and students. Inspired by an ethnographic approach, classroom observations, interviews and documents formed the data, and for the analysis concepts from activity theory were used. Main results were that teachers’ and students’ experiences used in teaching focused three actors’ perspectives: those of nurse-assistants’, patients’ and relatives’. These were expressed in subject specific as well as interdisciplinary teaching of general and vocational subjects. Using subject integration made it possible for both teachers and students to explore connections between the subjects. Furthermore, subject integration contributed to one of the main goals of the Health and Social Care Programme: to develop a holistic view of the human being.

  • 15.
    Christidis, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Stockholm University.
    Lindberg, Viveca
    Stockholm University.
    Subject-Integrated Teaching for Expanded Vocational Knowing and Everyday Situations in a Swedish Upper Secondary Health and Social Care Program2019In: Vocations and Learning, ISSN 1874-785X, E-ISSN 1874-7868Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore what subject-integrated teaching of vocational subjects, ethics and health care, contributed with in terms of vocational knowing. The case study was ethnographically inspired and followed a group of students (16 +) and their teachers in a Swedish Health and Social Care Program while they worked with a theme unit called Death for two weeks in autumn 2012. Data comprised observations, field notes, and audio recordings of the planning and teaching of the theme unit, informal discussions with teachers and students, handouts, a theme booklet, and student assignments. Analysis was based on concepts related to cultural historical activity theory, especially emphasizing rules, tools, actions, operations, and contradictions. Results showed three major objects emphasized in the teacher–student interaction and the tools chosen to support the subject-integrated teaching activity: vocational knowing related to vocational ethics, to everyday ethics, and argumentative skills. Manifestations of contradictions in the form of dilemmas related to the examples that teachers copied from a textbook. As these examples were mainly contextualized in everyday situations, and there are no formal ethical guidelines for nursing assistants on which teachers could rely on, teachers’ narratives were used to complement these examples. Students’ argumentative skills were emphasized and related to personal situations, in which ethical arguments for justification in vocationally relevant situations were made unclear.

  • 16.
    Crafoord, Marie-Therese
    et al.
    Södersjukhuset, Karolinska Institutet.
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences.
    Fagerdahl, Ann-Mari
    Södersjukhuset, Karolinska Institutet.
    Operating Room Nurses’ Perceptions of the Clinical Learning Environment: A Survey Study2018In: Journal of Continuing Education in Nursing: Continuing Competence for the Future, ISSN 0022-0124, E-ISSN 1938-2472, Vol. 49, no 9, p. 416-423Article in journal (Refereed)
    Abstract [en]

    Background: Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse. 

    Method: This study aimed to examine newly graduated operating room nurses’ perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education. 

    Results: Most participants perceived the clinical learning environment as good and highly associated with the supervisor’s ability to supervise, enjoy supervision, and show interest in the participants’ degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact. 

    Conclusion: Social interactions and structures within the operating room affect how the clinical learning environment is perceived. 

  • 17.
    Díaz, Miguel
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Manchester Metropolitan University, UK.
    Avila, A
    Manchester Metropolitan University, UK / KU Leuven, Belgium.
    Degens, H
    Manchester Metropolitan University, UK / Lithuanian Sports University, Lithuania.
    Coeckelberghs, E
    KU Leuven, Belgium.
    Vanhees, L
    KU Leuven, Belgium.
    Cornelissen, V
    KU Leuven, Belgium.
    Azzawi, M
    Manchester Metropolitan University, UK.
    Acute resveratrol supplementation in coronary artery disease: towards patient stratification2019In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, p. 1-20Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Resveratrol (RV) is a polyphenol with antioxidant, anti-inflammatory and cardio-protective properties. Our objective was to investigate whether acute supplementation with high doses of RV would improve flow-mediated dilation (FMD) and oxygen consumption (VO2) kinetics in older coronary artery disease (CAD) patients.

    DESIGN: We employed a placebo-controlled, single-blind, crossover design in which ten participants (aged 66.6 ± 7.8 years) received either RV or placebo (330 mg, 3x day-1) during three consecutive days plus additional 330 mg in the morning of the fourth day with a seven-day wash-out period in-between. On the fourth day, FMD of the brachial artery and VO2 on-kinetics were determined. Results; RV improved FMD in patients who had undergone coronary artery bypass grafting (CABG; -1.4 vs. 5.0%; p = 0.004), but not in those who had undergone percutaneous coronary intervention (PCI; 4.2 vs. -0.2%; NS).

    CONCLUSION: Acute high dose supplementation with RV improved FMD in patients after CABG surgery but impaired FMD in patients who underwent PCI. The revascularization method-related differential effects of RV may be due to its direct effects on endothelial-dependent dilator responses. Our findings have important implications for personalized treatment and stratification of older CAD patients.

  • 18.
    Díaz, Miguel
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Manchester Metropolitan University, Manchester, UK.
    Parikh, Vijay
    Manchester Metropolitan University, Manchester, UK.
    Ismail, Saira
    Manchester Metropolitan University, Manchester, UK.
    Maxamed, Raja
    Manchester Metropolitan University, Manchester, UK.
    Tye, Emily
    Manchester Metropolitan University, Manchester, UK.
    Austin, Clare
    Edge Hill University, Lancashire, UK.
    Dew, Tristan
    Manchester Metropolitan University, Manchester, UK.
    Graf, Brigitte A
    Manchester Metropolitan University, Manchester, UK.
    Vanhees, Luc
    University Leuven, Leuven, Belgium.
    Degens, Hans
    Manchester Metropolitan University, Manchester, UK / Lithuanian Sports University, Kaunas, Lithuania / University of Medicine and Pharmacy of Targu Mures, Romania..
    Azzawi, May
    Manchester Metropolitan University, Manchester, UK.
    Differential effects of resveratrol on the dilator responses of femoral arteries, ex vivo2019In: Nitric oxide, ISSN 1089-8603, E-ISSN 1089-8611, Vol. 92, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Resveratrol is a plant-derived phytoalexin with antioxidant, anti-inflammatory and cardio-protective properties and may be a promising therapeutic intervention strategy in cardiovascular disease. Here, we investigated the acute direct effects of trans-resveratrol (RV), on acetylcholine (ACh)-induced and flow-mediated dilation (FMD) of isolated pressurized femoral arteries of young (4-month-old) and old (26-month-old) mice. Vessel exposure to RV enhanced ACh (0.01-1.0 mM)-induced dilation (p < 0.05), but not FMD (@ 5-10 μL⋅min-1) (p < 0.05) in both young and old mice. After RV incubation, acute nitric oxide (NO) production by cultured endothelial cells was increased in response to 0.01 mM ACh, but reduced by flow (5-10 μL⋅min-1; p < 0.05). In isolated femoral arteries from endothelial nitric oxide synthase knockout (eNOS-/-) mice, RV had no overall effect on flow mediated dilation, but potentiated ACh induced dilation, that was completely abolished by potassium channel blockers, Apamin and Tram 34 (p < 0.01). We demonstrate that the non-metabolised form of RV stimulates ACh-induced dilation via the NO and EDHF pathways, but not FMD by interaction with the cyclo-oxygenase pathway. Our findings have important implications in the use of RV (for both young and aged) under 'normal' non-diseased physiological states.

  • 19.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Det subversiva arvet: Global Omvårdnad och relationer till vetenskapliga doktriner – en personlig betraktelse2018Conference paper (Other academic)
  • 20.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Förutsättningar för omvårdnad: genus2019In: Omvårdnadens grunder: perspektiv och förhållningsätt / [ed] Febe Friberg & Joakim Öhlén, Lund: Studentlitteratur AB, 2019, 3, p. 337-357Chapter in book (Other academic)
  • 21.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Intimitetens villkor i vårdandet2017In: Genusperspektiv på vård och omvårdnad / [ed] Helén Strömberg & Henrik Eriksson, Lund: Studentlitteratur AB, 2017, 3, p. 71-86Chapter in book (Other academic)
  • 22.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Omvårdnad i ett historiskt perspektiv: framväxt2019In: Omvårdnadens grunder: perspektiv och förhållningsätt / [ed] Febe Friberg & Joakim Öhlén, Lund: Studentlitteratur AB, 2019, 3, p. 33-60Chapter in book (Other academic)
  • 23.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    What is nursing? Nursing as the science of human life in a postmodern era: Clues from the past to understand the road ahead2018In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 3, p. 117-118Article in journal (Other academic)
  • 24.
    Eriksson, Henrik
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Dahlborg-Lyckhage, Elisabeth
    Högskolan Väst.
    Om Genus - introduktion2017In: Genusperspektiv på vård och omvårdnad / [ed] Helén Strömberg och Henrik Eriksson, Lund: Studentlitteratur AB, 2017, 3, p. 15-30Chapter in book (Other academic)
  • 25.
    Eriksson, Henrik
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Sandberg, Jonas
    Jönköping University.
    Röster från sidlinjen - former och normer i anhörigspelet2017In: Genusperspektiv på vård och omvårdnad / [ed] Helén Strömberg & Henrik Eriksson, Lund: Studentlitteratur AB, 2017, 3, p. 149-166-Chapter in book (Other academic)
  • 26.
    Eriksson, Henrik
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Strömberg, HelénUmeå Universitet.
    Genusperspektiv på vård och omvårdnad2017Collection (editor) (Other academic)
    Abstract [sv]

    Det som vanligen benämns genusfrågor är inte bara en angelägenhet för akademin och forskare, utan begreppet diskuteras i såväl politisk som populärvetenskaplig debatt.

    Genusrelaterade, feministiska  och/eller jämställdhetsfrågor är viktiga för samhället och för individer i många olika sammanhang. Men vad är egentligen genus och vad menas med att ha ett genusperspektiv? På vilket sätt kan genus vara en utgångspunkt när det talas om vård och omvårdnad som sträcker sig bortom dagsaktuella politiska utfästelser och olika myndigheters pågående jämställdhetsarbete?

    Genusperspektiv på vård och omvårdnad problematiserar vårdandet, dess handlingar, relationer och processer samt hälso-och sjukvårdens institutioner ur olika genusteoretiska perspektiv.

  • 27.
    Ernstsson, Olivia
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Burström, Kristina
    Karolinska Institutet / Stockholm County Council.
    The External Validity of Mapping MSIS-29 on EQ-5D Among Individuals With Multiple Sclerosis in Sweden2017In: Medical Decision Making Policy & Practice, ISSN 2381-4683, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Mapping can be performed to predict utility values from condition-specific measures when preference-based measures are absent. A previously developed algorithm that predicts EQ-5D-3L index values from the Multiple Sclerosis Impact Scale (MSIS-29) has not yet been externally validated. Aim: To examine the external validity of a previously developed mapping algorithm by testing the accuracy of predicting EQ-5D-3L index values from MSIS-29 among multiple sclerosis (MS) patients in Sweden. Methods: Cross-sectional individual-level data were collected from population-based Swedish registers between 2011 and 2014. Health-related quality of life was assessed through MSIS-29 and EQ-5D-3L at one point in time among 767 individuals with known disability level of MS. A previously developed mapping algorithm was applied to predict EQ-5D index values from MSIS-29 items, and the predictive accuracy was assessed through mean absolute error and root mean square error. Results: When applying the algorithm, the predicted mean EQ-5D-3L index value was 0.77 compared to the observed mean index value of 0.75. Prediction error was higher for individuals reporting EQ-5D values <0.5 compared to individuals reporting EQ-5D values ≥0.5. Mean absolute error (0.12) and root mean square error (0.18) were smaller or equal to the prediction errors found in the original mapping study. Conclusion: The mapping algorithm had similar predictive accuracy in the two independent samples although results showed that the highest predictive performance was found in groups with better health. Varied predictive accuracy in subgroups is consistent with previous studies and strategies to deal with this are warranted.

  • 28.
    Faag, Carina
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Örebro University.
    Bergenius, Johan
    Karolinska Institutet / Karolinska University Hospital.
    Forsberg, Christina
    Karolinska Institutet.
    Langius-Eklöf, Ann
    Karolinska Institutet.
    Feasibility and Effects of a Nursing Intervention for Patients with Peripheral Vestibular Disorders2017In: Rehabilitation Nursing, ISSN 0278-4807, Vol. 42, no 5, p. 274-281Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore the feasibility and possible outcomes of a nursing intervention in patients with peripheral vestibular disorders. Design: A randomized controlled trial (RCT). Methods: Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention, and patients in a control group (n = 18), who received standard care. The intervention includes patient education and individualized nursing support during a 6-month rehabilitation period. Outcomes were symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at 6 and 9 months later. Findings: At the 9-month follow up, the patients who received the intervention rated significantly fewer vertigo-related symptoms and a higher sense of coherence than the control group. Conclusion: The intervention was feasible and seems to support the patients to manage symptoms, but confirmative studies are warranted. Clinical Relevance: Patient education in combination with individual support may be beneficial to help patients with peripheral disorders during their rehabilitation.

  • 29.
    Forsner, Maria
    et al.
    Karolinska University Hospital.
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet, Karolinska University Hospital.
    Caring for Dying Children in the Pediatric Intensive Care Unit, Nurses and Parent’s Perspective2019In: Online Journal of Complimentary & Alternative Medicine, Vol. 1, no 2, p. 1-7, article id 000510Article in journal (Refereed)
    Abstract [en]

    Caring for dying children is complex and requires coordination of all resources. In PICU the main objective is to save lives and ensure vital functions in critically ill children. However due to the child’s critical and life-threatening condition, there is always the possibility the child will not survive. The acuity and technical nature of the intensive care context can provide an obstacle in the transition to palliative care and furthermore conflict with the affected families’ needs. The study aim was to enlightening caring as it is represented in caring situations of dying children at PICU. An Interpretative Phenomenological design was applied. The data collection was performed at three PICU in Sweden in two different occasions at 2011 and 2016 [1,2]. Caring situations of a total of 18 children were observed, of these five cases were estimated as end of life care or lifethreatening conditions. Additionally, nurses and parents were interviewed in direct connection to the observation. Results showed that for nurses, it was a challenge to change perspective from curative to palliative care. Furthermore, medical examinations and treatment was experienced to disturb the dying child thus causing unnecessary suffering. Parents found it difficult to leave their dying children even just for a moment. At the same time the space in PICU usually did not support closeness and parenting but rather separated the dying child from her/his family. In conclusion, since it isn´t possible to always care for dying children in specialized palliative care units these results illuminate the importance of guidelines and training in palliative care in PICU and other acute pediatric care units. Children and their family ought to have the best care possibly when affected by life-limiting or life-threatening illness.

  • 30.
    Fossum, Maren
    et al.
    Norwegian University of Science and Technology, Trondheim, Norway.
    Tunc, Zozan
    KTH.
    Strömberg, Emma
    KTH.
    Frostell, Claes
    Karolinska Institutet.
    Liljegren, Annelie
    Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Aune, Ragnhild
    Norwegian University of Science and Technology, Trondheim, Norway.
    In-vitro and In-vivo Exposure of Intravascular Catheters to Cytostatic Drugs2018Conference paper (Refereed)
  • 31.
    Gedin, F
    et al.
    Karolinska Institutet / Scandinavian College of Chiropractic.
    Dansk, V
    Scandinavian College of Chiropractic.
    Egmar, Ann-Charlotte
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Sundberg, T
    Karolinska Institutet.
    Burström, K
    Karolinska Institutet / Stockholm County Council.
    Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain - A national observational study in Sweden2019In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 23, no 2, p. 241-246Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chiropractic care is a common but not often investigated treatment option for back pain in Sweden. The aim of this study was to explore patient-reported outcomes (PRO) for patients with back pain seeking chiropractic care in Sweden.

    METHODS: Prospective observational study. Patients 18 years and older, with non-specific back pain of any duration, seeking care at 23 chiropractic clinics throughout Sweden were invited to answer PRO questionnaires at baseline with the main follow-up after four weeks targeting the following outcomes: Numerical Rating Scale for back pain intensity (NRS), Oswestry Disability Index for back pain disability (ODI), health-related quality of life (EQ-5D index) and a visual analogue scale for self-rated health (EQ VAS).

    RESULTS: 246 back pain patients answered baseline questionnaires and 138 (56%) completed follow-up after four weeks. Statistically significant improvements over the four weeks were reported for all PRO by acute back pain patients (n = 81), mean change scores: NRS -2.98 (p < 0.001), ODI -13.58 (p < 0.001), EQ VAS 9.63 (p < 0.001), EQ-5D index 0.22 (p < 0.001); and for three out of four PRO for patients with chronic back pain (n = 57), mean change scores: NRS -0.90 (p = 0.002), ODI -2.88 (p = 0.010), EQ VAS 3.77 (p = 0.164), EQ-5D index 0.04 (p = 0.022).

    CONCLUSIONS: Patients with acute and chronic back pain reported statistically significant improvements in PRO four weeks after initiated chiropractic care. Albeit the observational study design limits causal inference, the relatively rapid improvements of PRO scores warrant further clinical investigations.

  • 32.
    Gellerstedt, Linda
    et al.
    Sophiahemmet University / Danderyd Hospital, Karolinska Institutet.
    Medin, Jörgen
    The Swedish Red Cross University College, Department of Health Sciences. Sophiahemmet University.
    Kumlin, Maria
    Sophiahemmet University / Karolinska Institutet.
    Karlsson, Monica Rydell
    Ersta Sköndal Bräcke University College / Danderyd Hospital, Karolinska Institutet.
    Sleep as a topic in nursing education programs?: A mixed method study of syllabuses and nursing students' perceptions2019In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 79, p. 168-174Article in journal (Refereed)
    Abstract [en]

    Background: Sleep is a basic human need and is considered important for maintaining health. It is even more important during illness due to its impact for example on our immune system. Nurses have an important role in identifying sleep deprivation. They are also in a unique position to promote and address sleep among patients. However, it is essential that they are provided with the appropriate knowledge during training.

    Aim: To explore and describe nursing students' perceptions of preparedness to adress and support patients' sleep during hospitalization and to apply sleep-promoting interventions in a clinical context. Furthermore, the aim was to investigate if, and how, the topic of sleep is explicitly incorporated in nursing education programs.

    Design: A descriptive study based on a mixed method approach.

    Methods: Quantitative and qualitative data were collected from program and course syllabuses and intended learning outcomes from three universities. Twenty-one nursing students from the same universities were interviewed during their final year of education.

    Results: The results of both quantitative and qualitative data consistently show that education regarding sleep and patients' sleep is limited and, in some respects, absent in the Bachelor of Science Nursing programs investigated.

    Conclusion: This study indicates that education about sleep and patients' sleep in the nursing programs studied is insufficient and limited. This gap in knowledge may lead to prospective registered nurses using their own experiences instead of evidence-based knowledge when assessing, supporting and applying sleep-promoting interventions.

  • 33.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet / Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden2018In: Multiple sclerosis journal - experimental, translational and clinical, E-ISSN 2055-2173, Vol. 4, no 3, article id 2055217318783352Article in journal (Refereed)
    Abstract [en]

    Background: Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

    Objectives: To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21-64 years of age.

    Methods: Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

    Results: Among 8906 multiple sclerosis patients, EDSS 0.0-3.5 and 7.0-9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

    Conclusion: Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

  • 34.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet; University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet; Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden2019In: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, no 2, article id 2055217319858383Article in journal (Refereed)
    Abstract [en]

    Background

    Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

    Objectives

    To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age.

    Methods

    Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

    Results

    Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

    Conclusion

    Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

  • 35.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Comparing costs of illness of multiple sclerosis in three different years: A population-based study2018In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, no 4, p. 520-528Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about changes in the costs of illness (COI) among multiple sclerosis (MS) patients during recent years.

    OBJECTIVES: To compare the COI among MS patients and matched controls in 2006, 2009, and 2012, respectively, indicating the costs attributable to the MS disease.

    METHODS: Three cross-sectional datasets were analyzed, including all MS patients in Sweden aged 20-60 years and five matched controls for each of them. The analyses were based on 10,531 MS patients and 52,655 matched controls for 2006, 11,722 and 58,610 individuals for 2009, and 12,789 and 63,945 for 2012. Nationwide registers, including prescription drug use, specialized healthcare, sick leave, and disability pension, were linked to estimate the prevalence-based COI.

    RESULTS: Adjusted for inflation, the average difference in COI between MS patients and matched controls were Swedish Krona (SEK) 243,751 (95% confidence interval: SEK 239,171-248,331) in 2006, SEK 238,971 (SEK 234,516-243,426) in 2009, and SEK 225,923 (SEK 221,630-230,218) in 2012. The difference in indirect costs were SEK 170,502 (SEK 166,478-174,525) in 2006, SEK 158,839 (SEK 154,953-162,726) in 2009, and SEK 141,280 (SEK 137,601-144,960) in 2012.

    CONCLUSION: The inflation-adjusted COI of MS patients was lower in 2012 than in 2006, in particular regarding indirect costs.

  • 36.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Norlund, Anders
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Ernstsson, Olivia
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age2018In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, no 3, p. 435-446Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society.

    OBJECTIVES: We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups.

    METHODS: A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension.

    RESULTS: The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI.

    CONCLUSIONS: Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.

  • 37.
    Hallberg, David
    The Swedish Red Cross University College, Department of Health Sciences. University of Douala, Douala, Cameroun.
    Community gardens as multipurpose, technological systems2018In: Journal of Sociology and Social Anthropology, ISSN 0976-6634, Vol. 9, no 2, p. 38-48Article in journal (Refereed)
    Abstract [en]

    This paper introduces the notion of community gardens as multipurpose, technological systems with dynamic boundaries. It also strives to revise the notion of food security and health in regards to such systems. This is a cross-cultural project where twelve community gardens located in urban regions within three different countries were examined. This paper explores common tendencies rather than diversities or differences. The paper describes a behavioural chain that depends on various factors and affects various types of health. It is suggested that a community garden has the potential to serve as a link between the past and the present. While a community garden may provide food, it is suggested that it may also encourage social interactions, knowledge sharing, and relaxation. The cultivation of food occurs, but it may not always be the sole purpose.

  • 38.
    Hallberg, David
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. University of Douala, Douala, Cameroon.
    Kimario, T. D.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Mtuya, C.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Msuya, M.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Factors affecting HIV disclosure among partners in Morongo, Tanzania2019In: International Journal of Africa Nursing Sciences, E-ISSN 2214-1391, Vol. 10, p. 49-54Article in journal (Refereed)
    Abstract [en]

    Background: Human immunodeficiency virus (HIV) remains a major concern globally and locally. Married couples and those in stable relationships account for the highest percentage of new HIV and acquired immune deficiency syndrome (AIDS) infections. The rate of HIV disclosure among couples is low and affected by both known and unknown factors. The aim of this study was to describe the reasons for HIV status (non)disclosure among partners in Morongo. Methods: A sampling containing two stages was used in this quantitative, exploratory, and descriptive study to select the 100 participants. The location was a Care and Treatment Clinic in the Morogoro municipality. Results: The participants had a moderate level of knowledge about the importance of HIV serostatus disclosure. Female genital mutilation was the most mentioned (44%) custom affecting disclosure. The participants’ level of knowledge about their partner's HIV status was also moderate (28%). Nitty-six percent had not disclosed due to fear of divorce and 98% due to fear of loss of financial support. Cultural factors such as traditional practices (95%) were also a major reason that hindered disclosure. Conclusions: Interventions to address the negative attitudes are necessary to promote HIV disclosure and, in turn, better adherence to psychological adjustment therapy and reduction in the risk of HIV transmission among couples.

  • 39.
    Hanpatchaiyakul, Kulnaree
    et al.
    Boromarajonani College of Nursing, Changwat Nonthaburi, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Kijsomporn, Jureerat
    Praboromarajchanok Institute for Health Workforce Development, Ministry of Public Health, Thailand.
    Gunnel, Östlund
    School of Health, Care and Social Welfare, Malardalen University.
    Lived Experience of Thai Women with Alcohol Addiction2017In: Asian Nursing Research, ISSN 1976-1317, Vol. 11, no 4, p. 304-310Article in journal (Refereed)
    Abstract [en]

    Purpose: This study explores the lived experiences of Thai women in relation to alcohol addiction in treatment. Methods: Twelve women aged 20 to 65 years, were participated. The participants were recruited from two special hospitals and one outpatient clinic in a general hospital. Descriptive phenomenology was applied to analyze the transcripts of the individual interviews. Result: The explored phenomenon of Thai women experiencing alcohol addiction included four essential aspects, (1) feeling inferior and worthless (2) feeling physically and emotionally hurt, (3) fearing physical deterioration and premature death, and (4) feeling superior and powerful. Through these different aspects of Thai women's lived experiences, the following essence was synthesized. The essence of the lived experience of alcohol addiction among the studied Thai women was ambivalence between feeling inferior and worthless and feeling superior and powerful when acting as a man. Drinking alcohol lessened life's difficulties and fears; for example, of violence, bodily demolition, premature death and marginalization from family and society. Conclusion: Thai women who experience alcohol addiction are treated with gender-related double standards when trying to undo gender traditional roles. Their marginalization from family and society deepens making them even more vulnerable to the positive side effects of alcohol drinking.

  • 40.
    Hedlund Lindberg, Mathilde
    et al.
    Karolinska Institutet.
    Samuelsson, Mats
    Karolinska Institutet.
    Perseius, Kent-Inge
    The Swedish Red Cross University College, Department of Health Sciences.
    Björkdahl, Anna
    Karolinska Institutet / Stockholms läns landsting.
    The experiences of patients in using sensory rooms in psychiatric inpatient care2019In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, no 4, p. 930-939Article in journal (Refereed)
    Abstract [en]

    The use of sensory rooms and similar sensory approaches in psychiatric inpatient settings is becoming increasingly common. In sensory rooms, patients can choose different sensory stimulating items that may help regulate distress and enhance well-being. Outcomes are often measured as effects on patients' self-rated distress and rates of seclusion and restraint. The subjective experiences of patients using sensory rooms have been less explored. This paper presents a qualitative study of the experiences of 28 patients who chose to use sensory rooms on seven different types of psychiatric inpatient wards. Data were collected by individual patient interviews and by texts written by patients. A qualitative content analysis resulted in four categories: emotional calm, bodily calm, empowerment, and unexpected effects. A majority of the participants described several positive experiences, such as enhanced well-being, reduced anxiety, increased self-management, and enhanced self-esteem. Our findings align with previous research that has shown similar positive patient experiences, and support the use of sensory rooms as part of person-centred care.

  • 41.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Trajectories of work disability and unemployment among young adults with common mental disorders2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1228Article in journal (Refereed)
    Abstract [en]

    BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19-30years with an incident diagnosis of a CMD in year 2007 (n=7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n=7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n=1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n=2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n=665) followed increasing or constant high levels of work disability and 21 % (n=1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n=4546, 63%) or unemployment (n=2745, 38%), compared to the level of constant low work disability (n=6158, 85%) and unemployment (n=3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R-difference(2)=0.02-0.05, p<0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.

  • 42.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University of Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 5, p. 407-415Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

    Methods: All non-pensioned individuals aged 19-60 years who were resident in Sweden on 31 December 2009 were included (n= 4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010-2013.

    Results: Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

    Conclusion: Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

  • 43.
    Holmgren, Jessica
    The Swedish Red Cross University College, Department of Health Sciences.
    A Visual Analysis on How the Physical Environment Conditions Relatives' Involvement in Nursing Homes2017In: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 7, no 4, p. 1-10Article in journal (Refereed)
    Abstract [en]

    This study seeks to describe how the composition of the physical care environment conditions relatives' involvement in nursing home institutions. It is well known that the physical care environment in institutions has a significant impact on the well-being of residents and the work satisfaction of nursing staff. Less explored is how physical care environmental factors are related to the involvement of relatives in nursing homes. A visual analysis of 52 photographs from three nursing homes in Sweden shows how the physical environment acts to condition the involvement of relatives through the use of design, information displays, and cultural symbols. Although various aspects of the physical environment promoted participation of relatives, that engagement was based on certain limited concepts of involvement. This suggests that other conceptual frameworks of involvement in nursing homes are possible, and that these might encourage other aspects of involvement from the relatives of nursing home residents.

  • 44.
    Holmgren, Jessica
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Tegnestedt, Charlotta
    The Swedish Red Cross University College, Department of Health Sciences.
    Global nursing as visualised on the internet: a netnographic analysis of the emerging global paradigm in nursing2018In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 54, no 4-5, p. 443-455Article in journal (Refereed)
    Abstract [en]

    Background: Positioned to face increasing issues relating to the growing and aging population, ill health, climate change, natural disasters, and humanitarian crises, nurses play a crucial role in responding to the challenges of globalisation. With nurses rising to meet these challenges, the term ‘global nursing’ has been coined. Given the ongoing proliferation of the term, it seems relevant to explore the key relationship of the concepts of ‘global’ and ‘nursing’ within the milieus provided through the internet.

    Aim: To describe how global nursing as a concept is visualised in images on the internet.

    Method: A cross-sectional observational design based on netnographic methodology was conducted. By searching the term ‘global nursing’ in the Google search engine, a total of 973 images illustrating ‘global nursing’ were collected and stored on one specific search occasion. The inclusion of data covered all regions but no other search limits.

    Results: The results show that global nursing, first and foremost, is visualised as an academic discourse, as a nursing activity, and as an approach to target sustainability. Further, the results also highlight that global nursing has manifested as a Western discourse, targeting students with access to resources and a humanitarian interest. Conclusion: By paying attention to global nursing as it is presented in this study, it has been possible to provide valuable insights about colonial boundaries in the nursing discourse relating to globality. Based on these results, we stress that the nursing paradigm would benefit from a greater postcolonial awareness and some reflexivity connected with the global issues that nurses are facing.

    Impact statement: Global nursing is paradoxically visualised as something distant, connected to ideas of ‘otherness’, and of not belonging to the Western nursing community

  • 45.
    Holmgren, Jessica
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Kraft, Mia
    The Swedish Red Cross University College, Department of Health Sciences.
    A global nursing framework in the Swedish Red Cross undergraduate nursing program2018In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 3, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Alongside a globalized world and a demographic shift in Sweden, future nurses must provide globally significant nursing care based on relevant knowledges and skills. To contribute to the global nursing discourse, this article aims to describe the process undertaken in developing and implementing a global nursing approach and curriculum in the Swedish Red Cross undergraduate nursing program. A comprehensive process of educational change was carried out, targeting both faculty and students with various academic activities. The new global-oriented curriculum was evaluated positively by nursing students, and a definition of global nursing was disseminated among educators. Nursing students at the Swedish Red Cross University College are now encouraged to advocate for vulnerable persons in need of healthcare services and to counteract inequalities and social injustice in sustainable ways. It is suggested that a global nursing framework is what is required when educating nurses to meet tomorrow’s nursing care needs.

  • 46.
    Holmgren, Jessica
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Health Sciences.
    Saaristo, Panu
    The International Federation of the Red Cross and Red Crescent Societies (IFRC), Geneva, Switzerland.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Health Sciences.
    Nurses’ experiences of health concerns, teamwork, leadership and knowledge transfer during an Ebola outbreak in West Africa2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 824-833Article in journal (Refereed)
  • 47.
    Holmgren, Jessica
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Tegnestedt, Charlotta
    The Swedish Red Cross University College, Department of Health Sciences.
    Rodriguez, Marita
    Svenska Röda Korset.
    Frivillighetens arena: Frivilligas erfarenheter av mångfald, identitet och glokala utmaningar inom svensk frivilligverksamhet2019Report (Other academic)
    Abstract [sv]

    Bakgrund I mitten på 2010-talet befann sig runt 65 miljoner människor på flykt runt om i världen på grund av krig, katastrofer och väpnade konflikter. Många människor flydde för sina liv och sökte skydd och fristad i Europa och Sverige. På lokal nivå anlitades ofta rödakorskretsar i det humanitära bemötandet och omhändertagandet av dessa människor. Delvis var detta en ny situation och erfarenhet för frivilligarbetare. Syfte Syftet med forskningsprojektet var att undersöka hur frivilliga beskriver och resonerar kring lokala och globala utmaningar relaterade till demografiska förändringar, med fokus på personer som är på flykt och är i behov av humanitära frivilliginsatser. Metod Data har samlats in via fokusgruppsintervjuer i tre olika kretsar i Mellansverige. Intervjuerna genomfördes på tre olika nivåer i varje krets, med frivilliga, frivilligledare och kretsstyrelse. Resultat De transkriberade intervjuerna analyserades tematiskt och följande teman identifierades; Erfarenheter från flyktingströmmen 2015, Kärnan i frivilligt arbete inom Svenska Röda Korset, Förvalta och bevara, men också tänka nytt, Tredje sektorns betydelse och frivillighet under ansvar, Tankar framåt och fortsatt arbete i rödakorskretsarna. Slutsatser och framåtblickar Några paradoxer och framtida utmaningar identifierades. Utmaningarna tycks ligga i att kunna överbrygga och tänka ”både och” i stället för ”antingen eller” vad gäller frivilligas traditionella villkor i relation till vad som kan utvecklas, i en tid där frivilligverksamhet kommer att få en alltmer betydande roll i det svenska samhället.

  • 48.
    Holst, Göran
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Johansson, Maria
    Lund University.
    Ahlström, Gerd
    Lund University.
    Signs in People with Intellectual Disabilities: Interviews with Managers and Staff on the Identification Process of Dementia.2018In: Healthcare, E-ISSN 2227-9032, Vol. 6, no 3, article id E103Article in journal (Refereed)
    Abstract [en]

    The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The aim of the present study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with an ID within intellectual disability services (ID-services). Twenty managers and 24 staff within an ID-service were interviewed and qualitative latent content analysis was applied. A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identify deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed a need for early and continuous guidance and education from specialists in dementia and primary healthcare. This finding indicates an urgent need for intervention research and digital support for staff in dementia care.

  • 49.
    Hägg Martinell, Ann
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Hult, Håkan
    Karolinska Institutet.
    Henriksson, Peter
    Karolinska Institutet.
    Kiessling, Anna
    Karolinska Institutet.
    Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e027590Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.

    DESIGN AND SETTING: Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.

    PARTICIPANTS: 21 medical, 4 nursing students and 30 supervisors participated.

    RESULTS: Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.

    CONCLUSION: This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

  • 50.
    Johansson, M.
    et al.
    Lund University.
    Holst, Göran
    The Swedish Red Cross University College, Department of Health Sciences.
    Ahlstrom, G.
    Lund University.
    Signs In People With Intellectual Disabilities: Interviews With Managers And Staff On The Identification Process Of Dementia2019In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 63, no 7, p. 649-649Article in journal (Other academic)
    Abstract [en]

    Introduction: An increasing number of people with intellectual disability (ID) are reaching older ages and an increased risk of dementia diseases. Staff and managers give support in daily living and can deliver information about residents' changes in behavior. The aim of the study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with ID within intellectual disability services (ID‐services).

    Methods: Twenty managers and 24 staff within ID‐service were interviewed and qualitative latent content analysis was applied.

    Results: A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identifies deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed needs for guidance and education from specialists in dementia and primary healthcare.

    Implications: This finding indicates an urgent need for intervention research and digital support for staff in dementia care.

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