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  • 1.
    Ahmadi, Nasser S.
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Bennet, Louise
    Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
    Larsson, Charlotte A.
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden / Department of Clinical Sciences in Malmö, Social Medicine and Global Health, Lund University, Malmö, Sweden.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Månsson, Jörgen
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, SwedenDepartment of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Lindblad, Ulf
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
    Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self-rated health and N-terminal B-type natriuretic peptide: a cross-sectional study2016In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 3, no 3, p. 205-211Article in journal (Refereed)
    Abstract [en]

    AimsLeft ventricular hypertrophy, obesity, hypertension, and N-terminal B-type natriuretic peptide (Nt-proBNP) predict left ventricular diastolic dysfunction with preserved systolic function (DD-PSF). Self-rated health (SRH) is shown to be associated with chronic diseases, but the association of SRH with DD-PSF is unclear. In light of the clinical implications of DD-PSF, the following goals are of considerable importance: (1) to determine the role of SRH in patients with DD-PSF in the general population and (2) to study the association between Nt-proBNP and DD-PSF.

    Methods and resultsThe current study is a cross-sectional study conducted on a random sampling of a rural population. Individuals 30–75 years of age were consecutively subjected to conventional echocardiography and tissue velocity imaging. Data were collected on 500 (48%) men and 538 (52%) women (n = 1038). DD-PSF was the main outcome, and SRH and Nt-proBNP were the primary indicators. Diabetes mellitus, hypertension, and obesity were accounted for as major confounders of the association with SRH. DD-PSF was identified in 137 individuals, namely, 79 men (15.8%) and 58 women (10.8%). In a multivariate regression model, SRH (OR 2.95; 95% CI 1.02–8.57) and Nt-proBNP (quartile 4 vs. quartile 1 OR 4.23; 95% CI 1.74–10.26) were both independently associated with DD-PSF.

    ConclusionsSRH, evaluated based on a descriptive question on general health, should be included in the diagnostic process of DD-PSF. In agreement with previous studies, our study confirms that Nt-proBNP is a major indicator of DD-PSF.

  • 2.
    Andersson, Susanne
    University of Skövde, School of Life Sciences.
    Med risk för diabetes: Studier av symtom, självskattad hälsa och erfarenheter av att leva med risk för att utveckla typ 2 diabetes2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Individuals with impaired glucose tolerance (IGT) have a high risk of developing both type 2 diabetes mellitus (T2DM) and cardiovascular disease. T2DM is a common chronic disease in a global perspective, and it is estimated to continue to grow, which is a serious health problem. It is of significance to increase knowledge about persons with IGT to direct preventive activities more efficiently thus to limit its progression to T2DM.

    Aim: The overall aim was to describe experiences of living with the increased risk of type 2 diabetes, and to identify self-reported symptoms and bodily sensations associated to prediabetes by the persons themselves. Specific aim were to explore the associations between experiences of sleep, vitality and self-rated health, respectively, and IGT.

    Methods: The design was explorative and descriptive. Participants were randomly selected from a cross-sectional population-based survey in two municipalities in Southwestern of Sweden. Data were collected by means of interviews and a questionnaire about life-style and health.

    Results: Living with prediabetes means living in the borderline between health and type 2 diabetes. Living in the borderline and the balance between opportunities and obstacles were interpreted as a burdensome sense of living with increased risk of developing type 2 diabetes, although this feeling could be changed so you could see either opportunities or obstacles. Persons with IGT are experiencing symptoms, which they relate to their elevated plasma glucose level associated with IGT. The diagnosis in itself gave them something to relate to because they received confirmation and a possible explanation for their symptoms. In men a statistically significant age-adjusted association was found between self-reported lack of sleep and IGT: It did not weaken after further adjustment for BMI, smoking, education, and leisure time physical activity No such associations were found in females. Corresponding age-adjusted statistically significant associations between low vitality and IGT in both men and women were successively lost with multivariate adjustments. Both men and women with low self-rated health had a worse risk factor profile than those with high self-rated health and a statistically significant crude association between self-rated health and IGT. After controlling for major lifestyles factors and biomedical variables the association remained only in men.

    Conclusions: A special focus must be directed towards persons with prediabetes as they experience both opportunities and obstacles. Although prediabetes is often described as a condition without symptoms, persons with IGT experienced many symptoms, which they related to their IGT. Insufficient sleep and low self-rated health may be a risk factor for IGT in men. A generous sampling of plasma glucose, HbA1c and oral glucose tolerance tests is suggested, even in vague symptoms. There is a link between the measurable (signs) and the perceived in form of symptoms, interpreted as “the guiding feeling”. This should be considered in pedagogical encounters with patients to prevent the onset of type 2 diabetes.

  • 3.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Berglund, Mia
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Vestman, Caroline
    Primary Health Care Center, Gullspång, Sweden.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden.
    Experiences of specially trained personnel of group education for patients with type 2 diabetes: A lifeworld approach2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 635-641Article in journal (Refereed)
    Abstract [en]

    Aim:To describe how the group education process for people with type 2 diabetes is experienced by diabetes nurses and dietitians who support the patients’ learning, in a primary care setting.

    Design:The project took place at two primary care settings in the south of Sweden.

    Methods:Data collected from focus‐group interviews and reflection notes were subjected to phenomenological analysis.

    Results:The specially trained personnel experienced that group education made it possible for the patients to learn through reflection concerning their own and others’ experiences. Furthermore, group education entailed increased knowledge for the trained personnel. When the patients were challenged to make changes in their lives with the illness, the personnel experienced that both patients and personnel supported each other. The study concludes that the trained personnel person‐centred approach, with help of the didactic model, get tools to support patients learning.

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  • 4.
    Andersson, Susanne
    et al.
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden.
    Ekman, Inger
    Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / Faculty of Social Sciences, Department of Health, University of Stavanger, Stavanger, Norway.
    Bøg-Hansen, Erik
    Institute of Medicine, Department of Primary Health Care, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden.
    Lindblad, Ulf
    Institute of Medicine, Department of Primary Health Care, The Sahlgrenska Academy of the University of Gothenburg, Gothenburg, Sweden / The Department of primary health care, University of Gothenburg, Gothenburg, Sweden.
    The association between self-reported lack of sleep, low vitality and impaired glucose tolerance: A Swedish cross-sectional study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 1, article id 700Article in journal (Refereed)
    Abstract [en]

    Background: The increased incidence of impaired glucose tolerance (IGT), are serious public health issues, and several studies link sleeping disorders with increased risk of developing type 2 diabetes, impaired glucose tolerance and insulin resistance (IR). This study explore how self-reported lack of sleep and low vitality, are associated with IGT in a representative Swedish population. Methods. A cross-sectional survey conducted in two municipalities in South-western Sweden. Participants aged 30-75 were randomly selected from the population in strata by sex and age. Altogether, 2,816 participants were surveyed with a participation rates at 76%. Participants with normal glucose tolerance (n=2,314), and those with IGT (n=213) were retained for analyses. The participants answered a questionnaire before the oral glucose tolerance test (OGTT). Associations for questions concerning sleeping disorders, vitality and IGT were analysed using logistic regression and were expressed as odds ratios (OR) with 95% CI. Results: In men a statistically significant age-adjusted association was found between self-reported lack of sleep and IGT: OR 2.4 (95% CI: 1.1-5.4). It did not weaken after further adjustment for body mass index (BMI), smoking, education, and leisure time physical activity 2.3 (1.0-5.5, p=0.044). No such associations were found in females. Corresponding age-adjusted associations between low vitality and IGT in both men 2.8 (1.3-5.8), and women 2.0 (1.2-3.4) were successively lost with increasing adjustment. Conclusions: Insufficient sleep seems independently associated with IGT in men, while low vitality was not independently associated with IGT neither in men nor women, when multiple confounders are considered. IGT should be considered in patients presenting these symptoms, and underlying mechanisms further explored. © 2013 Andersson et al.; licensee BioMed Central Ltd.

  • 5.
    Andersson, Susanne
    et al.
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ekman, Inger
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Faculty of Social Sciences, Department of Health, University of Stavanger, Norway.
    Daka, Bledar
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
    Lindblad, Ulf
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Charlotte A.
    Insitute of Medicine, Department of Primary Health Care, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden / University of Lund, Department of Clinical Sciences, Malmö, Social Medicine and Global Health, Malmö, Sweden.
    The association between self-rated health and impaired glucose tolerance in Swedish adults: A cross-sectional study2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance. Design. A cross-sectional population-based study. Setting. The two municipalities of Vara and Skovde in south-western Sweden. Subjects. A total of 2502 participants (1301 women and 1201 men), aged 30-75, were randomly selected from the population. Main outcome measures. IGT was regarded as the outcome measure and SRH as the main risk factor. Results. The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8-4.4) and women (OR = 1.5, 95% CI 1.0-2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2-4.3). Conclusion. The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.

  • 6.
    Andersson, Susanne
    et al.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Sweden / Skara Primary Health Care Center, Sweden.
    Ekman, Inger
    Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, SE 405 30 Göteborg, Sweden.
    Lindblad, Ulf
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, SE 405 30 Göteborg, Sweden / Faculty of Social Sciences, Department of Health Studies, University of Stavanger, Norway .
    It's up to me! Experiences of living with pre-diabetes and the increased risk of developing type 2 diabetes mellitus2008In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 2, no 4, p. 187-193Article in journal (Refereed)
    Abstract [en]

    Aims: To explore experiences of pre-diabetes and the associated increased risk of type 2 diabetes mellitus. Methods: Eight participants with pre-diabetes were interviewed for a 45-60 min period. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological hermeneutic approach. Results: Living with pre-diabetes means existing on the borderline of being healthy and suffering from T2DM. Three themes were formulated; "seeing possibilities in an uncertain future", "facing obstacles and loss of liberty" and "balancing between possibilities and obstacles" Being on the borderline and balancing between possibilities and obstacles were interpreted as a distressing feeling of being at increased risk of developing T2DM, although this feeling can change to one of either facing possibilities or facing obstacles. Conclusions: Special focus must be directed towards persons with pre-diabetes, as they are caught between possibilities and obstacles. Advanced care in the form of health dialogues can convince these people of their own abilities to influence the outcome of pre-diabetes. The result of this study can guide health care practitioners in comprehending each participant's understanding of the situation, thus helping them to create pedagogical dialogues in which patients' experiences, conceptions, explanations as well as explicit and implicit questions are identified. © 2008 Primary Care Diabetes Europe.

  • 7.
    Andersson, Susanne
    et al.
    University of Skövde, School of Life Sciences.
    Ekman, Inger
    The Sahlgrenska Academy, University of Gothenburg.
    Lindblad, Ulf
    The Sahlgrenska Academy, University of Gothenburg.
    Friberg, Febe
    The Sahlgrenska Academy, University of Gothenburg.
    Perceived symptoms in people living with Impaired Glucose Tolerance2011In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, p. Article ID 937038, 9 s.-Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to identify symptoms in people with impaired glucose tolerance (IGT) and describe their experiences of living with the symptoms which they related to their condition. Twenty-one participants, from a cross-sectional population-based study, diagnosed as having IGT, were invited for an interview. The interviews were analyzed in two phases by means of a manifest and latent content analysis. The narratives included seven categories of symptoms (and more than 25 different symptoms) presented by the respondents. This study shows that symptoms such as the patient's own interpretation of different perceptions in the body must be considered, as well as signs and/or objective observations. Symptoms ought to be seen as complementary components in the health encounter and health conversation. The results of this study indicate that health professionals should increase their awareness of the balance between the implicit and the explicit bodily sensations that individuals communicate. Further studies are needed.

  • 8.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Karlsson, Veronika
    Department of Health Sciences, University West, Trollhattan, Sweden.
    Bennet, Louise
    Center for Primary Health Care Research, Family Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Fellbrant, Klas
    Family Medicine, Department of Primary Health Care, Skövde, Sweden.
    Hellgren, Margareta
    Institute of Medicine, Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Attitudes Regarding Participation in a Diabetes Screening Test among an Assyrian Immigrant Population in Sweden2016In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, article id 1504530Article in journal (Refereed)
    Abstract [en]

    Immigrants from the Middle East have higher prevalence and incidence of type 2 diabetes (T2D) compared with native Swedes. The aim of the study was to describe and understand health beliefs in relation to T2D as well as attitudes regarding participation in a screening process in a local group of Assyrian immigrants living in Sweden. A qualitative and quantitative method was chosen in which 43 individuals participated in a health check-up and 13 agreed to be interviewed. Interviews were conducted, anthropometric measurements and blood tests were collected, and an oral glucose tolerance test was performed. In total, 13 of the 43 participants were diagnosed with impaired glucose metabolism, 4 of these 13 had TD2. The interviewed participants perceived that screening was an opportunity to discover more about their health and to care for themselves and their families. Nevertheless, they were not necessarily committed to taking action as a consequence of the screening. Instead, they professed that their health was not solely in their own hands and that they felt safe that God would provide for them. Assyrians' background and religion affect their health beliefs and willingness to participate in screening for TD2.

  • 9.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Svanström, Rune
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, Health and Education.
    Rosén, Helena
    Health Sciences, University of Lund, Lund.
    Berglund, Mia
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    'The challenge to take charge of life with long-term illness': Nurses' experiences of supporting patients' learning with the didactic model2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23-24, p. 3409-3416Article in journal (Refereed)
  • 10.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Att drabbas av långvarig sjukdom2017In: Vägen till patientens värld och personcentrerad vård: Att bli lyssnad på och förstådd / [ed] Karin Dahlberg, Inger Ekman, Stockholm: Liber, 2017, 1, p. 93-116Chapter in book (Refereed)
  • 11.
    Svanström, Rune
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Rosén, Helena
    Health Sciences, University of Lund, Lund, Sweden.
    Berglund, Mia
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Moving from theory to practice: experience of implementing a learning supporting model designed to increase patient involvement and autonomy in care2016In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 9, article id 361Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings.

    RESULTS: At the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants' approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants' experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients.

    CONCLUSIONS: Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.

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  • 12.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Fröden, Marie
    Public Health Center, Molkom, Sweden.
    Vikström, Viktoria
    Herrhags School, Karlstad, Sweden.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Swedish school nurses’ experiences in supporting students with type 1 diabetes in their school environment2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 3, p. 142-147Article in journal (Refereed)
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