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  • 51.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Reflekterande KRAFT-givande samtal2017In: Vägen till patientens värld och personcentrerad vård: Att bli lyssnad på och förstådd / [ed] Karin Dahlberg, Inger Ekman, Stockholm: Liber, 2017, 1, p. 317-334Chapter in book (Refereed)
  • 52.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Reflekterande KRAFT-givande samtal i vården av äldre som lever med långvarig smärta i hemmet2015In: Ä. Riksföreningen för Sjuksköterskan inom äldrevård, ISSN 2001-1164, no 1, p. 14-16Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Reflekterande KRAFT-givande samtal är en metod utvecklad för att användas som ett verktyg i vården. Syftet är att stärka människors hälsa och välbefinnande samt den egna förmågan att bemästra sin situation på ett sätt som ger glädje och mening i livet. För den äldre kan det innebära en möjlighet att kunna bo kvar längre i det egna hemmet. Metoden har utvecklats utifrån resultaten av två avhandlingar, en om hemmets betydelse och att leva med långvarig smärta samt en om lärande vid långvarig sjukdom.

  • 53.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. College of Nursing, University of Rhode Island, USA.
    Svanström, Rune
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Keys to person-centred care to persons living with dementia: Experiences from an educational program in Sweden2019In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 18, no 7-8, p. 2695-2709Article in journal (Refereed)
    Abstract [en]

    Growing old entails an increased risk of disabilities and illnesses such as dementia. The orientation in Sweden on national level is that individuals remain in their own homes if desired and receive person-centred home care. The aim of this study was to describe the experience of an educational program and its influence on daily provision of care to persons with dementia. A lifeworld approach was used. Data were collected through group interviews with care providers in the context of home. The findings are presented in five themes: Increased knowledge about dementia and treatment, Relationship-building in order to provide good care, Open and flexible approach conveys calm, Continuity and flexibility are cornerstones in the care and Perceived improvements. This person-centred educational intervention resulted in a care that was based on each individual’s personality, preferences and priorities in life. Education given with continuity over time is key to improving provision of care to person with dementia.

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  • 54.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nässén, Kristina
    Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. College of Nursing, University of Rhode Island, Kingston, USA.
    Fluctuation between Powerlessness and Sense of Meaning: A Qualitative Study of Health Care Professionals’ Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain2015In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 96Article in journal (Refereed)
    Abstract [en]

    Background: There is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context.

    The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home.

    Methods: The phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed.

    Results: The health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect.

    Conclusions: The findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes.

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  • 55.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nässén, Kristina
    Academy of Care, Working Life and Social Welfare, University of Borås, Sweden.
    Hedén, Lena
    Academy of Care, Working Life and Social Welfare, University of Borås, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Older Adults' Experiences of Reflective STRENGTH-Giving Dialogues: An Interview Study2016In: Journal of Gerontology & Geriatric Research, ISSN 2167-7182, Vol. 5, no 3, article id 1000304Article in journal (Refereed)
    Abstract [en]

    Background: A major health problem that frequently accompanies old age is long-term pain, but pain must be acknowledged by older adults and health care providers. Interventions are needed to alleviate pain and suffering’ while holistically providing health care that promotes wellbeing. The intervention project, Reflective STRENGTHGiving Dialogues© (STRENGTH) was implemented to increase health and wellbeing among community dwelling older adults living with long-term musculoskeletal pain at home.

    Aim: The aim of this study was to describe the older adults’ experiences of the intervention Reflective STRENGTH-Giving Dialogue.

    Method: A life world hermeneutic approach was used in collection and analysis of data. Twenty community dwelling older adults participated were interviewed in their homes after the intervention.

    Findings: The findings consisted of five themes and showed that the older adults experienced the Reflective STRENGTH-Giving Dialogues as a continuous and trusting relationship that alleviates the pain and breaks the loneliness. They expressed it as a new way to talk about life with pain. The dialogues supported reflection and memory and resulted in a transition in orientation in life.

    Conclusion: The Reflective STRENGTH-Giving Dialogues helped the older adults to increase their intellectual, emotional, and physical engagement in daily living. The dialogues facilitated a transition in orientation from past to present, to the future, and from obstacles to opportunities. The dialogues were oriented towards enjoyments, meaning, courage and strength in life as a whole which promoted the older adults’ sense of well-being and vitality. The dialogues also facilitated carrying out small and large life projects. The Reflective STRENGTH-Giving Dialogues created a deepened caring relationship that contributed to an increased sense of security, strength and courage, all of which enhanced the potential for better health and wellbeing.

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  • 56.
    Bisholt, Birgitta
    et al.
    Department of Health Sciences, Karlstad University, Sweden.
    Ohlsson, Ulla
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kullén Engström, Agneta
    School of Health, University of Borås, Borås, Sweden.
    Johansson Sundler, Annelie
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gustafsson, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nursing students' assessment of the learning environment in different clinical settings2014In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, no 3, p. 304-310Article in journal (Refereed)
    Abstract [en]

    Introduction: Nursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings. Aim: The aim was to compare the learning environment in different clinical settings from the perspective of the nursing students. Design: A cross-sectional study with comparative design was conducted. Method: Data was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement. Results: The nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives. Conclusion: In the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved. © 2013 Elsevier Ltd. All rights reserved.

  • 57.
    Bixby, Honor
    et al.
    Imperial College London, United Kingdom.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ezzati, Majid
    Imperial College London, United Kingdom.
    Rising rural body-mass index is the main driver of the global obesity epidemic in adults2019In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 569, no 7755, p. 260-264Article in journal (Refereed)
    Abstract [en]

    Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3-6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

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  • 58.
    Bjerkeli, Pernilla J.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Unit for Social Epidemiology, Faculty of Medicine, CRC, Lund University, Malmö, Sweden.
    Mulinari, Shai
    Unit for Social Epidemiology, Faculty of Medicine, CRC, Lund University, Malmö, Sweden / Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden.
    Zettermark, Sofia
    Unit for Social Epidemiology, Faculty of Medicine, CRC, Lund University, Malmö, Sweden.
    Merlo, Juan
    Unit for Social Epidemiology, Faculty of Medicine, CRC, Lund University, Malmö, Sweden.
    Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden2018In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 2, p. 209-218Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to investigate the relationship between sociodemographic factors and pharmacy dispensing of medications for erectile dysfunction (ED) in the general population of middle-aged and elderly men. By considering a number of medical conditions that could promote or contraindicate use of ED medication, the analysis could help capture prescription patterns that might not be explained by medical needs.

    METHODS: Individual-level pharmacy dispensing data from 2006 for a population-based cohort of 216,148 men aged 45-79 years in the county Scania, Sweden, were analysed. Multiple logistic regression was applied, and area under the receiver operating characteristic curve (AUC) was calculated to quantify the discriminatory accuracy (DA) of the associations. National trends in pharmacy dispensing of ED medication between 2006 and 2016 were also analysed.

    RESULTS: Pharmacy dispensing of ED medication increased between 2006 and 2016, particularly among men aged 65-79 years (from 6.8 to 9.2%). Dispensing of ED medication was positively associated with higher socioeconomic position, and divorced and widowed men were more likely to fill a prescription with ED medication than married men. These associations remained after adjusting for medical conditions. The DA of the associations was, however, rather low (AUC = 0.69 among 45-64 year olds and AUC = 0.65 among 65-79 year olds).

    CONCLUSIONS: Pharmacy dispensing of ED medication seem linked to the individuals socioeconomic position, age and marital status suggesting sociodemographic disparities in the pharmacy dispensing targeting sexual function. However, the low DA of the associations shows the limited capacity of these factors to predict ED medication use at the individual level.

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  • 59.
    Bjerkeli, Pernilla J.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
    Vicente, Raquel Perez
    Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
    Mulinari, Shai
    Department of Sociology, Lund University, Lund, Sweden.
    Johnell, Kristina
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Merlo, Juan
    Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden / Center for Primary Health Care Research, Region Skåne, Malmö, Sweden.
    Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data2018In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1657-1665Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics. Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose. Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3). Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

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  • 60.
    Björk, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. CHILD Research Group, Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Sundler, Annelie J.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Hallström, Inger
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Like being covered in a wet and dark blanket: Parents' lived experiences of losing a child to cancer2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 25, p. 40-45Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to illuminate parents' lived experiences of losing a child to cancer. Method: Interviews and a narrative about parents' experiences of losing a child to cancer were gathered from six parents of children whom had participated in a longitudinal study across the child's illness trajectory. The analysis of the data was inspired by van Manen's hermeneutic phenomenological approach. Results: One essential theme emerged: Like being covered in a wet and dark blanket, as well as six related themes: Feeling conflicting emotions, Preparing for the moment of death, Continuing parenting after death, Recollecting and sharing memories, Working through the sorrow and New perspectives in life. Conclusion: There is a need for good palliative care. If not, there is a risk that the parent will perseverate and blame themselves for not being a good parent during the suffering child's last time in life. Meetings with the parents six months and two years after the child's death might facilitate healing through the grief process. 

  • 61.
    Blixt, Ingrid
    et al.
    Department of Obstetrics and Gynaecology, Mälarhospital, Eskilstuna, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette C.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Process-oriented training in breastfeeding for health professionals decreases women’s experiences of breastfeeding challenges2014In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 9, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization recommends promoting exclusive breastfeeding for six months. Women much too often end breastfeeding earlier than they planned, but women who continue to breastfeed despite problems more often experience good support and counselling from health professionals. The aim in this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, in relation to women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk, pain or nipple sores in relation to exclusive breastfeeding shorter or longer than 3 months.

    Methods: An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. The present study was performed in Sweden, in 2000- 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n=540) were asked to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n=162) started before the intervention was initiated. Data for control group B (n=172) were collected simultaneously with the intervention group (IG) (n=206).Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

    Results: Women in IG were more satisfied with the breastfeeding counselling (p=0.008) and felt the breastfeeding counselling was more coherent (p=0.002) compared with control groups, when the exclusively breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p=0.01).

    Conclusion: A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in conformity with their planned breastfeeding duration, compared with women who had breastfeeding duration < 3 months.

    Trial registration: ACTRN12611000354987

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  • 62.
    Blixt, Ingrid
    et al.
    University of Skövde, School of Health and Education. Mälarsjukhuset Eskilstuna / Centrum för klinisk forskning i Sörmland, Uppsala universitet.
    Mårtensson, Lena
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Utbildning minskar amningsproblem2014In: Amningsnytt, ISSN 1102-7207, no 4, p. 4-5Article in journal (Other (popular science, discussion, etc.))
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    Utbildning minskar amningsproblem
  • 63.
    Blomberg, Karin
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bisholt, Birgitta
    Department of Nursing, Karlstad University, Karlstad, Sweden.
    Kullén Engström, Agneta
    School of Health, University of Borås, Borås, Sweden.
    Ohlsson, Ulla
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Johansson Sundler, Annelie
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gustafsson, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2264-2271Article in journal (Refereed)
  • 64.
    Blomberg, Karin
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Isaksson, Ann-Kristin
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Allvin, Renée
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden / Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.
    Bisholt, Birgitta
    Department of Nursing, Karlstad University, Karlstad, Sweden.
    Ewertsson, Mona
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kullén Engström, Agneta
    School of Health, University of Borås, Borås, Sweden.
    Ohlsson, Ulla
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Sundler, Annelie Johansson
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Gustafsson, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Work stress among newly graduated nurses in relation to workplace and clinical group supervision2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 1, p. 80-87Article in journal (Refereed)
  • 65.
    Blomberg, Karin
    et al.
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Wengström, Yvonne
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden / Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Kay
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Isaksson, Ann-Kristin
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nyman, Maria Hälleberg
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Langius-Eklöf, Ann
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer - Scoping the perspectives of patients, professionals and literature2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 21, p. 139-145Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.

    METHODS: The study combines data from interviews with patients (n = 8) and health care professionals (n = 10) and a scoping review of the literature (n = 26) focusing on the period during and up to 6 months after radiotherapy.

    RESULTS: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.

    CONCLUSIONS: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.

  • 66.
    Boberg, Lena
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Szekeres, Ferenc L. M.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Arner, Anders
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Signaling and metabolic properties of fast and slow smooth muscle types from mice2018In: Pflügers Archiv: European Journal of Physiology, ISSN 0031-6768, E-ISSN 1432-2013, Vol. 470, no 4, p. 681-691Article in journal (Refereed)
    Abstract [en]

    This study aims to improve the classification of smooth muscle types to better understand their normal and pathological functional phenotypes. Four different smooth muscle tissues (aorta, muscular arteries, intestine, urinary bladder) with a 5-fold difference in maximal shortening velocity were obtained from mice and classified according to expression of the inserted myosin heavy chain (SMHC-B). Western blotting and quantitative PCR analyses were used to determine 15 metabolic and 8 cell signaling key components in each tissue. The slow muscle type (aorta) with a 12 times lower SMHC-B had 6-fold lower expression of the phosphatase subunit MYPT1, a 7-fold higher expression of Rhokinase 1, and a 3-fold higher expression of the PKC target CPI17, compared to the faster (urinary bladder) smooth muscle. The slow muscle had higher expression of components involved in glucose uptake and glycolysis (type 1 glucose transporter, 3 times; hexokinase, 13 times) and in gluconeogenesis (phosphoenolpyruvate carboxykinase, 43 times), but lower expression of the metabolic sensing AMP-activated kinase, alpha 2 isoform (5 times). The slow type also had higher expression of enzymes involved in lipid metabolism (hormone-sensitive lipase, 10 times; lipoprotein lipase, 13 times; fatty acid synthase, 6 times; type 2 acetyl-coenzyme A carboxylase, 8 times). We present a refined division of smooth muscle into muscle types based on the analysis of contractile, metabolic, and signaling components. Slow compared to fast smooth muscle has a lower expression of the deactivating phosphatase and upregulated Ca2+ sensitizing pathways and is more adapted for sustained glucose and lipid metabolism. © 2018 The Author(s)

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  • 67.
    Brolin, Magnus
    et al.
    School of Health and Medical Sciences, Örebro University.
    Quennerstedt, Mikael
    School of Health and Medical Sciences, Örebro University.
    Maivorsdotter, Ninitha
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Casey, Ashley
    School of Sport, Exercise and Health Sciences, Loughborough University, UK.
    A salutogenic strengths-based approach in practice: an illustration from a school in Sweden2018In: Curriculum Studies in Health and Physical Education, ISSN 2574-2981, Vol. 9, no 3, p. 237-252Article in journal (Refereed)
    Abstract [en]

    Despite an extensive debate and an openness of teachers to a strength-based approach to health and physical education, it is not always clear what a salutogenic strengths-based approach might look like in practice, at least not in the day-to-day work in schools. The purpose of this article is to present a salutogenic strengths-based school initiative in Sweden and to identify health discourses in the school’s practice. An insider perspective is used to explore health in the school through Brook field’s four lenses fo exploring one’s own teaching practice. Two health discourses are identified: (1) an individual health discourse rooted in the fostering of personal development, and (2) a value-based health discourse build up around social relations and the fostering of democratic values. The individual health discourse can be understood as based in a pathogenic norm, and in the investigated school practice the individual health discourse dominated the school health initiative despite the salutogenic intentions.

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  • 68.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Brandberg, Yvonne
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Rydberg, Per
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Bergh, Jonas
    Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    Rydén, Andreas
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Xie, Hanjing
    Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Wengström, Yvonne
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden / Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment2017In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 25, no 5, p. 1423-1429Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim was to prospectively map symptom clusters in patients with stage I–IIIa breast cancer during standard chemotherapy treatment in a randomised study.

    Methods

    Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined.

    Results

    The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48–79%), difficulty sleeping (54–78%), difficulty concentrating (53–74%), worrying (54–74%) and pain (29–67%).

    Conclusion

    In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.

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  • 69.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Forsberg, Christina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Karolinska University Hospital, Breast and Sarcoma Unit, Radiumhemmet, Sweden.
    Assessing patient outcomes and cost effectiveness of nurse-led follow-up for women with breast cancer: have relevant and sensitive evaluation measures been used?2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 13-14, p. 1770-1786Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost effectiveness.

    Background

    As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients’ satisfaction with the model of physician-led follow-up.

    Design

    Systematic review.

    Method

    Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005 and 2013. The quality of appraisal assessment was inspired by the GRADE system.

    Results

    The results show that there are many different instruments used when evaluating nurse-led follow up which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses and the results are hard to interpret.

    Conclusions

    Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients’ information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness.

  • 70.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Henoch, Ingela
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden / University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden.
    Melin-Johansson, Christina
    Mid Sweden University, Department of Nursing, Östersund, Sweden.
    Strang, Susann
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden.
    Danielson, Ella
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden / Mid Sweden University, Department of Nursing, Östersund, Sweden.
    Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 636-644Article in journal (Refereed)
    Abstract [en]

    Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress. Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer. Methods and sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured. Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live. Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs. (C) 2014 Elsevier Ltd. All rights reserved.

  • 71.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Persson, Lars-Olof
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
    Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 2, p. 324-333Article in journal (Refereed)
  • 72.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Huddinge, Sweden.
    Mijwel, Sara
    Karolinska Institutet, Stockholm, Sweden.
    Rundqvist, Helen
    Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Huddinge, Sweden / Karolinska University Hospital, Stockholm, Sweden.
    Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences2018In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 1, p. 16-30Article, review/survey (Refereed)
    Abstract [en]

    Background: In oncology, physical activity (PA) is recognized to improve psychological and physiological functions. Motivating women with breast cancer to sustain a physically active lifestyle is important for promoting positive health after diagnosis. To review and synthesize what is known about how women with breast cancer experience supervised and unsupervised PA during and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched, yielding 994 citations. The final review included 17 articles published between 2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme) instrument was used to appraise quality. Results: Exercise is experienced as a positive element with multiple benefits. However, maintaining a physically active lifestyle during and after chemotherapy is sometimes challenging. Reported benefits of PA include feeling empowered, and improving and reclaiming health. Facilitators to PA comprised exercising with peers and skilled instructors. Barriers included social factors and lack of information. Conclusions: Findings highlight the importance of incorporating PA programs from a patient experience perspective as routine treatment. Health care professionals play a crucial gateway role in providing information on implementation and benefits of PA. Providing support and educated advice about how to safely start or continue regular PA to minimize symptoms, reduce morbidity, and increase well-being during or after treatment is vital for women with breast cancer. Implications for Practice: Health care professionals need increased knowledge of the breast cancer patients' perspectives on facilitators and barriers to PA during and after treatment, in order to provide sufficient support for women to stay physically active during a breast cancer illness.

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  • 73.
    Buck, Christoph
    et al.
    Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Lauria, Fabio
    National Research Council, Institute of Food Sciences, Avellino, Italy.
    Konstabel, Kenn
    National Institute for Health Development, Tallinn, Estonia.
    Page, Angie
    Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Bristol, United Kingdom / NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, United Kingdom.
    Ahrens, Wolfgang
    Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany / Faculty of Mathematics/Computer Science, University of Bremen, Germany.
    Pigeot, Iris
    Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany / Faculty of Mathematics/Computer Science, University of Bremen, Germany.
    Urban Moveability and physical activity in children: Longitudinal results from the IDEFICS and I.Family cohort2019In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 16, no 1, article id 128Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity (PA) is one of the major protective behaviours to prevent non-communicable diseases. Positive effects of the built environment on PA are well investigated, although evidence of this association is mostly based on cross-sectional studies. The present study aims to investigate the longitudinal effects of built environment characteristics in terms of a moveability index on PA of children in their transition phase to adolescence using data of the IDEFICS/I.Family cohort. Methods: We used data on 3394 accelerometer measurements of 2488 children and adolescents aged 3 to 15 years old from survey centres of three countries, Germany, Italy, and Sweden, who participated in up to three surveys over 6 years. In network-dependent home neighbourhoods, a moveability index was calculated based on residential density, land use mix, street connectivity, availability of public transport and public open spaces such as green spaces and public playgrounds in order to quantify opportunities for PA of children and adolescents. Linear trajectories of light PA (LPA) and moderate-to-vigorous PA (MVPA) were estimated using linear mixed models accounting for repeated measurements nested within individuals. Least squares means were estimated to quantify differences in trajectories over age. Results: LPA and MVPA declined annually with age by approximately 20 min/day and 2 min/day respectively. In girls, the moveability index showed a consistent significantly positive effect on MVPA (β $ \hat{\beta} $ = 2.14, 95% CI: (0.11; 4.16)) for all ages, while in boys the index significantly lessened the decline in LPA with age for each year. (β $ \hat{\beta} $ = 2.68, 95% CI: (0.46; 4.90)). Availability of public open spaces was more relevant for MVPA in girls and LPA in boys during childhood, whereas in adolescence, residential density and intersection density became more important. Conclusion: Built environment characteristics are important determinants of PA and were found to have a supportive effect that ameliorates the decline in PA during the transition phase from childhood to adolescence. In childhood environmental support for leisure time PA through public open spaces was found to be the most protective factor whereas in adolescence the positive influence of street connectivity and residential density was most supportive of physical activity. © 2019 The Author(s).

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  • 74.
    Bäckström, Caroline
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Aktuell avhandling: Stöd till förstagångsföräldrar i samband med barnafödande2018In: Jordemodern, ISSN 0021-7468, Vol. 131, no 1, p. 4-7Article in journal (Other academic)
  • 75.
    Bäckström, Caroline
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Professional and social support for first-time mothers and partners during childbearing2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Expecting a child and becoming a parent is one of life’s major events, during which the parents’ perspective on life and their couple relationship changes. For some parents, childbearing entails a decrease in parental couple relationship quality. The way in which parents are able to cope with childbearing may be connected with their Sense of Coherence; which is a person’s ability to perceive life as comprehensible, manageable and meaningful. For parents’ positive childbearing experiences, professional and social support have been proven to be valuable. However, far from all parents have access to social support; furthermore, professional support does not always meet the needs of expectant parents. Hence, more research is needed to increase knowledge about expectant parents’ experiences of professiona land social support. In addition, more research is needed to explore factors associated with quality of couple relationship among parents during childbearing.

    Aims: The overall aim of the thesis was to explore professional and social support for first-time mothers and partners during childbearing in relation toquality of couple relationship and Sense of Coherence.

    Methods: The study’s designs were explorative, prospective and longitudinal; both qualitative and quantitative methods were used. Specifically, explorative designs, qualitative methods and phenomenographic analysis were used to explore expectant first-time mothers’ (I) and partners’ perceptions of professional support (II). Furthermore, an explorative design, qualitative method and qualitative content analysis were used to explore expectant first-time mothers’ experiences of social support (III). Within Study IV, a prospective longitudinal design, descriptive statistics, non-parametric tests and multiple linear regression analysis were used to evaluate factors associated with quality of couple relationship among first-time mothers and partners, during pregnancy and the first six months of parenthood.

    Results: The overall results of the thesis revealed both similarities and differences between expectant first-time mothers’ and partners’ perceptions of professional support, effects from social support and associated factors with perceived quality of couple relationship. The similarities were; both mothers and partners perceived that professional support could facilitate partner involvement, influence their couple relationship and facilitate contacts with other expectant parents. According to first-time mothers’ experiences, their couple relationship with their partner was also strengthened by social support during pregnancy. Further, the results showed that both first-time mothers’ and partners’ higher perceived couple relationship quality six months after birth, was associated with their higher perceived social support. The results showed also that both mothers and partners perceived their quality of couple relationship to decrease and Sense of Coherence to increase six months after childbirth, compared to the pregnancy. Differences revealed were such as: higher Sense of Coherence was only associated with mothers’ higher perceived quality of couple relationship, and first-time mothers reported perceiving more social support compared to the partners both during pregnancy, first week and six months after childbirth.

    Conclusions: Professional and social support can strengthen first-time mothers and partners both individually and as a couple, in their abilities to cope with childbearing. On the individual basis, the expectant parents could be strengthened through professional and social support that contributed to their understanding and feeling of being prepared for childbirth and parenting, for instance. As a couple, the parents were strengthened by professional support that included the partner’s role, as well as higher perceived social support overall. In contrast, lack of support could have a negative influence on the expectant parents’ feeling of being prepared for childbirth and parenting. Besides this, the results indicates that childbearing has a positive effect on parents’ abilities to cope with life even though their quality of couple relationship decrease. Professionals can use these results in their further understanding about how to offer satisfactory support to first-time mothers and partners during childbearing.

  • 76.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Two sides of breastfeeding support2014Conference paper (Refereed)
  • 77.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospital Skövde, Woman, Child (K3), Skövde, Sweden / Jönköping University, School of Health and Welfare, CHILD-Research Group, Jönköping, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Golsäter, Marie H.
    Jönköping University, School of Health and Welfare, CHILD-Research Group, Jönköping, Sweden.
    Thorstensson, Stina A.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    "It's like a puzzle": Pregnant women's perceptions of professional support in midwifery care2016In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 29, no 6, p. e110-e118Article in journal (Refereed)
    Abstract [en]

    ProblemPregnant women are not always satisfied with the professional support they receive during their midwifery care. More knowledge is needed to understand what professional support pregnant women need for childbirth and parenting.

    BackgroundChildbearing and the transition to becoming a parent is a sensitive period in one's life during which one should have the opportunity to receive professional support. Professional support does not always correspond to pregnant women's needs. To understand pregnant women's needs for professional support within midwifery care, it is crucial to further illuminate women's experiences of this support.

    AimTo explore pregnant women's perceptions of professional support in midwifery care.

    MethodsA qualitative study using semi-structured interviews. Fifteen women were interviewed during gestational weeks 36–38. Data was analysed using phenomenography.

    FindingsThe women perceived professional support in midwifery care to be reassuring and emotional, to consist of reliable information, and to be mediated with pedagogical creativity. The professional support facilitated new social contacts, partner involvement and contributed to mental preparedness. The findings of the study were presented in six categories and the category Professional support contributes to mental preparedness was influenced by the five other categories.

    ConclusionPregnant women prepare for childbirth and parenting by using several different types of professional support in midwifery care: a strategy that could be described as piecing together a puzzle. When the women put the puzzle together, each type of professional support works as a valuable piece in the whole puzzle. Through this, professional support could contribute to women's mental preparedness for childbirth and parenting.

  • 78.
    Bäckström, Caroline
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospital Skövde, ‘ Woman, Child ’ (K3) Skövde, Sweden / Jönköping University, School of Health and Welfare, CHILD-research Group, Jönköping, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping, Sweden / Karolinska Institutet and Stockholm University, Aging Research Center, Gävlegatan 16, Stockholm, Sweden.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, CHILD-research Group, Jönköping, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Quality of couple relationship among first-time mothers and partners during pregnancy and the first six months of parenthood2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 56-64Article in journal (Refereed)
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  • 79.
    Bäckström, Caroline
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospital Skövde, Jönköping University, School of Health and Welfare, CHILD-research Group, Jönköping, Sweden.
    Larsson, Therese
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Närhälsan Midwifery Unit, Skövde, Sweden.
    Wahlgren, Emma
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospital Skövde.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, CHILD-research Group, Jönköping, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    ‘It makes you feel like you are not alone’: Expectant first-time mothers’ experiences of social support within the social network, when preparing for childbirth and parenting2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 51-57Article in journal (Refereed)
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  • 80.
    Bäckström, Caroline
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Skaraborg Hospital Skövde, Woman, Child (K3), Skövde, Sweden / Jönköping University, School of Health and Welfare, CHILD-research group, Jönköping, Sweden.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Grimming, Rebecca
    University of Skövde, School of Health and Education. Närhälsan Skaraborg, Young Persons Clinic, Skövde, Sweden.
    Nyblin, Yrsa
    University of Skövde, School of Health and Education. Danderyd Hospital AB, Women’s care, Gynecology ward, Stockholm, Sweden.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, CHILD-research group, Jönköping, Sweden.
    'To be able to support her, I must feel calm and safe': pregnant women's partners perceptions of professional support during pregnancy2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, p. 1-11, article id 234Article in journal (Refereed)
    Abstract [en]

    Background: Professional support does not always meet the needs of expectant fathers or co-mothers. The way in which professional support is offered during pregnancy varies internationally, depending on the country. In order to attain a greater understanding of partners' experiences of professional support, it is necessary to further illuminate their perceptions of it. The aim of this study was therefore to explore pregnant women's partners' perceptions of professional support during pregnancy. Methods: Qualitative research design. Partners of pregnant women were interviewed during gestational week 36-38. Individual semi-structured interviews were used to explore the partners' perceptions. The data was analysed using a phenomenographic approach. The study was performed in a county in south-western Sweden; the data collection was conducted from November 2014 to February 2015. Fourteen partners (expectant fathers and co-mothers) of women who were expectant first-time mothers with singleton pregnancies, were interviewed. Results: The findings of the study are presented through four descriptive categories: Ability to absorb adequate information; Possibility to meet and share with other expectant parents; Confirmation of the partner's importance; and Influence on the couple relationship. Using a theoretical assumption of the relationship between the categories showed that the fourth category was influenced by the other three categories. Conclusions: The partners perceived that professional support during pregnancy could influence the couple relationship. The partners' ability to communicate and to experience togetherness with the women increased when the expectant couple received professional support together. The support created also possibilities to meet and share experiences with other expectant parents. In contrast, a lack of support was found to contribute to partners' feelings of unimportance. It was essential that the midwives included the partners by confirming that they were individuals who had different needs for various types of professional support. The partners perceived it easier to absorb information when it was adequate and given with a pedagogic that made the partners become interested and emotionally engaged.

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  • 81.
    Bäckström, Åsa
    et al.
    Swedish School of Sport and Health Sciences, Sweden.
    Quennerstedt, Mikael
    School of Health Sciences, Örebro University, Sweden.
    Maivorsdotter, Ninitha
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Meckbach, Jane
    Swedish School of Sport and Health Sciences, Sweden.
    Routes and roots to knowing in Shaun White’s snowboarding road trip: A mycorrhizaic approach to multisensory emplaced learning in exergames2019In: Scandinavian Sport Studies Forum, E-ISSN 2000-088X, Vol. 10, p. 251-278Article in journal (Refereed)
    Abstract [en]

    This article explores learning during game-play of a snowboarding video game intrigued by questions raised in the wake of the increasing mediatisation and digitisation of learning. Correspondingly, we answer to calls for more suitable metaphors for learning to cater for the entangled learning processes that changes related to the increase of digital media may infer. Using a short term sensory ethnography approach, we elaborate on the idea of multisensory emplaced learning and propose an organic metaphor – mycorrhiza – to both methodology and learning. Mycorrhiza refers to a symbiotic relationship between fungi and roots of plants in its environment where fungi are the visible effects of the mycorrhiza. The metaphor provides a way to start to unpack sensory, visual and embodied aspects of learning in the complexities of the digital age. By elaborating on the mycorrhizaic concepts fungus, soil, growth, mycelia and symbiosis we show three interrelated ways of moving through this game: (i) a social and cultural route, (ii) a competitive route, and (iii) an experiential route. With help of the metaphor we discern the symbiotic relations between what appeared in our empirical material as visual and other human and non-human aspects of emplacement.

  • 82.
    Caldeborg, Annica
    et al.
    School of Health Science, Örebro University, Örebro, Sweden.
    Maivorsdotter, Ninitha
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Öhman, Marie
    School of Health Science, Örebro University, Örebro, Sweden.
    Touching the didactic contract: a student perspective on intergenerational touch in PE2019In: Sport, Education and Society, ISSN 1357-3322, E-ISSN 1470-1243, Vol. 24, no 3, p. 256-268Article in journal (Refereed)
    Abstract [en]

    A growing anxiety around intergenerational touch in educational settings has both emerged and increased in recent years. Previous research reveals that Physical Education (PE) teachers have become more cautious in their approaches to students and they avoid physical contact or other behavior that could be regarded as suspicious [Fletcher, 2013. Touching practice and physical education: Deconstruction of a contemporary moral panic. Sport, Education and Society, 18(5), 694–709. doi:10.1080/ 13573322.2013.774272; Öhman, 2016. Losing touch—teachers’ selfregulation in physical education. European Physical Education Review, 1–14. doi:10.1177/1356336X15622159; Piper, Garratt, & Taylor, 2013. Child abuse, child protection and defensive ‘touch’ in PE teaching and sports coaching. Sport, Education and Society, 18(5), 583–598. doi:10.1080/13573322.2012.735653]. Some also feel anxious about how physical contact might be perceived by the students. The purpose of this article is to investigate physical contact between teachers and students in PE from a student perspective. This is understood through the didactic contract. For this purpose, focus group interviews using photo elicitation have been conducted with upper secondary school students in Sweden. One of the major findings is that intergenerational touch is purpose bound, that is, physical contact is considered relevant if the teacher has a good intention with using physical contact. The main agreements regarding physical contact as purpose bound are the practical learning and emotional aspects, such as learning new techniques, preventing injury, closeness and encouragement. The didactic contract is in these aspects stable and obvious. The main disagreements are when teachers interfere when the students want to feel capable or when teachers interfere when physical contact is not required in the activity. In these aspects the didactic contract is easily breached. It is also evident that personal preference has an impact on how physical contact is perceived. In conclusion, we can say that physical contact in PE is not a question of appropriate or inappropriate touch in general, but rather an agreement between the people involved about what is expected. Consequently, we should not ban intergenerational touch, but rather focus on teachers’ abilities to deal professionally with the didactic contract regarding physical contact.

  • 83.
    Carlén, Urban
    et al.
    Department of Social and Behavioural Studies, University West, Trollhättan, Sweden.
    Maivorsdotter, Ninitha
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Exploring the role of digital tools in running: The meaning-making of user-generated data in a social networking site2016In: Qualitative Research in Sport, Exercise and Health, ISSN 2159-676X, E-ISSN 2159-6778, Vol. 9, no 1, p. 18-32Article in journal (Refereed)
    Abstract [en]

    The aim of the study is to examine how runners make meaning of digital tools in the dialogues published on a social networking site (SNS) created by and for runners who choose to run alone. The study explores the digital data generated by the runners using global positioning systems, such as how many kilometres have been covered, the average pace, the geographical location, the total climb, health information related to pulse rate and the number of calories burned. Some runners share this kind of data when publishing postings on the SNS. The empirical data consists of published postings of visual graphs and photographs with comments in threads retrieved from the online archives. A transactional approach and practical epistemology analysis are employed to focus on and analyse the meaning-making processes that are located in the social practices that the runners create when participating online. The participants make meaning of digital tools (such as sport watches and associated apps) by: (1) sharing details about their running performances, (2) signalling their presence in the social network of lone runners and (3) planning running events. Digital information is primarily used to reinforce the runners’ identity formation. The meaning-making of digital tools thus becomes a way of highlighting an individual’s social affinity to a runners’ collective. Surprisingly, lone runners do not use the performance-related feedback and health information offered by the digital tools to enhance their running progress when participating in the SNS.

  • 84.
    Carlén, Urban
    et al.
    University West, Trollhättan, Sweden.
    Maivorsdotter, Ninitha
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Understanding athletes' online participation: A ticket to qualitative research on online arenas2018In: Digital qualitative research in sport and physical activity / [ed] Andrea Bundon, London: Routledge, 2018, p. 59-79Chapter in book (Other academic)
  • 85.
    Chang, Angela Y.
    et al.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, USA.
    Dalal, Koustuv
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Dieleman, Joseph L.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, USA / Univ Washington, Dept Hlth Metr Sci, Seattle, USA.
    Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–20502019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10187, p. 2233-2260Article, review/survey (Refereed)
    Abstract [en]

    Background Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. Findings Between 1995 and 2016, health spending grew at a rate of 4.00% (95% uncertainty interval 3.89-4.12) annually, although it grew slower in per capita terms (2.72% [2.61-2.84]) and increased by less than $ 1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5.55% [5.18-5.95]), mainly due to growth in government health spending, and in lower-middle-income countries (3.71% [3.10-4.34]), mainly from DAH. Health spending globally reached $ 8.0 trillion (7.8-8.1) in 2016 (comprising 8.6% [8.4-8.7] of the global economy and $ 10.3 trillion [10.1-10.6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$ 5252 (5184-5319) in high-income countries, $ 491 (461-524) in upper-middle-income countries, $ 81 (74-89) in lower-middle-income countries, and $ 40 (38-43) in low-income countries. In 2016, 0.4% (0.3-0.4) of health spending globally was in low-income countries, despite these countries comprising 10.0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($ 9.5 billion, 24.3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6.27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($ 644.7 million in 2018). Globally, health spending is projected to increase to $ 15.0 trillion (14.0-16.0) by 2050 (reaching 9.4% [7.6-11.3] of the global economy and $ 21.3 trillion [19.8-23.1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1.84% (1.68-2.02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0.6% (0.6-0.7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15.7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130.2 (122.9-136.9) in 2016 and is projected to remain at similar levels in 2050 (125.9 [113.7-138.1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. Interpretation Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets.

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  • 86.
    Chaudhari, Aditi
    et al.
    University of Gothenburg.
    Ejeskär, Katarina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Wettergren, Yvonne
    University of Gothenburg, Sahlgrenska University Hospital/Östra.
    Kahn, Ronald
    Joslin Diabetes Center and Harvard Medical School, United States.
    Rotter Sopasakis, Victoria
    University of Gothenburg / Joslin Diabetes Center and Harvard Medical School, United states.
    Hepatic deletion of p110α and p85α results in insulin resistance despite sustained IRS1-associated phosphatidylinositol kinase activity2017In: F1000 Research, E-ISSN 2046-1402, Vol. 6, article id 1600Article in journal (Refereed)
    Abstract [en]

    Background: Class IA phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) is an integral mediator of insulin signaling. The p110 catalytic and p85 regulatory subunits of PI3K are the products of separate genes, and while they come together to make the active heterodimer, they have opposing roles in insulin signaling and action. Deletion of hepatic p110α results in an impaired insulin signal and severe insulin resistance, whereas deletion of hepatic p85α results in improved insulin sensitivity due to sustained levels of phosphatidylinositol (3,4,5)-trisphosphate. Here, we created mice with combined hepatic deletion of p110α and p85α (L-DKO) to study the impact on insulin signaling and whole body glucose homeostasis.Methods: Six-week old male flox control and L-DKO mice were studied over a period of 18 weeks, during which weight and glucose levels were monitored, and glucose tolerance tests, insulin tolerance test and pyruvate tolerance test were performed. Fasting insulin, insulin signaling mediators, PI3K activity and insulin receptor substrate (IRS)1-associated phosphatidylinositol kinase activity were examined at 10 weeks. Liver, muscle and white adipose tissue weight was recorded at 10 weeks and 25 weeks.Results: The L-DKO mice showed a blunted insulin signal downstream of PI3K, developed markedly impaired glucose tolerance, hyperinsulinemia and had decreased liver and adipose tissue weights. Surprisingly, however, these mice displayed normal hepatic glucose production, normal insulin tolerance, and intact IRS1-associated phosphatidylinositol kinase activity without compensatory upregulated signaling of other classes of PI3K.Conclusions: The data demonstrate an unexpectedly overall mild metabolic phenotype of the L-DKO mice, suggesting that lipid kinases other than PI3Ks might partially compensate for the loss of p110α/p85α by signaling through other nodes than Akt/Protein Kinase B.

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  • 87.
    Cheng, Lan
    et al.
    Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany / Faculty of Mathematics and Computer Science, University of Bremen, Germany.
    Pohlabeln, Hermann
    Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
    Ahrens, Wolfgang
    Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany / Faculty of Mathematics and Computer Science, University of Bremen, Germany.
    Russo, Paola
    Institute of Food Sciences, National Research Council, Avellino, Italy.
    Veidebaum, Toomas
    Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.
    Chadjigeorgiou, Charalambos
    Research and Education Institute of Child Health, Strovolos, Cyprus.
    Molnár, Dénes
    Department of Pediatrics, Medical School, University of Pécs, Hungary.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    De Henauw, Stefaan
    Department of Public Health, Ghent University, Belgium.
    Moreno, Luis
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Spain.
    Page, Angie
    Centre for Exercise, Nutrition & Health Sciences, University of Bristol, Bristol, United Kingdom.
    Hebestreit, Antje
    Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
    Sex differences in the longitudinal associations between body composition and bone stiffness index in European children and adolescents2020In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 131, article id 115162Article in journal (Refereed)
    Abstract [en]

    Fat mass (FM) and fat free mass (FFM) may influence bone health differentially. However, existing evidences on associations between FM, FFM and bone health are inconsistent and vary according to sex and maturity. The present study aims to evaluate longitudinal associations between FM, FFM and bone stiffness index (SI) among European children and adolescents with 6 years follow-up. A sample of 2468 children from the IDEFICS/I.Family was included, with repeated measurements of SI using calcaneal quantitative ultrasound, body composition using skinfold thickness, sedentary behaviors and physical activity using self-administrated questionnaires. Regression coefficients (β) and 99%-confidence intervals (99% CI) were calculated by sex-specified generalized linear mixed effects models to analyze the longitudinal associations between FM and FFM z-scores (zFM and zFFM) and SI percentiles, and to explore the possible interactions between zFM, zFFM and maturity. Baseline zFFM was observed to predict the change in SI percentiles in both boys (β = 4.57, 99% CI: 1.36, 7.78) and girls (β = 3.42, 99% CI: 0.05, 6.79) after 2 years. Moreover, baseline zFFM (β = 8.72, 99% CI: 3.18, 14.27 in boys and β = 5.89, 99% CI: 0.34, 11.44 in girls) and the change in zFFM (β = 6.58, 99% CI: 0.83, 12.34 in boys and β = 4.81, 99% CI: -0.41, 10.02 in girls) were positively associated with the change in SI percentiles after 6 years. In contrast, a negative association was observed between the change in zFM and SI percentiles in boys after 6 years (β = -3.70, 99% CI: -6.99, -0.42). Besides, an interaction was observed between the change in zFM and menarche on the change in SI percentiles in girls at 6 years follow-up (p = .009), suggesting a negative association before menarche while a positive association after menarche. Our findings support the existing evidences for a positive relationship between FFM and SI during growth. Furthermore, long-term FM gain was inversely associated with SI in boys, whereas opposing associations were observed across menarche in girls. 

  • 88.
    Choulagai, Bishnu P.
    et al.
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Shrestha, Binjwala
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 29396Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.

    DESIGN: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.

    RESULTS: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.

    CONCLUSIONS: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

  • 89.
    Choulagai, Bishnu P.
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Subedi, Narayan
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Bhatta, Dharma N.
    Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
    Shrestha, Binjwala
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, / School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 8, p. 1092-1101Article in journal (Refereed)
    Abstract [en]

    Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.

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  • 90.
    Curtin, Alicia
    et al.
    Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, USA.
    Martins, Diane C.
    University of Rhode Island, College of Nursing, Kingston, RI, USA.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Schwartz-Barcott, Donna
    University of Rhode Island, College of Nursing, Kingston, RI, USA.
    Ageing out of place: The meaning of home among hispanic older persons living in the United States2017In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 12, no 3, article id e12150Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore the meaning of home among older Hispanic immigrants who are “aging out of place.”

    Background

    Emerging evidence supports the concept of older persons ageing in place. Nurse researchers have demonstrated that older person who age in place have better physical, psychological and cognitive outcomes. Less, however, is known about older persons who are “aging out of place,” meaning out of their country of origin. With the growth of home health care, there is a need to understand the older immigrants' meaning of home when ageing out of their country of origin.

    Design and Method

    An inductive, qualitative descriptive research design was used. Seventeen Hispanic participants, ranging in age from 65 to 83 years were interviewed using a semi-structured interview protocol.

    Findings

    Two major finding of the study focused on participants' descriptions of home in their country of origin and in the USA. The majority of participants described their home in their native country as the community, countryside or town (pueblo) and in the U.S.A. as family. The level of social isolation and loneliness among participants was evident.

    Conclusions

    Older Hispanic immigrants who are “aging out of place” integrate their past experiences of sense of place in their native country with their present experiences of home in the USA. The need to understand the role of the community and the family in the provision of nursing care in the home may be more important than the physical structure or setting in which it is delivered. Further intra- and cross-national studies are needed to provide a framework for understanding the issues of ageing and immigration globally.

    Implications for Practice

    Gerontological nurses need to recognise the complexity of family relationships for older Hispanic persons who are ageing out of place of origin and their risk of depression, social isolation, and loneliness.

  • 91.
    Dahl-Halvarsson, Martin
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Olive, Montse
    Institut Investigació Biomèdica de Bellvitge – Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
    Pokrzywa, Malgorzata
    University of Gothenburg, Gothenburg, Sweden.
    Ejeskär, Katarina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Palmer, Ruth H.
    University of Gothenburg, Gothenburg, Sweden.
    Uv, Anne Elisabeth
    University of Gothenburg, Gothenburg, Sweden.
    Tajsharghi, Homa
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Drosophila model of myosin myopathy rescued by overexpression of a TRIM-protein family member2018In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 115, no 28, p. E6566-E6575Article in journal (Refereed)
    Abstract [en]

    Myosin is a molecular motor indispensable for body movement and heart contractility. Apart from pure cardiomyopathy, mutations in MYH7 encoding slow/β-cardiac myosin heavy chain also cause skeletal muscle disease with or without cardiac involvement. Mutations within the α-helical rod domain of MYH7are mainly associated with Laing distal myopathy. To investigate the mechanisms underlying the pathology of the recurrent causative MYH7 mutation (K1729del), we have developed a Drosophila melanogaster model of Laing distal myopathy by genomic engineering of the Drosophila Mhc locus. Homozygous MhcK1728del animals die during larval/pupal stages, and both homozygous and heterozygous larvae display reduced muscle function. Flies expressing only MhcK1728del in indirect flight and jump muscles, and heterozygous MhcK1728del animals, were flightless, with reduced movement and decreased lifespan. Sarcomeres of MhcK1728del mutant indirect flight muscles and larval body wall muscles were disrupted with clearly disorganized muscle filaments. Homozygous MhcK1728del larvae also demonstrated structural and functional impairments in heart muscle, which were not observed in heterozygous animals, indicating a dose-dependent effect of the mutated allele. The impaired jump and flight ability and the myopathy of indirect flight and leg muscles associated with MhcK1728del were fully suppressed by expression of Abba/Thin, an E3-ligase that is essential for maintaining sarcomere integrity. This model of Laing distal myopathy in Drosophila recapitulates certain morphological phenotypic features seen in Laing distal myopathy patients with the recurrent K1729del mutation. Our observations that Abba/Thin modulates these phenotypes suggest that manipulation of Abba/Thin activity levels may be beneficial in Laing distal myopathy.

  • 92.
    Dahl-Halvarsson, Martin
    et al.
    Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pokrzywa, Malgorzata
    Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rauthan, Manish
    Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden.
    Pilon, Marc
    Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden.
    Tajsharghi, Homa
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Myosin Storage Myopathy in C. elegans and Human Cultured Muscle Cells2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 1, article id e0170613Article in journal (Refereed)
    Abstract [en]

    Myosin storage myopathy is a protein aggregate myopathy associated with the characteristic subsarcolemmal accumulation of myosin heavy chain in muscle fibers. Despite similar histological findings, the clinical severity and age of onset are highly variable, ranging from no weakness to severe impairment of ambulation, and usually childhood-onset to onset later in life. Mutations located in the distal end of the tail of slow/beta-cardiac myosin heavy chain are associated with myosin storage myopathy. Four missense mutations (L1793P, R1845W, E1883K and H1901L), two of which have been reported in several unrelated families, are located within or closed to the assembly competence domain. This location is critical for the proper assembly of sarcomeric myosin rod filaments. To assess the mechanisms leading to protein aggregation in myosin storage myopathy and to evaluate the impact of these mutations on myosin assembly and muscle function, we expressed mutated myosin proteins in cultured human muscle cells and in the nematode Caenorhabditis elegans. While L1793P mutant myosin protein efficiently incorporated into the sarcomeric thick filaments, R1845W and H1901L mutants were prone to formation of myosin aggregates without assembly into striated sarcomeric thick filaments in cultured muscle cells. In C. elegans, mutant alleles of the myosin heavy chain gene unc-54 corresponding to R1845W, E1883K and H1901L, were as effective as the wild-type myosin gene in rescuing the null mutant worms, indicating that they retain functionality. Taken together, our results suggest that the basis for the pathogenic effect of the R1845W and H1901L mutations are primarily structural rather than functional. Further analyses are needed to identify the primary trigger for the histological changes seen in muscle biopsies of patients with L1793P and E1883K mutations.

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  • 93.
    Dahlheim-Englund, Ann-Charlotte
    et al.
    The academy for Work Life and Social Welfare, Faculty of Caring Science, University of Borås, Sweden.
    Carlsson, Gunilla
    The academy for Work Life and Social Welfare, Faculty of Caring Science, University of Borås, Sweden.
    Nyström, Maria
    The academy for Work Life and Social Welfare, Faculty of Caring Science, University of Borås, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. College of Nursing, University of Rhode Island, RI, USA.
    Eriksson, Irene
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Palmér, Lina
    The academy for Work Life and Social Welfare, Faculty of Caring Science, University of Borås, Sweden.
    Life without professional work: perceptions about one’s self, interpersonal relations and social life after retirement2019In: Healthy Aging Research, ISSN 2261-7434, Vol. 8, no 1Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed, and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings ‘relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required.

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    fulltext
  • 94.
    Dahlstedt, Magnus
    et al.
    Linköpings universitet.
    Olson, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Stockholms universitet, Högskolan Dalarna.
    Ana's tragedy and Europe's: a contemplation over Romani, belonging and the conditioned citizenship making in a Europe of Migration2016In: European Journal of Futures Research, ISSN 2195-4194, E-ISSN 2195-2248, Vol. 4, no 16, p. 1-10Article in journal (Refereed)
    Abstract [en]

    This article deals with the notion of belonging in today’s multi-ethnic Sweden and hints at perpectives of future European identity-building. On the basis of Frantz Fanon’s understanding of colonialism and the colonized mentality as theoretical, the article deals with the situation of Roma in Sweden – and Europe. With the story of a young Roma woman that has migrated to Sweden from Hungary as point of departure, the article addresses the situation for Romani people, but also for other migrants in Europe, with particular focus on who are allowed to belong to the community of Swedish and European citizens, and who are not.

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    Dahlstedt & Olson 2016
  • 95.
    Dalal, Koustuv
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lee, Ming-Shinn
    National Dong Hwa University, Hualien, Taiwan.
    Ussatayeva, Gainel
    Kazakhstan School of Public Health, Almaty, Kazakhstan.
    Gifford, Mervyn
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Female genital mutilation: a multi-country study2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 4, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: Female genital mutilation (FGM) is a major women’s health problem and human right violation. FGM has several physical and psychological consequences. The focus of the current study is the extent of FGM, the association of demographic and economic factors with FGM and women’s beliefs and attitudes towards FGM in Egypt, Guinea, Mali and Sierra Leone. Methods: The study used national representative, cross-sectional, household sample surveys with large sample of women of reproductive age (15 – 49 years) from each country. Multi stage cluster sampling and face-to-face interviews were used. It was cross-sectional analysis, using DHS data. Cross tabulation, multivariate analyses and bar-diagram were used. Results: In Egypt 94%, in Guinea 97%, in Mali 89% and in Sierra Leone, 91%) women had genital mutilation. The majority of the respondents believe that FGM that FGM is socially acceptable and a religious obligation. Majority of the respondents believe that FGM helps to maintain virginity and that it leads to better marriage prospects and the prevention of adultery. Conclusions: The majority of women in the four countries argued in favor for the continuation of FGM. There is an inverse relationship between FGM and higher education and affluence. Proper policies and awareness generation among less educated and less affluent women in rural areas are warranted in an attempt to reduce FGM.

  • 96.
    Dalal, Koustuv
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Centre for Injury Prevention and Safety Promotion (CIPSP), School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Svanström, Leif
    University of Skövde, School of Health and Education. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Economic Burden of Disability Adjusted Life Years (DALYs) of Injuries2015In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 7, no 4, p. 487-494Article in journal (Refereed)
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    Economic burden
  • 97.
    Dalal, Koustuv
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Centre for Injury Prevention and Safety Promotion (CIPSP), School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Wang, Shumei
    School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.
    Svanström, Leif
    University of Skövde, School of Health and Education. WHO CC Community Safety Promotion, Karolinska Institutet, Stockholm, Sweden.
    Intimate Partner Violence against Women in Nepal: An Analysis through Individual, Empowerment, Family and Societal Level Factors2014In: Journal of Research in Health Sciences, ISSN 1682-2765, Vol. 14, no 4, p. 251-257Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The current study estimated the national prevalence rate of intimate partner violence against women (IPVAW) in Nepal. Besides, the individual level, empowerment level, family and societal level factors were assessed to relate with the victims of IPAVW in Nepal.

    METHODS: Nationally representative sample of 4210 women of reproductive age (15-49 yr) were included in the study. Household surveys using two stage sampling procedures, face to face interview with pre-tested questionnaires were performed. Emotional, physical and sexual violence were target variables. A violence variable was constructed from these three types of violence. Individual level factors were measured by age, residency, education, religion and husband's education. Empowerment factors included employment status and various decision making elements. Family and societal factors included economic status, neighborhood socioeconomic disadvantage index, history of family violence, husband's controlling behavior and other issues. Cross tabulation with chi-square tests and multivariate logistic regression were employed.

    RESULTS: Prevalence of emotional IPVAW was 17.5%, physical IPAVW 23.4% and sexual IPAVW 14.7%. Overall the prevalence of IPVAW in Nepal was 32.4%. Joint decision making for contraception, husband's non-controlling behavior to wives and friendly feelings were emerged as less likely to be IPVAW perpetration.

    CONCLUSIONS: The findings have immense policy importance as a nationally representative study and indicating necessity of more gender equality.

  • 98.
    Darcy, Laura
    et al.
    Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden / School of Health Sciences, University College Borås, Borås, Sweden.
    Björk, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Enskär, Karin
    Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Knutsson, Susanne
    Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden / School of Health Sciences, University College Borås, Borås, Sweden.
    The process of striving for an ordinary, everyday life, in young children living with cancer, at six months and one year post diagnosis2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 605-612Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Health care focus is shifting from solely looking at surviving cancer to elements of attention relating to living with it on a daily basis.The young child's experiences are crucial to providing evidence based care. The aim of this study was to explore the everyday life of young children as expressed by the child and parents at six months and one year post diagnosis.

    METHODS: Interviews were conducted with children and their parents connected to a paediatric oncology unit in Southern Sweden. A qualitative content analysis of interview data from two time points, six months and one year post diagnosis, was carried out.

    RESULTS: The process of living with cancer at six months and at one year post diagnosis revealed the child's striving for an ordinary, everyday life. Experiences over time of gaining control, making a normality of the illness and treatment and feeling lonely were described.

    CONCLUSION: Nurses have a major role to play in the process of striving for a new normal in the world post-diagnosis, and provide essential roles by giving the young child information, making them participatory in their care and encouraging access to both parents and peers. Understanding this role and addressing these issues regularly can assist the young child in the transition to living with cancer. Longitudinal studies with young children are vital in capturing their experiences through the cancer trajectory and necessary to ensure quality care.

  • 99.
    Darcy, Laura
    et al.
    Jönköping University, Jönköping, Sweden / University of Borås, Borås, Sweden.
    Björk, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Jönköping University, Jönköping, Sweden.
    Knutsson, Susanne
    Jönköping University, Jönköping, Sweden / University of Borås, Borås, Sweden.
    Granlund, Mats
    Jönköping University, Jönköping, Sweden.
    Enskär, Karin
    Jönköping University, Jönköping, Sweden.
    Following Young Children's Health and Functioning in Everyday Life Through Their Cancer Trajectory2016In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 33, no 3, p. 173-189Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge of living with childhood cancer, through the trajectory, is sparse. Aim: The aim of this study was to follow young children's health and functioning in everyday life through their cancer trajectory. Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis. Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children's trajectories in relation to diagnosis but individual patterns were seen for each child. Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.

  • 100.
    Darcy, Laura
    et al.
    CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden / School of Health Sciences, University College Borås, Borås, Sweden.
    Enskär, Karin
    CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Granlund, M.
    CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Simeonsson, R. J.
    CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden / School of Psychology and Early Childhood Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
    Peterson, C.
    CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Björk, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY)2015In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 41, no 3, p. 475-482Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY).

    AIMS: The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment.

    METHOD: Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures.

    RESULTS: A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence.

    CONCLUSIONS: The ICF-CY can be used to document the nature and range of characteristics and consequences of cancer experienced by children. The identified comprehensive code set could be helpful to health care professionals, parents and teachers in assessing and supporting young children's health and everyday life through the cancer trajectory. The comprehensive code set could be developed as a clinical assessment tool for those caring for young children with cancer. The universal language of the ICF-CY means that the utility of a clinical assessment tool based on identified codes can have wide reaching effects for the care of young children with cancer.

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