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  • 1.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences.
    Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients2020In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292Article in journal (Refereed)
  • 2.
    Chapman, David
    et al.
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Architecture and Water.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Climate change and human behaviour: Understanding modal choice in a rapidly urbanising Arctic2020In: Local or Global Arctic?: Multi-scaled considerations of connections and remoteness in climate-impacted communities, 2020Conference paper (Refereed)
    Abstract [en]

    This research explores the human dimension of non-motorised transport, i.e. soft-mobility in Arctic communities. Empirical results are used to show how people’s modal choice in the European Arctic is being influenced by climate evolution and human-made climate change. From these results, it is possible to conceive new visions of the how to design the outside environments of Arctic settlements that can better enable people to move around in Arctic communities with reduced reliance on vehicles. At the societal level, this research will help reduce energy consumption and pollution from transport. For the individual, it highlights social, economic and the health benefits of soft-mobility. This includes creating places that are attractive, safe, and recognisable, as a basis for people’s informed decision-making about outdoor activities and modal choice. Pilot projects are ongoing in Riksgränsen, Björkliden and Abisko (Sweden) with data collected from residents and tourists using citizen science. Outcomes have practical and policy implications for town planning and tourism.

    The project is supported by the ARCTIC FIVE (a partnership of UiT The Arctic University of Norway, Luleå University of Technology, Umeå University, The University of Lapland and The University of Oulu) and Access Abisko 2020-22 (research enabling by the Swedish Polar Research Secretariat).

  • 3.
    Tishelman, Carol
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. Center for Rural Medicine (GMC), Storuman, Sweden. Stockholm Health Care Services (SLSO), Stockholm country council (SLL), Stockholm, Sweden. School of Health Sciences, University of Southampton, Southampton, UK.
    Eneslätt, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Menkin, Elizabeth
    Institute for Palliative Medicine, San Diego Hospice, San Diego, California, USA.
    Lindqvist, Olav
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden-Department of Nursing, Umeå University, Umeå, Sweden.
    Developing and using a structured, conversation-based intervention for clarifying values and preferences for end-of-life in the advance care planning-naïve Swedish context: Action research within the DöBra research program2020In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683Article in journal (Refereed)
    Abstract [en]

    Sweden has no systematic advance care planning (ACP), nor legal recognition of end-of-life proxies. We describe our experiences and reflections from a participatory action research process, aiming at developing and initially using a conversation-based, structured ACP approach among community-dwelling, older adults in Sweden. Eco-mapping and DöBra cards were used with 65 people to catalyze discussions on preferences for the end-of-life. We found great individual variation in both Eco-map depictions of social networks and prioritization of the 37 DöBra card items. The DöBra cards were concluded to be a viable tool for stimulating person-centered conversations on preferences for future end-of-life care.

  • 4.
    Nyman, Anneli
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Enacted togetherness: A concept to understand occupation as socio-culturally situated2020In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    Background: This paper is in line with the on-going discussion of a theoretical re-orientation towards acknowledging the socio-cultural dimensions of occupation.

    Aim: To define enacted togetherness as a concept and share our understandings of how this concept can add to the understanding of occupation as socio-culturally situated.

    Method and material: The concept enacted togetherness emerged from empirical findings of a larger research project with older adults living with late-life depression. Informed by a transactional understanding of occupation and a narrative approach, the concept emerged as a contextually situated process holding qualities and potential as a source of meaning-making.

    Findings: Enacted togetherness as described herein has a clear association to occupation in terms of doing activities together. We reflect on enacted togetherness as a process of meaning-making, connecting people and places through unfolding stories; as an arena where togetherness and belonging can be created; and as a space for interpretation, providing opportunities to negotiate issues of meaning that can lead to possibilities for change.

    Conclusion: The concept of enacted togetherness can contribute to the ongoing discussion of a theoretical reorientation towards understanding socio-cultural dimensions of occupation.

    Significance: Enacted togetherness is a concept that can contribute to occupational therapy and occupational science as it adds to an understanding of the qualities and potentials inherent in engagement in occupations with others.

  • 5.
    Jacobsson, Lars
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden. Department of Rehabilitation Medicine, Sunderby Hospital, Luleå, Sweden.
    Lexell, Jan
    Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden. Department of Rehabilitation Medicine, Sunderby Hospital, Luleå, Sweden. Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
    Functioning and disability from 10 to 16 years after traumatic brain injury2020In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 141, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Objectives

    With increased long‐term survival after traumatic brain injury (TBI), there is a need to understand the life situation many years after the injury. In this study, we have assessed persons on average 16 years after their injury and determined changes over 6 years in overall outcome, living condition, marital status and vocational situation, and in their functioning and disability.

    Materials & Methods

    Individuals (n = 49, mean age 45 years, 28‐70 years) who were assessed 6‐15 years (average 10 years) post‐TBI were reassessed 12‐21 years after their injury (average 16 years) using internationally established TBI outcome measures.

    Results

    From the first to the second assessment, overall outcome using the Glasgow Outcome Scale (GOS) was stable for a large majority and no significant changes in marital status or vocational situation was found. There was some significant, but very small, decline regarding cognitive function, home integration and social integration. In the multiple regression analysis, there was a small significant decline in the Mayo‐Portland Adaptability Inventory (MPAI‐4) Adjustment subscale score for women with a moderate‐to‐severe injury.

    Conclusions

    The very small changes over 6 years imply that persons with a TBI can reach and maintain a stable level of functioning many years post‐TBI. Women with a moderate‐to‐severe TBI seem to be more vulnerable and may experience a small decline in some aspects of their functioning related to anxiety, depression, irritability, pain and headache and fatigue. The relatively small sample requires further studies to confirm these findings.

  • 6.
    Rutberg, Stina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Castelli, Darla
    Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA.
    Lindqvist, Anna-Karin
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Grit as Perseverance in Physical Activity Participation2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 3, article id 807Article in journal (Refereed)
    Abstract [en]

    Childhood is a critical period for the acquisition of healthy behaviors, and the promotion of sustainable healthy behavior among children is greatly important. Therefore, an increased understanding of the relationship between grit and physical activity in a school context is needed. The purpose of this study is to describe and develop an understanding of students’ and teachers’ awareness and experiences concerning grit as a health-promoting factor. Fifty-five students and three teachers participated in the study. Data were collected through the Short Grit Scale and focus group interviews. There were weak to non-significant correlations between the three teachers’ ratings of their students’ grit and the children’s own ratings. The qualitative results show that children and teachers understood the construct of grit but had slightly different perceptions of it and that grit is not considered to be set in stone. The participants made an association between grit, motivation, meaningfulness, and setting goals. The findings indicate that grit might be an ideal target for making physical activity interventions sustainable.

  • 7.
    Sjöblom, Margareta
    Luleå University of Technology, Department of Health Sciences.
    Health promotion through the lifespan - the phenomenon of the inner child reflected in childhood events - experienced by children, adults and older persons2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In spite of the fact that we are living longer lives, we still have to face challenges in our society like mental ill-health and stress-related conditions. However, human experiences may give insight on how to overcome challenges like these, by using a health-promoting perspective focusing on salutogenic aspects of health and well-being. The overall aim of this thesis was to describe and gain more knowledge about the phenomenon of the inner child reflected in human beings’ experiences of childhood in connection to health and well-being in the present and through the life course. The thesis consists of three data collections and four studies, and they are all based on a qualitative approach. A total of 53 human beings aged 9 to 91 participated. Open-ended interviews (I – III) were conducted to explore the participants’ lived experiences of childhood. The schoolchildren were also asked to create a drawing to support their narrations about playing (I). A hermeneutical phenomenological approach was used to analyse the data (I – III). A secondary analysis of the data from the three hermeneutical phenomenological studies was performed (IV). The comprehensive understanding of all studies (I-IV) was about meeting the challenges in our society of mental ill-health and stress-related conditions. The findings suggest that the participants by practicing self-knowledge to be the best they can be are turning challenges into life lessons. The findings illuminate how human beings are influenced by the inner child throughout the lifespan. Experiences during childhood have an impact on how we act in relation to the next generation, in our choice of profession, and in the promotion of health. The notion of “test-driving life” was about the participants trying to manoeuvre through life with experiences of supportive relationships and safe surroundings, and also of the opposite. Using a health promotion perspective focusing on salutogenic aspects of health and wellbeing, human experiences during the lifespan may give insight on how to overcome challenges in life increasing health literacy – an area in need of further research. The phenomenon of the inner child may further the discussion of health promotion.

  • 8.
    Simonsson, Johan
    et al.
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    Keijzer, Karl
    Luleå University of Technology.
    Södereld, Theres
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Intensive critical care nurses' with limited experience; Experiences of caring for an organdonor during the donation process2020In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
  • 9.
    Gustafsson, Silje
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patient Satisfaction With Telephone Nursing: A Call for Calm, Clarity, and Competence2020In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 35, no 1, p. E6-E11Article in journal (Refereed)
    Abstract [en]

    Background:Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services.Purpose:This study described patients' experiences and perceptions of satisfaction with telephone nursing.Methods:The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden.Results:Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills.Conclusion:These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.

  • 10.
    Larsson, Agneta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Chapman, David
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Architecture and Water.
    Perceived impact of meteorological conditions on the use of public space in winter settlements2020In: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254Article in journal (Refereed)
    Abstract [en]

    This study aimed to assess the impact of meteorological conditions on the use of public space in Scandinavia and Canada. Between September 21 and December 18, 2017, a cross-sectional online survey ‘EAMQ-Climate: space’ was distributed via web-based platforms. Survey responses were received from 361 residents (258 people from Scandinavia and 103 from Canada). The relative impact of the meteorological determinants on the use of public space was calculated, and a factor analysis was performed. Disparities between Canada and Scandinavia as well as between the climate zones represented were analysed using ANOVA. Overall results showed that the most significant meteorological enablers for the use of outdoor public spaces in winter were solar gain, snowfall and snow-covered surfaces. The main barriers were slush-covered and icy surfaces, rainfall and darkness. Wind and cold were conditions with less influence. The impact of rain and ice, however, differed between climatic zones. It was also established that, when addressing the meteorological impact on avoiding the use of public spaces in winter, it is vital to discriminate between conditions related to a) the ground surface and b) ambient conditions, as well as the particular significance of c) snow and sun, and d) darkness. For the design of public space in winter cities, we conclude that designers need to focus on a wider range of weather conditions than sun, wind and cold, and include snow, rainfall, slushy and icy ground and poor visibility. The study suggests that winter public space has a higher climatic design requirement to be successful than streets and pathways that are mainly used for soft mobility.

  • 11.
    Sjöblom, Margareta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Jacobsson, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Öhrling, Kerstin
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Kostenius, Catrine
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Schoolchildren’s play: A tool for health education2020In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 79, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to gain more knowledge about the phenomenon of the inner child in relation to health and well-being as reflected in play experienced by schoolchildren. Design/method: Participants were 20 schoolchildren recruited from a primary school in a medium-size city in central Sweden. The children who agreed to participate were 14 girls and 6 boys aged between 9 and 10 years old in grade 3. A hermeneutic phenomenological approach was used to analyse the data consisting of the schoolchildren’s drawings and transcribed interviews. Participants’ verbal reflections on their drawings enabled deeper insight into their lived experiences of play. Results: Findings from this study demonstrate how schoolchildren are influenced by the inner child in childhood to handle conflicts, to cope, to make choices, to build relationships to connect and to dream about the future. The schoolchildren in this study developed their coping skills in conflict situations as part of friendship making. Conclusion: The value play offers for health and well-being reveals how schoolchildren are influenced by the inner child in childhood. Gaining knowledge from schoolchildren’s own voices about play makes a worthwhile contribution to research. In addition, the value play provides to schoolchildren’s health and well-being suggest that play can be an important tool as part of health education.

  • 12.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Warm, Katja
    Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health: a report from the OLIN adult asthma cohort2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.

    Methods: In 2012–2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32–92 years) and were included in the study.

    Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1–3 24.1%, and treatment steps 4–5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).

    Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

  • 13.
    Röijezon, Ulrik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Prellwitz, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Ahlmark, Daniel Innala
    van Deventer, Jan
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Embedded Internet Systems Lab.
    Nikolakopoulos, George
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    Hyyppä, Kalevi
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Embedded Internet Systems Lab.
    A haptic navigation aid for individuals with visual impairments: Indoor and outdoor feasibility evaluations of the LaserNavigator2019In: Journal of Visual Impairment & Blindness, ISSN 0145-482X, E-ISSN 1559-1476, Vol. 113, no 2, p. 194-201Article in journal (Refereed)
  • 14.
    Lindgren, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Kostenius, Catrine
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    A method to give voice to young people with experience of mental ill-health2019In: 5TH HORATIO FESTIVAL OF PSYCHIATRIC NURSING, 2019Conference paper (Refereed)
  • 15.
    Jafari, Hedyeh
    et al.
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    Pauelsen, Mascha
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nikolakopoulos, George
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    Gustafsson, Thomas
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    A novel data driven model of ageing postural control2019Conference paper (Refereed)
    Abstract [en]

    Background

    Postural control is a complex system. Based on sensorimotor integration, the central nervous system (CNS) maintains balance by sending suitable motor commands to the muscles. Physiological decline due to ageing, affects balance performance through failing postural control – and in turn affects falls self-efficacy and activity participation. Understanding how the CNS adapts to these changes and predicts the appropriate motor commands to stabilize the body, has been a challenge for postural control research the latest years.

    Aims

    To understand and model the performance of the central nervous system as the controller of the human body.

    Methods

    Modelling was based on postural control data from 45 older adults (70 years and older). Ankle, knee and hip joint kinematics were measured during quiet stance using a motion capture system. Principal component analysis was used in order to reduce the measured multidimensional kinematics from a set of correlated discrete time series to a set of principal components. The outcome was utilized to predict the motor commands. The adaptive behaviour of the CNS was modelled by recurrent neural network including the efference copy for rapid predictions. The data from joint kinematics and electromyography (EMG) signals of the lower limb muscles were measured and separated into training and test data sets.

    Results

    The model can predict postural motor commands with very high accuracy regardless of a large physiological variability or balancing strategies. This model has three characteristics: a) presents an adaptive scheme to individual variability, 2) showcases the existence of an efference copy, and 3) is human experimental data driven.

    Conclusion

    The model can adapt to physical body characteristics and individual differences in balancing behaviour, while successfully predict motor commands. It should therefore be utilised in the continued pursuit of a better understanding of ageing postural control.

  • 16.
    Nordström, Birgitta
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Prellwitz, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    A pilot study of children and parents experiences of the use of a new assistive device: the electro suit Mollii2019In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614Article in journal (Refereed)
    Abstract [en]

    Electrical stimulation has been used for many years to treat spasticity in children with cerebral palsy and some improvements have been noted. Building on the benefits of electrical stimulation, a new assistive device, a suit with imbedded electrodes designed to reduce spasticity through electrical stimulation of the antagonistic muscles, has been tested.

    Aim: The aim of this study was to describe experiences from children with cerebral palsy and their parents regarding the use of the suit. Methods: Individual interviews were conducted with six children 5 to 10 years of age and their parents. The interviews were transcribed and analyzed using a qualitative content analysis. Results: The analysis resulted in three themes: (1) the suit’s impact on image, (2) changes that make a difference and (3) dealing with a desire for change. Each of the themes included subthemes. Conclusion: All children reported some impact on their body and self and/or in some activities after the use of the suit. The parents also saw improvements during the trial period. However, the results are inconclusive and a larger study is needed to determine if the suit is useful from a longer perspective and whether it can affect activity and participation in daily activities for children with spasticity.

  • 17.
    Skjaerven, Liv Helvik
    et al.
    Department Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
    Gómez-Conesa, Antonia
    Murcia University Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence “Campus Mare Nostrum”, Murcia, Spain.
    Catalan-Matamoros, Daniel
    Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain. Research Group of Health Sciences CTS-451, University of Almeria, Almeria, Spain.
    A vocabulary describing health-terms of movement quality: a phenomenological study of movement communication2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to develop a vocabulary targeting communication of health-terms ofmovement quality, establishing professional knowledge of a movement terminology usefull withinrehabilitation.

    Methods: A phenomenological study design was chosen, inviting movement experts working inrehabilitation to describe movement observations when a change into more functional, health relatedways of moving appeared in the rehabilitation processes. 15 physiotherapy experts were recruited,five from the field of neurology, primary health care and psychiatry. The informants had between12-38 years of clinical practice, treating patients of all ages with a wide specter of diagnoses. Datacollection followed a qualitative study design, of individual, in-depth interviews, based on a semi-structured interview guide. The interviews were taped, transcribed and sent to the informants forvalidation. Data analysis followed recommendation of Giorgi, modified by Malterud. Ethical considera-tions were followed.

    Results: Data revealed a vocabulary, clustered in five themes, Biomechanical, Physiological, Psycho-socio-cultural, Existential and Overarching perspective, 16 underlying categories and 122 descriptive health-terms of movement quality.

    Conclusion: The study demonstrated a multi-perspective movement vocabulary of 122 health characteris-tic terms, developed to facilitate movement communication within the broad field of rehabilitation. Theresult calls for further research concerning a movement vocabulary.

  • 18.
    Lindqvist, Anna-Karin
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Löf, Marie
    Karolinska Institutet; Linköping University, Linköping.
    Ek, Anna
    Karolinska Institutet.
    Rutberg, Stina
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Active School Transportation in Winter Conditions: Biking Together is Warmer2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 2, article id 234Article in journal (Refereed)
    Abstract [en]

    There has been a decline in children’s use of active school transportation (AST) while there is also limited research concerning AST in winter conditions. This study aimed to explore the prerequisites and experiences of schoolchildren and parents participating in an empowerment- and gamification-inspired intervention to promote students’ AST in winter conditions. Methods: Thirty-five students, who were aged 12–13 years, and 34 parents from the north of Sweden participated in the study. Data were collected using photovoice and open questions in a questionnaire and analyzed using qualitative content analysis. Results: The results show that involvement and togetherness motivated the students to use AST. In addition, during the project, the parents changed to have more positive attitudes towards their children’s use of AST. The students reported that using AST during wintertime is strenuous but rewarding and imparts a sense of pride. Conclusion: Interventions for increasing students’ AST in winter conditions should focus on the motivational aspects for both children and parents. For overcoming parental hesitation with regards to AST during winter, addressing their concerns and empowering the students are key factors. To increase the use of AST all year around, targeting the challenges perceived during the winter is especially beneficial.

  • 19.
    Antoniewicz, Lukasz
    et al.
    Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Brynedal, Amelie
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Bosson, Jenny A
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways2019In: Cardiovascular Toxicology, ISSN 1530-7905, E-ISSN 1559-0259, Vol. 19, no 5, p. 441-450Article in journal (Refereed)
    Abstract [en]

    The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain largely unknown due to the novelty of this product. The present study examines the acute effects of e-cigarette aerosol inhalation, with and without nicotine, on vascular and pulmonary function in healthy volunteers. Seventeen healthy subjects inhaled electronic cigarette aerosol with and without nicotine on two separate occasions in a double-blinded crossover fashion. Blood pressure, heart rate, and arterial stiffness measured by pulse wave velocity and pulse wave analysis were assessed at baseline, and then at 0 h, 2 h, and 4 h following exposure. Dynamic spirometry and impulse oscillometry were measured following vascular assessments at these time points, as well as at 6 h following exposure. e-Cigarette aerosol with nicotine caused a significant increase in heart rate and arterial stiffness. Furthermore, e-cigarette aerosol-containing nicotine caused a sudden increase in flow resistance as measured by impulse oscillometry, indicating obstruction of the conducting airways. Both aerosols caused an increase in blood pressure. The present study indicates that inhaled e-cigarette aerosol with nicotine has an acute impact on vascular and pulmonary function. Thus, chronic usage may lead to long-term adverse health effects. Further investigation is warranted.

  • 20.
    Backman, Tess
    et al.
    Ambulance Care, Mora, Sweden.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Borg, Ronja
    Västerås Hospital, Region of Västmanland, Västerås, Sweden.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ambulance nurses' experiences of deciding a patient does not require ambulance care2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 783-789Article in journal (Refereed)
    Abstract [en]

    Aim: To describe ambulance nurses’ experience of deciding a patient does not require ambulance care.

    Design:An inductive, empirical study with a qualitative approach.Methods: Data collection was conducted through semi‐structured interviews, and collected data were analysed with qualitative manifest content analysis. Data were collected during the spring 2017, and eight ambulance nurses participated.Results:The findings are presented in one main category, which is “Not very ill but a difficult decision” with totally three subcategories. The ambulance nurse's experi‐ence of making the assessment when the patient has no need for ambulance care is like walking the balance of slack line. This means that the assessment can be both easy and very difficult but something that definitely requires experience, knowledge and dedication.

  • 21.
    Selberg, Stina
    et al.
    The OLIN Studies, Norrbotten County Council, Luleå.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Backman, Helena
    The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma control and acute health care visits among young adults with asthma: A population‐based study2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 12, p. 3525-3534Article in journal (Refereed)
    Abstract [en]

    Aims

    To study asthma control and acute health care visits among young adults with asthma.

    Background

    Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.

    Design

    A population‐based cohort study.

    Methods

    In 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7‐8yr), N=2291 young adults (27‐28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.

    Results

    Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one‐fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.

    Conclusion

    The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.

    Impact

    Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced‐based nursing interventions, contributing to a more efficient asthma management in primary care.

  • 22.
    Rutberg, Stina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Lindqvist, Anna-Karin
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Children’s motivation overcame parental hesitation: active school transportation in Sweden2019In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 34, no 6, p. 1149-1156Article in journal (Refereed)
    Abstract [en]

    Abstract

    To meet the recommendation of 60 min of daily physical activity, children can be encouraged to walk or bike to school, which is known as active school transportation (AST). The aim of this study was to describe parents’ attitudes to AST and to explore their experience when implementing interventions to promote it. To explore parent’s experiences, we collected pre- and post-intervention data via three questionnaires, using both closed and open questioning techniques. The pre-intervention questionnaire informed development of the intervention. Open-ended questions (pre- and post-) were analyzed with qualitative content analysis. In the intervention, there were 42 children, with 63 parents answering pre-intervention questionnaires and 44 answering a post-intervention questionnaire. The analysis resulted in one main theme: children’s motivation and active travel reduces parents’ perception of problems, along with three subthemes: parental concerns and suggestions for solutions, children’s motivation guides parental choice of transport mode, and trying it changes attitudes. In conclusion, it is beneficial to use the enthusiasm and motivation of children to overcome parental hesitation with AST. In addition, it is critical to acknowledge their concerns, as they are the gatekeepers to the children’s use of AST and it is valuable to empower parents when designing relevant interventions. Interventions to increase AST could preferably target changed behavior, and parents’ confidence in their children’s ability to use active transport in a safe and effective way, vs focusing on changing parental attitudes.

  • 23.
    Chapman, David
    et al.
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Architecture and Water.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Climate change and human behaviour: Understanding modal choice in a rapidly urbanising Arctic2019In: Adaptation to Climate Change, 2019Conference paper (Refereed)
    Abstract [en]

    This poster explores the human dimension of non-motorised transport, i.e. soft-mobility in Arctic communities. Empirical results are used to show how people’s modal choice in the European Arctic is being influenced by climate evolution and human-made climate change. From these results, it is possible to conceive new visions of the how to design the outside environments of Arctic settlements that can better enable people to move around in Arctic communities with reduced reliance on vehicles. At the societal level, this research will help reduce energy consumption and pollution from transport.

  • 24.
    Gard, Gunvor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Lund University, Lund, Sweden.
    Nyboe, L.
    Aarhus University Hospital, Risskov, Denmark.
    Gyllensten, A.L.
    Lund University, Lund, Sweden.
    Clinical reasoning and clinical use of basic body awareness therapy in physiotherapy: a qualitative study?2019In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177Article in journal (Refereed)
    Abstract [en]

    Background: Clinical reasoning is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process to arrive at a diagnosis. Body awareness is an approach directed toward an awareness of how the body is used in terms of body function, behaviour, and interaction with self and others. Methods: In the present study, 36 physiotherapists (PTs) from 13 countries working with body awareness methods, mainly Basic Body Awareness Therapy (BBAT) in mental health were interviewed in six focus groups. Content analysis was used to analyse how the informants’ reasoned around the concept of body awareness therapy, and how they use it in their clinical work with patients. Result: Body awareness was conceived as being in contact with sensations and emotions, to be able to control symptoms, such as pain, to find a balance and to develop one’s identity by relating to oneself and others. BBAT was used as a whole body treatment, to promote balance and stability, to teach about body, movements, and coping strategies, to interact in a therapeutic approach and to be integrated with other methods and professionals. Conclusion: The present results can be used to improve the PTs clinical reasoning.

  • 25.
    Lundvik Gyllensten, Amanda
    et al.
    Department of Health Sciences, Research Group Physiotherapy, Lund University, Lund, Sweden.
    Nyboe Jacobsen, Lene
    Research unit for PTSD, Section for depression and anxiety, Aarhus University Hospital, Risskov, Denmark.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Health Sciences, Research Group Physiotherapy, Lund University, Lund, Sweden.
    Clinician perspectives of Basic Body Awareness Therapy (BBAT) in mental health physical therapy: An international qualitative study2019In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 23, no 4, p. 746-751Article in journal (Refereed)
    Abstract [en]

    Introduction

    Body awareness is a movement therapy used in Physical Therapy in Mental Health especially in Scandinavia. The method Basic Body Awareness Therapy has been scientifically investigated in particular for patients with Depression, Schizophrenia and Post Traumatic Stress Syndrome (PTSD).

    Methods

    Thirty-four Physical Therapists from 13 countries working with the Basic Body Awareness Therapy method in Mental Health Care were interviewed in six focus groups about what effects they have experienced in their work with patients. The Physical Therapists worked within the whole Mental Health spectra. Content analysis was used to analyze the informants’ experiences of the clinical effects of body awareness.

    Results

    Five categories emerged: To be in contact, Refocus and coping, Sense of Self, Relations to others and Daily life activities. The results are discussed in relation to previous research, existing theories of body awareness and cognitive neuroscience and findings of experimental psychology.

    Conclusion

    The informants experienced that Basic Body Awareness Therapy worked mainly by helping the patients to be in better contact with their “bodily self.” Stability, balance, improved grounding and the ability to relax were understood as the basis to establish an improved sense of self and leading to improved acceptance of oneself and one’s ability to relate to others.

  • 26.
    Grönlund, Catarina Fischer
    et al.
    Department of Nursing , Umeå University , Umeå.
    Söderberg, Anna
    Department of Nursing , Umeå University , Umeå.
    Dahlqvist, Vera
    Department of Nursing , Ersta Sköndal University College , Stockholm .
    Sandlund, Mikael
    Department of Clinical Science/Psychiatry , Umeå University , Umeå.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Communicative and organizational aspects of clinical ethics support2019In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, no 6, p. 724-733Article in journal (Refereed)
    Abstract [en]

    Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

  • 27.
    Skjærven, Liv H.
    et al.
    Department of Occupational Therapy, Physiotherapy and Radiography , Western Norway University of Applied Sciences, Campus Kronstad, Bergen, Norway.
    Mattsson, M.
    Department of Clinical Sciences, Division of Psychiatry , Umeå University, Umeå, Sweden.
    Catalan-Matamoros, D.
    Department of Nursing, Physiotherapy and Medicine, University of Almeria; Faculty of Humanities, Communication and Documentation, University Carlos III of Madrid, Spain.
    Parker, A.
    Physiotherapy Department, Royal Edinburgh Hospital.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Gyllensten, Al
    Department of Health Sciences, Lund University, Lund, Sweden.
    Consensus on core phenomena and statements describing Basic Body Awareness Therapy within the movement awareness domain in physiotherapy2019In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 35, no 1, p. 80-93Article in journal (Refereed)
    Abstract [en]

    Physiotherapists are facing complex health challenges in the treatment of persons suffering from long-lasting musculoskeletal disorders and mental health problems. Basic Body Awareness Therapy (BBAT) is a physiotherapy approach within the movement awareness domain developed to bridge physical, mental, and relational health challenges. The purpose of this study was to reach a consensus on core phenomena and statements describing BBAT. A consensus-building process was conducted using the nominal group technique (NGT). Twenty-one BBAT experts from 10 European countries participated in a concentrated weekend workshop of 20 hours. All participants signed informed consent. Participants reached a consensus on 138 core phenomena, clustered in three overarching categories: clinical core, historical roots, and research and evaluation phenomena. Of the 106 clinical core phenomena, the participants agreed on three categories of phenomena: movement quality, movement awareness practice, and movement awareness therapy and pedagogy. Furthermore, the participants reached 100 percent consensus on 16 of 30 statements describing BBAT. This study provides a consensus on core phenomena and statements describing BBAT. The data reveal phenomena implemented when promoting movement quality through movement awareness. Data provide clarity in some aspects of the vocabulary as fundamental theory. Further reearch will be developed.

  • 28.
    Lindqvist, Anna-Karin
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Cykelväg till skolan kan vara vägen till framgång2019In: Skolledaren, ISSN 0037-6515, no 3Article in journal (Other (popular science, discussion, etc.))
  • 29.
    Dabija, Marius
    et al.
    Division of Surgery, Sollefteå Hospital.
    Fedog, Fredrik
    Division of Surgery-Anaesthesia, Stavanger University Hospital.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Difficult airways: key factors for sucessful management2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 1, p. 151-159Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe anesthetic nurses’ experiences of key factors for thesuccessful management of difficult airways in adult patients.Design: This study had a qualitative observational and descriptive designfollowing the critical incident technique.Methods: Twelve experienced anesthetic nurses were interviewed.Findings: We identified five key factors for the successful management ofdifficult airways: identification of the difficult airway, creating a plan ofaction, remaining calm and focusing on the task, technical skills, and usingthe equipment. Identification of the difficult airway implies preassessmentwith standardized methods and actively observing for signsindicative of a difficult airway. Having all equipment available atbedside during induction and creating a backup plan increases the actionforce in unexpected situations. A calm and methodical work procedurefacilitates the management of the difficult airway as well as selectingtechniques and equipment according to the patient and situation.Conclusions: Reflective practice can aid the anesthetic nurse in drawingon experience and remaining calm in acute situations.

  • 30.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ett personligt ansvar för god och säker vård2019In: Vårdande vid psykisk ohälsa: på avancerad nivå / [ed] Lena Wiklund Gustin, Lund: Studentlitteratur AB, 2019, 3, p. 571-594Chapter in book (Other (popular science, discussion, etc.))
  • 31.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Evaluating reflective practice groups in a mental health context: Swedish translation and psychometric evaluation of the clinical supervision evaluation questionnaire2019In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 18, article id 2Article in journal (Refereed)
    Abstract [en]

    Background

    Implementation of reflective practice groups in psychiatric and mental health contexts might improve the quality of care through promoting self-awareness, clinical insight, and facilitating stress management and team building. There is a need for valid and reliable instruments to test the outcomes of reflective practice groups in the mental health context. This study aimed to test the validity and reliability of the Swedish version of the Clinical Supervision Evaluation Questionnaire.

    Methods

    The instrument was translated from English to Swedish using a translation and back-translation procedure. Data for the calculation of content validity was collected from an expert group. Data for the reliability analysis was collected from rehabilitation assistants and ward managers participating in reflective practice groups (n = 20). Content validity was measured by computing a content validity index. Construct validity was assessed by calculating the corrected item-total correlation statistics. Reliability was evaluated by analysing the Cronbach’s alpha coefficient, the intraclass correlation coefficient and inter-item correlations.

    Results

    The content validity index for the scale as a whole was 0.94. Item-total correlations ranged between 0.23 and 0.81, and deletion of an item did not notably improve Cronbach’s alpha. Cronbach’s alpha for the scale was 0.89. The intraclass correlation coefficient for single measures was 0.35. The mean inter-item correlation was .37.

    Conclusion

    The Swedish version of the Supervision Evaluation Questionnaire has a degree of reliability and validity that is comparable to the original version in English, indicating that it can be used as an assessment of reflective practice groups in the mental health context.

  • 32.
    Kostenius, Catrine
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Melder, Cecilia
    Uppsala University, Sweden.
    Existential health: A valuable dimension when promoting health throughout the life-course in Sweden2019In: WAIORA: Promoting Planetary Health and Sustainable Development for All, 2019Conference paper (Refereed)
  • 33.
    Nilsson, Carina
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Experiences of striving to maintain daily life among women with osteoporosis2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, article id 1647402Article in journal (Refereed)
    Abstract [en]

    In order to describe how women with osteoporosis strive to maintain daily life we interviewed11 women using a reflective lifeworld approach based on phenomenological analysis.Osteoporosis is a major public health concern in the Western world, and is predominantamong women. Our findings indicated that meanings of striving to maintain daily life implya belief in oneself and one’s own capabilities. The women expressly speak out for themselvesas a way of finding reconciliation without giving in to the illness. Women with osteoporosisexpect to gain support early in the course of their illness. They require advice on how tomanage the disease as well as support for striving to maintain daily living. Therefore, it iscrucial that the women not only are given information about the disease. Equally important isto establish continuity in healthcare encounters, and that health care offers support foundedin the women’s lived experiences with focus on their capacities.

  • 34.
    Sandström, Linda
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nilsson, Carina
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Experiences of suffering multiple trauma: A qualitative study2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 54, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Objectives

    In an effort to strengthen health care professionals’ ability to anticipate and address multiple trauma patients’ needs, this study aims to explore the experience of suffering from multiple trauma.

    Design

    This is a qualitative descriptive study. Nine interviews were analysed using content analysis.

    Setting

    The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma.

    Findings

    The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with ‘dead ends’ during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care.

    Conclusions

    A shared understanding is essential in order to define a person’s needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients’ needs and address them with supportive guidance.

  • 35.
    Larsson, Agneta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Berggård, Glenn
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Architecture and Water.
    Rosander, Peter
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Architecture and Water.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Gait speed with anti-slip devices on icy pedestrian crossings relate to perceived fall-risk and balance2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 14, article id 2451Article in journal (Refereed)
    Abstract [en]

    It is important to find criteria for preventive measures and appropriate assistive devices to reduce pedestrian injuries and increase walking in winter. Reducing the rate of falls on icy surfaces and improving people’s ability to safely cross a street in winter conditions by achieving an adequate walking speed, for example, need to be considered. This study explores pedestrian perceptions of fall risk, balance, and footfall transitions while using different designs for anti-slip devices on ice and snow-covered ice and relates these to measures of gait speed and friction. Trials were performed with nine pedestrians testing 19 anti-slip devices on ice and ice covered with snow. Laboratory tests of the dynamic coefficient of friction (DCOF) on plain ice were also performed. The findings suggest that there was conformity in the participants’ perceptions of good balance and low fall risk for one-fifth of the devices (three whole-foot designs and one design with built-in spikes). We also found that gait speed on icy pedestrian crossings is related to perceived fall-risk and balance control, but not to DCOF of the anti-slip devices.

  • 36.
    Kottorp, Anders
    et al.
    Division of Occupational Therapy, Karolinska Institutet, Huddinge; Department of Occupational Therapy, University of Illinois at Chicago.
    Malinovsky, Camilla
    Division of Occupational Therapy, Karolinska Institutet, Huddinge.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nygård, Louise
    Division of Occupational Therapy, Karolinska Institutet, Huddinge.
    Gender and diagnostic impact on everyday technology use: a differential item functioning (DIF) analysis of the Everyday Technology Use Questionnaire (ETUQ)2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 22, p. 2688-2694Article in journal (Refereed)
    Abstract [en]

    Background: As the use of everyday technology is increasingly important for participation in daily activities, more in-depth knowledge of everyday technology use in relation to diagnosis and gender is needed. The purpose of this study was to investigate the stability of the perceived challenge of a variety of everyday technologies across different samples of varying diagnoses including both males and females.

    Methods: This cross-sectional study used 643 data records from clinical and research samples, including persons with dementia or related disorders, acquired brain injury, intellectual disability, various mental or medical disorders, and adults without known diagnoses. The Everyday Technology Use Questionnaire, comprising 93 everyday technology artifacts and services (items) measuring the level of everyday technology challenge and relevance of and perceived ability to use these was used for data gathering. A two-faceted Rasch model in combination with differential item functioning (DIF) analyses were used for comparing item hierarchies across samples.

    Results: Only three items (3.2%) demonstrated a clinically relevant DIF by gender, and nine items (9.7%) by diagnosis.

    Discussion: The findings support a stable hierarchy of everyday technology challenge in home and community that can facilitate planning of an accessible and inclusive society from a technological departure point.

    • Implications for Rehabilitation
    • The ability to manage everyday technology is increasingly important for participation in everyday activities at home and in the community for people with and without disabilities.

    • This study demonstrates that differences in perceived challenges in using various everyday technologies across gender and diagnosis are minimal.

    • The findings provide evidence of no or minor systematic bias in testing when using the Everyday Technology Use Questionnaire in clinical practice and research.

    • Empirical knowledge about the perceived challenge of specific everyday technologies of people with variations in gender or diagnosis is still sparse, hence this study can inspire practice and future research.

  • 37.
    Strandkvist, Viktor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Norrbotten County Council.
    Hand grip strength and postural control among individuals with and without Chronic Obstructive Pulmonary Disease: Epidemiological and motion laboratory studies2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Chronic obstructive pulmonary disease (COPD) is estimated to affect approximately 8%–10% of all adults. The disease is considered to be a heterogenic syndrome with systemic effects, in which comorbidities including cardiovascular diseases, muscle dysfunction and fatigue are common. The majority of all individuals with COPD have mild to moderate disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2), and only a third are identified by health care, and this under-diagnosis contributes to a lack of knowledge of COPD in the population. COPD is related to skeletal muscle dysfunction, where muscle weakness, frequently assessed with hand grip strength (HGS), is one of the components. Evidence of postural control limitations among individuals with severe or very severe COPD has been emerging during the last decade. These limitations are partly related to muscle weakness, however, research of the other underlying systems of postural control is scarce, and an increased knowledge is of importance for the prevention of falls.

    Aim

    The main objective of the thesis was to increase the population-based knowledge about muscle strength, assessed as hand grip strength, and also postural control among individuals with and without COPD. Another objective was to investigate the value of hand grip strength measurements in relation to lower limb muscle strength and postural control among community-dwelling older adults.

    Methods

    Paper I and II are based on the population-based Obstructive Lung disease in Northern Sweden (OLIN) COPD study. All individuals with obstructive lung function impairment (n=993) and an age- and sex-matched group without (n=993) (COPD and non-COPD) were identified after re-examination of population based cohorts during 2002-04. They (n=1,986) have been invited to recurrent examinations including structured interviews and spirometry. Paper I (n=1011) and II (n=831) include data from examinations during 2009-2010 and 2014, respectively, where measurements of HGS (Paper I & II) as well as assessment of fatigue and physical activity (Paper II) were included. Paper III and IV are based on the population-based Balancing Human and Robot (BAHRT) study. Randomly selected individuals over 70 years of age were invited to participate in a study of postural control aspects, in their homes and at the 2 Human Health and Performance Lab- Movement Science, at Luleå University of Technology. The examinations included a structured interview as well as measurements of postural control and sensory and motor systems including HGS, lower limb strength, proprioception, pressure sensitivity, visual acuity, vestibular function and reaction time. Participants in Paper III consisted of communitydwelling individuals over 70 years of age (n=45). Paper IV consisted of individuals with COPD recruited from both the OLIN COPD study as well as the BAHRT-study (n=22), as well as a control group without airway obstruction from the BAHRT-study (n=34).

    Results

    In Paper I, there was no differences in mean HGS between the groups with and without COPD. However, HGS was related to disease severity; HGS was lower among those with severe to very severe COPD (GOLD 3-4) compared to nonCOPD, and HGS was associated with forced expiratory volume during 1 second % of predicted value (FEV1 % predicted) in regression models. Five years later, in Paper II, mean HGS was lower in COPD compared to non-COPD. Further, individuals with COPD and clinically relevant fatigue had lower HGS than those without clinically relevant fatigue, significantly so among men and close to among women. There was no clear association between HGS and level of physical activity. In Paper III, there was a strong and valid model showing association between HGS and lower limb strength, where all tested muscle groups were significantly correlated to hand grip strength. The regression model with HGS and postural control was significant, however, the model was weak. In Paper IV, individuals with COPD had worse postural control than those without COPD, significantly so regarding mediolateral amplitude in quiet stance with eyes open on soft/unstable surface, as well as anteroposterior limits of stability. In the COPD group, mediolateral amplitude was related to eye sight and the burden of tobacco smoking assessed as pack-years. Further, muscle strength associated with anteroposterior amplitude in the limits of stability test.

    Conclusions

    In the population-based OLIN COPD study in 2009-2010, mean HGS was significantly lower among individuals with severe to very severe COPD (GOLD 3-4) than those without COPD. Five years later, mean HGS was lower among all individuals with COPD (GOLD 1-4) compared to those without COPD, which may indicate altered aging process in COPD. HGS was associated to fatigue among individuals with COPD, while there were no associations between HGS and physical activity. HGS is a valid tool for the estimation of lower limb muscle strength among community-dwelling older adults, however, HGS is not 3 appropriate to use as an estimation of postural control. Postural control was impaired among individuals with COPD and different postural control assessments had different demands on the sensory and motor systems. The burden of tobacco smoking and visual acuity might be important for quiet stance trials with visual input, while muscle strength might be important for the more dynamic limits of stability test. Further research regarding the longitudinal aspects of muscle weakness and postural control among individuals with COPD is needed to gain knowledge for appropriate preventive or rehabilitative interventions.

  • 38.
    Röijezon, Ulrik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Johansson, Anna-Maria
    Handen och underarmen2019In: Motorisk kontroll och inlärning: Med inriktning på muskuloskeletal rehabilitering / [ed] Ulrik Röijezon, Lund: Studentlitteratur AB, 2019, 1, p. 247-258Chapter in book (Other academic)
    Abstract [sv]

    Den stora variation av uppgifter som människohanden kan utföra kräver god sensomotorisk funktion. Därför kan muskuloskeletala besvär med störningar i handens sensoriska och motoriska funktioner inverka stort på individens förmåga och delaktighet, i såväl arbetsliv som fritid. Handens funktion är också tätt förknippad med underarmens och armbågens anatomi och funktion; därför omfattar detta kapitel besvärstillstånd i både hand, underarm och armbåge. Först beskrivs översiktligt sensomotoriska funktionsstörningar som rapporterats vid några specifika diagnoser, därefter följer exempel på metoder för undersökning och träning av sensomotorisk funktion.

  • 39.
    Röijezon, Ulrik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Brorsson, Sofia
    Johansson, Anna-Maria
    Handens sensomotoriska funktion2019In: Motorisk kontroll och inlärning: Med inriktning på muskuloskeletal rehabilitering / [ed] Ulrik Röijezon, Lund: Studentlitteratur AB, 2019, 1, p. 91-106Chapter in book (Other academic)
    Abstract [sv]

    Handen med alla dess mångfasetterade funktioner har central betydelse för människors vardagsaktiviteter, både i hemmet, i yrkesarbetet och på fritiden. Genom sin unika konstruktion, med bland annat opposition av tummen mot övriga fingrar möjliggörs ett flertal olika grepp och ändamålsenlig manipulation. Handen är även viktig för vår uppfattning om vår omvärld samt för vårt kroppsspråk och vår kommunikation. Handens särställning vad gäller såväl sensorisk som motorisk funktion exemplifieras av den relativt sett stora representation som handen har i såväl sensoriska som motoriska kortex. I detta kapitel presenteras handens funktionella anatomi och sensomotoriska funktioner.

  • 40.
    Riekkola, Jenni
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Rutberg, Stina
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Lilja, Margareta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Healthcare professionals’ perspective on how to promote older couples’ participation in everyday life when using respite care2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 2, p. 427-435Article in journal (Refereed)
    Abstract [en]

    Aims

    The aim is to describe healthcare professionals’ perspectives on how they understand and promote older couples’ participation in everyday life when using residential respite care.

    Design and Methods

    Eighteen healthcare professionals with varying degrees of competence and from one residential respite care facility participated in four focus group interviews. Data were analysed through qualitative latent content analysis.

    Findings

    The findings revealed a broad, multifaceted view of participation and ways in which participation in everyday life is promoted by these professionals. Trustworthy relationships between professionals, spousal caregivers and clients were implicated. Promoting participation also necessitated that clients have access to meaningful activities. In addition, participation entailed an environment that supported various needs.

    Conclusion

    Promoting participation for older couples that are using respite care involves multifaceted perspectives that consider social–relational aspects including both the client and their spouse. Furthermore, attention is needed to the meaning a change of context between home and the respite care facility has on relationships, environments and activities in everyday life. Such an approach could benefit the couples’ shared everyday life situation and in a wider perspective, also influence their health and well‐being when ageing in place together.

  • 41.
    Kostenius, Catrine
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Norrbotten Association of Local Authorities.
    Lundqvist, Catarina
    Norrbotten Association of Local Authorities.
    Nyström, Lena
    Norrbotten Association of Local Authorities.
    Henriksson, Annica
    Norrbotten Association of Local Authorities.
    Nordstrand, Annika
    Norrbotten County Council.
    "Hälsoskolan": the national government, local authorities and university in a joint effort to promote health literacy in arctic children and youth2019In: WAIORA: Promoting Planetary Health and Sustainable Development for All, 2019Conference paper (Refereed)
  • 42.
    Marklund, Lisa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Wahlroos, Terese
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    ‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care2019In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349Article in journal (Refereed)
    Abstract [en]

    Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients’ experiences and perceptions of forensic psychiatric inpatient care. Semi‐structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, ‘I know what I need to recover’, and three main categories: ‘A need for meaning in a meagre existence’, ‘A need to be a person in an impersonal context’, and ‘A need for empowerment in a restricted life’. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person‐centred and recovery‐oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.

  • 43.
    Larson, Fanny
    et al.
    Anesthesia Unit, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
    Nyström, Ingela
    Anesthesia Unit, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Key Factors for Successful General Anesthesia of Obese Adult Patients2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 5, p. 956-964Article in journal (Refereed)
    Abstract [en]

    Purpose

    To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients.

    Design

    The study was a qualitative observational study with a descriptive approach.

    Methods

    Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique.

    Findings

    Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams.

    Conclusions

    Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

    DOI:10.1016/j.jopan.2019.01.009

  • 44.
    Jobe, Ingela
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Knowledge and views about coordinated individual planning from the perspective of active older adults2019In: Clinical Journal of Nursing Care and Practice, ISSN 2639-9911, Vol. 3, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Background Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed.

    Aim

    The aim of the study was to explore active older adults’ knowledge and views regarding coordinated individual planning.

    MethodsThe study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes.

    ResultsThe four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individuals’ needs.

    ConclusionsOlder adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.

  • 45.
    Röijezon, Ulrik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Bexander, Catharina
    Koordination av öga, huvud och hand2019In: Motorisk kontroll och inlärning: Med inriktning på muskuloskeletal rehabilitering / [ed] Ulrik Röijezon, Lund: Studentlitteratur AB, 2019, p. 79-90Chapter in book (Other academic)
    Abstract [sv]

    Vid manuella uppgifter som att äta, laga mat, snickra, spela bordtennis eller sätta en nyckel i ett lås är det synen som vägleder handens rörelse. För att kunna tolka synintrycken korrekt måste kroppen känna till huvudets position och rörelse, dels i rummet och dels i förhållande till bålen. Dessutom måste denna information samordnas med information om handens och armens position och rörelse i förhållande till bålen. Motoriska kommandon för såväl ögon, huvud, arm och hand måste koordineras så att rörelserna utförs med stor precision. Detta involverar en mängd sensoriska och motoriska omkopplingar och kontrollprocesser och inkluderar såväl reflexer som viljemässiga rörelser. I detta kapitel beskrivs samordningen av öga–nacke och öga–huvud–handrörelser. Dessutom ges några exempel på hur smärttillstånd kan störa denna koordination.

  • 46.
    Haley, Katarina L.
    et al.
    Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
    Womack, Jennifer L.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
    Harmon, Tyson G.
    Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
    McCulloch, Karen L.
    Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
    Richard A., Faldowski
    Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
    Life activity choices by people with aphasia: repeated interviews and proxy agreement2019In: Aphasiology, ISSN 0268-7038, E-ISSN 1464-5041, Vol. 33, no 6, p. 710-730Article in journal (Refereed)
    Abstract [en]

    Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences.

    Aims: To characterize life activities that people with aphasia want to do, to estimate consistency in selections over time, and to replicate previous findings about the ability of family members and friends to identify their loved ones’ activity preferences.

    Methods & Procedures:  We administered the Life Interests and Values (LIV) Cards to 26 people with aphasia, asking them which of 95 depicted life activities they wanted to do more in their lives. Half the activity cards were presented again one to ten weeks later. Twenty family members or friends responded as proxies by selecting from a questionnaire with the same items.

    Outcomes & Results: Participants with aphasia selected diverse activities, though as a group they identified significantly more activities from the “social” activity category than from the “home and community”, “creative and relaxing”, or “physical” categories. Across the repeated interviews, they selected identical activities on average 78% of the time. Item-to-item agreement between people with aphasia and their proxy responders was significantly lower at 69%.

    Conclusions: People with aphasia have diverse activity interests and are reliable informants about their preferences. Because significant others have limited ability to predict these choices, their impressions are inadequate substitutes for direct interviews.

  • 47.
    Nord-Ljungquist, Helena
    et al.
    Department of Health and Caring Science, Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University,Växjö, Sweden,.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Fridlund, Bengt
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Elmqvist, Carina
    Centre of Interprofessional Collaboration within Emergency care (CICE), Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Lone and lonely in a double ambivalence situation as experienced by callers while waiting for the ambulance in a rural environment2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article, review/survey (Refereed)
    Abstract [en]

    Background

    In a rural environment where distances and access to ambulance resources in people’s immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called ‘While Waiting for the Ambulance’ (WWFA). Knowledge is limited about the experience from a caller’s perspective when a person has a life‐threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved.

    Aim

    The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective.

    Method

    A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in‐depth interviews with eight callers.

    Results

    An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm.

    Conclusion

    A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.

  • 48.
    Brännström, Margareta
    et al.
    Department of Nursing, Umeå University, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Grönlund, Catarina Fischer
    Department of Nursing, Umeå University, Sweden.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Norrbotten County Council, Sweden.
    Söderberg, Anna
    Department of Nursing, Umeå University, Sweden.
    Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 577-583Article in journal (Refereed)
    Abstract [en]

    Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

  • 49.
    Sundbaum, Johanna
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science. Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden.
    Eriksson, Niclas
    Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Hallberg, Pär
    Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Lehto, Niklas
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Wadelius, Mia
    Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Baecklund, Eva
    Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden.
    Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice2019In: International Journal of Rheumatic Diseases, E-ISSN 1756-185X, Vol. 22, no 7, p. 1226-1232Article in journal (Refereed)
    Abstract [en]

    Aim

    To assess predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and to describe the monitoring of liver enzymes, including handling and outcome of elevated ALT.

    Methods

    All RA patients starting MTX in January, 2005 to April, 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden) were identified from electronic medical records. Clinical and laboratory data were obtained from medical records, supplemented by telephone interviews. Predictors for ALT >1.5× over the upper limit of normal (ULN) were identified by multiple regression analysis.

    Results

    The study comprised 213 RA patients starting MTX. During a mean follow‐up of 4.3 years, 6288 ALT tests were performed; 7% of tests with ALT were >ULN. ALT >1.5× ULN was observed in 44 (21%) patients and the strongest predictor was a pre‐treatment elevation of ALT (adjusted odds ratio = 6.8, 95% CI 2.2‐20.5). Recurrent elevations occurred in 70% of patients who continued treatment, and the proportion was similar in those with and without interventions, for example MTX dose reduction (67% vs 73%, P = 0.43). Seven patients (3%) permanently stopped MTX due to ALT elevation, and two were eventually diagnosed with non‐alcoholic fatty liver disease. No patient developed hepatic failure.

    Conclusion

    Only a small number of ALT tests performed during MTX therapy in RA capture an elevation. A pre‐treatment elevation of ALT was the strongest predictor for early and recurrent ALT elevations during therapy. This study supports a more individualized approach to monitoring and handling of ALT elevations during MTX therapy in RA than recommended in current guidelines.

  • 50.
    Srivastava, Karnica
    et al.
    Physics Department, University of Lucknow, Lucknow, India.
    Shukla, Anuradha
    Physics Department, University of Lucknow, Lucknow, India.
    Karthick, T.
    Physics Department, University of Lucknow, Lucknow, India;Institute of Organic Chemistry and Biochemistry, Academy of Sciences, Prague, Czech Republic.
    Velaga, Sitaram
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Tandon, Poonam
    Physics Department, University of Lucknow, Lucknow, India.
    Sinha, Kirti
    Physics Department, University of Lucknow, Lucknow, India.
    Shimpi, Manishkumar R.
    Luleå University of Technology, Department of Civil, Environmental and Natural Resources Engineering, Chemical Engineering.
    Molecular structure, spectroscopic signature and reactivity analyses of paracetamol hydrochloride monohydrate salt using density functional theory calculations2019In: CrystEngComm, ISSN 1466-8033, E-ISSN 1466-8033, Vol. 21, no 5, p. 857-865Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to understand the role of the intermolecular hydrogen bond interactions present in paracetamol hydrochloride monohydrated salt. Paracetamol hydrochloride monohydrate salt (PRA-HCl) and paracetamol (form I) were investigated via vibrational (FT-IR and FT-Raman) spectroscopy and density functional theory (DFT) to gain insight into the hydrogen bond patterns present in these crystalline materials. Two different density functionals, wB97X-D and M062X, were used for the comparison of the results. The geometrical parameters of PRA-HCl and form I obtained using these functional were compared with the crystallographic data, which proved the existence of intra-molecular and intermolecular hydrogen bonds. The C10O2 group of form I forms an intramolecular hydrogen bond, while the O1–H18 group of PRA-HCl forms an intermolecular hydrogen bond with a chloride ion (Cl), resulting in the elongation of the bond length and shift to a lower wavenumber for the O1–H18 group. To examine the potency of hydrogen bonding, quantum theory of atoms in molecules (QTAIM) calculations were performed and the results suggested that O1–H18⋯Cl22 is a strong intermolecular hydrogen bond. The chemical reactivity parameters reveal that the PRA-HCl and PRA-OXA cocrystals are more reactive and softer (low HOMO–LUMO energy gap) in comparison to paracetamol (form I).

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