Aim: To evaluate the differences in postoperative pain, nausea and time of discharge in children 3–12 years old after Tonsillectomy or Tonsillotomy at the postanaesthetic care unit, children’s ward and at home. 

Background: Tonsillectomy involves risk of bleeding, severe postoperative pain and nausea. Tonsillotomy is a less invasive method with lower risk of bleeding, postoperative pain and nausea according to previous studies.

Design: A prospective, comparative follow-up study design.

Method: From December 2008–April 2009 following parental agreement, 87 children in the ages 3–12 undergoing Tonsillectomy or Tonsillotomy participated. Visual analogue scale was used for children’s pain and nausea reports.

Result: Significantly, fewer children operated on by the Tonsillotomy reported postoperative pain ‡ 3 according to the visual analogue scale than children operated on by the Tonsillectomy at the postanaesthetic care unit and the children’s ward. A statistically significant difference of postoperative nausea was only present during the care at the postanaesthetic care unit and children’s ward with fewer Tonsillotomy children reporting nausea ‡ 3. The time of postoperative care was shorter among the Tonsillotomy children in both the postanaesthetic care unit and the children’s ward. Postoperative pain and pain related difficulties in eating after discharge was significantly more present among the Tonsillectomy children compared with the Tonsillotomy children.

Conclusion: The results of our study showed duration of postoperative pain and nausea in both groups, but indicated that Tonsillotomy is a more favourable alternative than Tonsillectomy in children. © 2012 Blackwell Publishing Ltd.

I denna rapport presenteras resultat från två enkäter som skickades till läkare verksamma inom psykiatrin i Stockholms län år 2018 respektive år 2020. Enkäterna innehöll frågor om läkares arbete med sjukskrivningar. Syftet var att få kunskap om läkares erfarenheter av arbete med sjukskrivning av patienter inom psykiatrin och om detta förändrades när den nya funktionen rehabiliteringskoordination(1-3) infördes vid psykiatriska enheter. Enkäterna baserades på enkäter använda i tidigare studier(4, 5).

Kronisk obstruktiv lungsjukdom är en progressiv sjukdom som kännetecknas av kronisk luftvägsobstruktion. Den främsta orsaken till sjukdomen är rökning. Andra orsaker till sjukdomen kan vara luftföroreningar samt ärftlighet. Tidigare forskning visar att kronisk sjukdom innebär begränsningar som ger upplevelsen av förlust, vilket ger upphov till lidande. KOL leder till andnöd vilket ger begränsningar i livet. Andning är förknippat med liv och vid andnöd kan livet upplevas hotat. Personer som drabbas blir beroende av att ha kontakt med hälso- och sjukvården och i de senare stadierna av sjukdomen är även behovet av omvårdnad stort.  Syftet med studien var att beskriva upplevelsen av att leva med KOL. Litteraturstudien baserades på 15 vetenskapliga artiklar. Resultatet innefattade fyra teman: att uppleva andnöd; att uppleva sociala och personliga förändringar; att hantera livet med KOL; att leva med en självförvållad sjukdom. Livet med KOL präglades av känslor så som oro, ångest, förlust, begränsningar, skam och skuld. Livet för personer med KOL kan upplevas lättare att hantera om en ny mening med livet hittas. Bemötandet från hälso- och sjukvården spelar in på hur personer med KOL upplever sin sjukdom och genom förståelse för hur personer med KOL upplever sjukdomen kan ett gott bemötande från sjuksköterskan samt personcentrerad omvårdnad ges. Mer forskning behövs så att sjuksköterskan får ökad förståelse för hur det är att leva med KOL och därigenom ge bästa möjliga omvårdnad.

Background: Lately, barefoot running has become popular and there is a debate on the pros and cons of barefoot running with regards to running injuries. Many factors are causing injuries and one of the factors discussed is the fact that we run in shoes. When we run in shoes the biomechanics of the running technique may and therefore be a possible cause to injury. Aim: The aim of the study was to assess how the foot strike pattern, angle of the knee and ankle joint at time of initial contact, as well as the step length changes between a shod and barefoot running condition in habitually shod runners when running in a pace equivalent to their running pace over ten kilometers. Method: Twenty-seven healthy runners (18 male, 9 female) were included in the study. The study took place at the fitness center of Halmstad University. Subjects ran on a treadmill, in an individual pace equivalent to their running pace over ten km, both in a shod and barefoot running condition. Two-dimensional analysis of the sagittal plane kinematics of the knee joint, ankle joint and foot position to horizontal, foot strike pattern and step length was done. Participants ran for ten minutes with shoes and for five minutes barefoot. Running technique was videotaped using an Iphone 6 camera and landmarks were marked with white tape to ease the analysis. Results: Changes in foot strike pattern was observed. When running barefoot 63% of the subjects adopted a non-heel strike pattern compared to 18.5% when shod (p=0.001). Knee flexion was increased at IC for the barefoot condition, with 164°±6 relative knee angle compared to 167°±6 when shod (p=0.001). Ankle angle at IC did not show a statistical significant difference between conditions (p=0.657). When barefoot the angle was 117°±8 compared to 115°±8 when shod. Foot angle to horizontal showed a flatter foot placement at IC with a less dorsiflexed foot for the barefoot condition (-4°±8) compared to shod (-12°±8), (p=0.001). Step length was decreased for the barefoot condition (0.82m ±0.15)   compared to shod (0.85m ±0.13), (p=0.008). Conclusion: Results are consistent with previous findings that barefoot running in some cases change the running technique with a flatter foot placement, an increased knee flexion at IC and a decreased step length. However, caution must be taken when habitually shod runners transition to barefoot running in regards to the biomechanical changes that may occur. To benefit from barefoot running a non-heel strike pattern is required. Further, the running technique may be the more important factor, regardless of wearing shoes or not.

Aims: The aim of this study was to investigate the prevalence of cybervictimization in the six Nordic countries and to assess its overlap with traditional bullying. A further aim was to examine potential associations between life satisfaction, on the one hand, and traditional bullying and cyberbullying on the other. Methods: Analyses were based on data from the 2013⁄2014 Health Behaviour in School-aged Children study. It included 32,210 boys and girls, aged 11, 13, and 15, living in the six Nordic countries. Results: The prevalence of cyberbullying by both pictures and by messages was around 2% in all the Nordic countries except Greenland. There it was considerably higher. The prevalence of being bullied in a traditional manner varied widely by country. For boys, this type of bullying was most frequent in the youngest age group and then decreased steadily in the older age groups. Girls were on average more likely to be cyberbullied. Cyberbullying was more common among 13- and 15-year-olds than 11-year-olds. Higher family affluence was unrelated to the risk of cyberbullying. However, it was related to traditional bullying and combined forms of bullying. Compared with intact families, cybervictimization was commoner among single-parent families and stepfamilies. Adjusting for age, gender, family affluence, and family structure, those subjected to cyberbullying had lower life satisfaction than those who were not bullied. Conclusions: We found relatively little overlap between cyberbullying and traditional bullying, indicating that the two may be separate phenomena stemming from different mechanisms, at least in the Nordic context.

Background: A squat is a common exercise that is used in many areas of strength training and for different purposes and the literature is inconclusive when it comes to whether the weight lifting belt (WB) affects performance and/or is injury-preventing. The use of breathing techniques is common during heavy lifting and therefore the practice of the breathing teqnice; valsalva maneuver (VM) may be of interest to study and if this along with the WB can provide some advantages in power output and velocity. Aim: The specific aim of the study was to evaluate whether the velocity in the eccentric and the concentric phase of the squat, and the peak velocity in the concentric phases are affected in power output through the use of the VM when the subjects use or did not use a WB. Method: Fifteen subjects (10 men and 5 women) volunteered freely to participate and did a total of 12 squats divided in four different sets with three repetitions each on 75% of their self-reported one repetition maximum (1RM). The first two sets were either with or without WB and the third and fourth sets were either with or without the practice of the VM. The three conditions (with WB, with WB + VM and VA only) were compared to each other and to the control group (without any instructions and no WB) in terms of power output and velocity in the eccentric, concentric and peak velocity in the concentric phase of the squat. Result: There was no significant difference in power output when comparing the four different test conditions. The velocity in the eccentric, concentric and peak velocity in the concentric phase did not have a significant difference between the different test conditions. Conclusions: This study shows a different output compared to previous literature. The WB and the practice of VM did not affect the power output and velocity in a squat, alone or together. 

Background: To learn how to swim with proper technique takes fairly large amount of time and practice to learn and anelite swimmer spends 6-7 days training for improving aerobic capacity, anaerobic capacity and strength training for energy saving technique. Freestyle is the fastest swimming style and is performed in many different distances, 50m is classified as a sprint and the 400m as a middle-distance. The research is inconclusive if there is a correlation in the lower body and the time in 50m and 400m and mostly in the middle distance which gives this study the importance reducing these uncertainties. Aim: The aim of this study was to determine the strength of the correlation between the upper- and lower body muscle strengthwith time in 50m and 400m freestyle and to analyze which of the variables of height, sex, upper- and lower body strength contribute to velocity in sprint and middle distance in competitive swimmers. Method:A total of 14 participants (3 men and 11 women) participated in the study. The participants were tested at three occasions. The first was to determine their three-repetition maximum (3RM) in the squat and lat-pulldown. The second occasion was the collection the time in 50m freestyle and the third was to collect the time in 400m freestyle. Relative strength (kg/kg BW; %) and absolute strength (kg) in 1RM was calculated and correlated with the time in 50m and 400m freestyle. Analysis was done to see which variables of height, sex, relative strength in the squat and lat-pulldown contribute the most to the time in freestyle. Result: The result show that there was a high correlation between the absolute strength in the squat and the time in 50m (r=-0.769) a moderate correlation in the absolute strength in lat-pulldown and the 50m freestyle sprint (r=-0.513). There was also a moderate correlation for the relative strength in the lat-pulldown and 50m freestyle (r=-0.599). The 400m correlate with the relative strength in both lat-pulldown(r=-0.563) and the squat (r=-0.555). The lat-pulldown contributed most to the time in 50m freestyle as well as the male sex. Conclusions: The absolute strength in the squat had a high correlation to the time in 50m freestyle swim. The 400m there was a moderate correlation to the relative strength in the squat and lat-pulldown showing that for the overall performance in middle-distance the relative strength has the advantage over absolute strength. The relative and absolute strength in upper body correlated to both 50m and 400m freestyle and could therefore strengthen the importance of upper body strength in sprint and middle distance as previous researchers has stated. The upper body strength is the best predictor of time in 50m.

BACKGROUND: An implantable cardioverter defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After an ICD implantation, the entire life situation of the patient their next of kin can be affected psychologically and socially. Healthcare professionals play a vital role in providing educational counselling, support and technical follow-up of the device, but little is known about their experiences.

AIM: This paper describes the experiences of Swedish healthcare professionals in delivering care to patients with an ICD.

METHODS: A qualitative, descriptive design based on a phenomenographic approach was used. Data were collected through interviews with 12 specialist ICD nurses and 12 physicians, representing 16 ICD implantation centres in Sweden.

FINDINGS: Two descriptive categories comprising seven subcategories emerged. Striving to provide competent care comprised the subcategories: providing access to care, improving one's qualifications and individualising care. Striving to infuse confirmation incorporated the subcategories: promoting independence, providing existential support, mediating security and comprising needs of next of kin.

CONCLUSIONS: The healthcare professionals described how they wished to develop the care further. Both nurses and physicians were consistent in wanting to provide competent and confirming care based on a holistic perspective with high accessibility to the ICD team. The findings describe how healthcare professionals strive to provide professional clinical care in order to give the patients tools to handle their life situation. They suggested that more structured education and counselling according to guidelines should be provided. They also highlighted the need to increase their own competence by improving their knowledge and skills.

Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.

Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.

Background:

The aim of this study was to evaluate the usefulness of an ultrasound-based method of examining extensor muscle architecture, especially the parameters important for force development. This paper presents the combination of two non-invasive methods for studying the extensor muscle architecture using ultrasound simultaneously with finger extension force measurements.

Methods:

M. extensor digitorum communis (EDC) was examined in 40 healthy subjects, 20 women and 20 men, aged 35-73 years. Ultrasound measurements were made in a relaxed position of the hand as well as in full contraction. Muscle cross-sectional area (CSA), pennation angle and contraction patterns were measured with ultrasound, and muscle volume and fascicle length were also estimated. Finger extension force was measured using a newly developed finger force measurement device.

Results:

The following muscle parameters were determined: CSA, circumference, thickness, pennation angles and changes in shape of the muscle CSA. The mean EDC volume in men was 28.3 cm3 and in women 16.6 cm3. The mean CSA was 2.54 cm2 for men and 1.84 cm2 for women. The mean pennation angle for men was 6.5° and for women 5.5°. The mean muscle thickness for men was 1.2 cm and for women 0.76 cm. The mean fascicle length for men was 7.3 cm and for women 5.0 cm. Significant differences were found between men and women regarding EDC volume (p < 0.001), CSA (p < 0.001), pennation angle (p < 0.05), muscle thickness (p < 0.001), fascicle length (p < 0.001) and finger force (p < 0.001). Changes in the shape of muscle architecture during contraction were more pronounced in men than women (p < 0.01). The mean finger extension force for men was 96.7 N and for women 39.6 N. Muscle parameters related to the extension force differed between men and women. For men the muscle volume and muscle CSA were related to extension force, while for women muscle thickness was related to the extension force.

Conclusion:

Ultrasound is a useful tool for studying muscle architectures in EDC. Muscle parameters of importance for force development were identified. Knowledge concerning the correlation between muscle dynamics and force is of importance for the development of new hand training programmes and rehabilitation after surgery.

© 2008 Brorsson et al; licensee BioMed Central Ltd.

Background

The progression of dementia disease implies increasing needs for both informal and formal care and services but also risk of institutionalisation. To better adjust care and services in the phase preceding institutionalisation it is important to find out whether utilisation of formal and informal care and services is determined by increased needs and by who meets the needs.Aim

The aim was to compare persons with dementia (65+) with different levels of cognitive impairment, regarding utilisation of formal and informal care and service at home.Methods

The participants consisted of 177 persons with dementia ≥65 years old and at risk of nursing home admission, divided into groups according to their cognitive function. Structured interviews were conducted based on questionnaires about type and amount of formal and informal care utilised, as well as questions regarding cognitive impairment, dependency in activities of daily living (ADLs) and neuropsychiatric symptoms. To analyse the data, descriptive and comparative statistics were used.Results

The findings revealed that the group with severe dementia used significantly more help with ADLs and supervision in terms of time (number of hours and days) provided by the informal caregiver, compared with the group with moderate dementia. Utilisation of formal care and services was highest in the group with the most severe cognitive impairments (Standardized Mini-Mental State Examination score of <9). The group with severe dementia were more dependent in ADLs and had more neuropsychiatric symptoms (hallucinations and motor disturbances). They were younger and more often cohabitated with the informal caregiver, compared with the group with moderate dementia.Conclusion

This study shows that in the phase preceding institutionalisation the ADL and supervision needs due to progression of dementia appear to tend to be met first and foremost by the informal caregivers. © 2017 Nordic College of Caring Science.

Idag lider cirka 50 000 personer i Sverige av svårläkta bensår. Att leva med svårläkta bensår innebär en kronisk sjukdom där läkningsprocessen oftast är långvarig och sannolikheten att sår återkommer är hög. Sjukdomen påverkar flera delar av patienters liv och ytterligare kunskap behövs om hur tillståndet påverkar de drabbade. Syftet med studien var att belysa patienters upplevelser av att leva med svårläkta bensår. Studien genomfördes som en systematisk litteraturstudie där tio relevanta vetenskapliga artiklar valdes ut för analys. Resultatet visade att svårläkta bensår påverkade flera dimensioner av patienternas liv och sammanfattades under rubrikerna; Upplevelser av att leva med en kronisk sjukdom, Upplevelser av smärta, Upplevelser av utanförskap, Upplevelser av nedsatt fysisk förmåga, Upplevelser av lukt och vätska, och Upplevelser av relationen mellan patient – vårdpersonal. Resultatet diskuterades med utgångspunkt från de omvårdnadsvetenskapliga teorierna kring hälsa och lidande. En huvudsaklig slutsats var att sjuksköterskan bör ha ett holistiskt förhållningssätt i omvårdnaden där fokus ligger både på sårläkningsprocessen och på de emotionella konsekvenser som sjukdomen medför hos patienten. Genom att göra patienten delaktig i sin vård kan sjuksköterskan hjälpa patienten utstå det lidande som sjukdomen medför, samt uppleva livet som fortsatt meningsfullt. Det krävs vidare forskning inom området, samt ytterligare undervisning inom sjuksköterskeprogrammet, för att synliggöra vikten av en helhetssyn i omvårdnaden av patienter med svårläkta bensår.

The most important factors in a tutorial session are the pedagogic discussions and making sure that the students have adequate knowledge for the nurse case under study. However, the question is how the tutors experience their situation and what resources and support they consider to be of importance in order to meet the demands for an optimum tutorial service. The aim of this study was to study factors affecting the nurse in the role as a tutor. The method was a systematic literature review and final detailed analysis of 10 specially selected articles.

The results showed that there are three different categories of problems. Category 1 includes obstacles within the nurse ward resulting in lack of time for nurses to perform tutorial activity. Category 2 problems are insufficient support from the health care unit, from the Nurse School, from colleagues or teachers. Category 3, finally, includes inadequate knowledge and experience from the tutor which may result in lack of acknowledgment. More studies on the nurse as a tutor and factors affecting the nurse in the tutorial role are needed. Many of the nurses on the health care units and wards are not feeling comfortable with the tutorial process, the support for the supervision being inadequate. Despite the increasing demands on the tutors during clinical education increases there are currently no national standards or guidelines that show what training is appropriate. Distinct demands and roles, deeply rooted in practical work, would be a god tool supporting the tutors in their teaching supervision.

.

The aim was to explore the documentation in shared care plans regarding the fulfilment of policy requirements and shared decision-making. The sample consists of 15 shared care plans established for older people in Sweden. The analysis was performed using directed content analysis. The requirements in the Swedish law and the 15 indicators of shared decision making (SDM) in the Multifocal Approach to the Sharing in SDM inventory was used to define the main categories. The policy requirements were fulfilled to a varied extent. All the care plans were established in collaboration between the municipality and the county council, but social services were not represented in six of them. The older person and next of kin were present at 14 of the care planning meetings. The individual’s agreement to the establishment was documented in ten of the plans but how and what the person had agreed to was not specified further. The headings focused at the policy requirements and did not support a care planning process, or a documentation based on SDM. Six out of 15 indicators of SDM were reflected. The decision-making process needs to be acknowledged more in the process of establishing shared care plans for older people.

Background: Executive functions (EF) help the individual to manage thoughts and actions to achieve specific goals. The importance of EF may play a pivotal role in the performance of an athlete, in certain types of sports, allowing athletes to make tactical and quick decisions while maintaining focus under pressure. Many researchers have presented a clear result in their studies, indicating that athletes have better EF in comparison with non-athletes which means that physical activity (PA) in the form of exercise related to sport could beneficially influence EF. Still, there is a knowledge gap concerning whether moderate PA beyond regular training acutely could enhance EF performance in athletes.  

Aim: The aim of this study was to test the acute effect of moderate PA on EF in female soccer players. A second aim was to study the association between two different tests measuring EF, the Digit Span Tasks (DST) and Trail Making Tests (TMT) 

Method: In an experimental intervention design 14 active, healthy female young soccer players were tested on two occasions. Data was collected on EF from two different tests: DST (forward and backward) measuring in digits, and TMT (TMT-A and TMT-B) measuring in time (sec) pre and post performing a moderate PA. The Wilcoxon Signed Ranged test was used to study differences pre and post PA, and Spearman’s correlation was used to analyze the association between the different EF tests. 

Results: The participants had a mean ± SD age 21 years ± 3. No statistically significant differences were found in DST forward pre and post PA (p=0.705), or DST backward (p=0.083). In addition, no statistically significant differences were found in TMT-A pre and post PA (p=0.245), or in TMT-B (p=0.124). The association between DST forward and TMT-A post PA indicated a high negative correlation (r = - 0.653), and association between DST backward and TMT-B post PA indicated a moderate negative correlation (r = - 0.334).  

Conclusion: There were no significant acute effects of moderate PA on EF measured with the DST and the TMT tests in female soccer players. Further, the DST and TMT tests had a moderate to high association, indicating the two different tests could be used equivalently in measuring EF. 

Nowadays, there are life-sustaining treatment that can prolong patients’ lives. This may make it difficult for medical personnel to set the limit for when the transition from curative to palliative care should be performed in institutional care. The purpose of the study was to describe the nurses’ experiences when a decision would be taken on when the patient went from curative to palliative care. In this study fifteen scientific articles were reviewed and analyzed. Four headlines emerged from the result: involvement, point in time, education/experience and feelings. One thing nurses had in common was that they thought that their opinion did not matter for the doctors about the transition from curative to palliative care, even though they spent more time with the patient and had a holistic point of view on the situation. The point in time was important in regards to when the decision was made and when the curative treatment was brought to an end. One difference between nurses was their experience and how secure they felt within their occupation. The nurses felt that it was difficult when there were not straight directives on how the treatment should be carried out. To be more secure in their jobs as nurses, there should be a higher level of education introduced throughout all of the health and medical care fields and there should be more research done about the patient’s experiences in their situation.

Background: In 2019 a new virus by the name Sars-coronavirus-2 that caused a disease named Covid-19 and spread globally creating a pandemic. Due to the pandemic, restrictions were created that limited people's everyday life. There were many variations of the restrictions between countries, but they were all based on distancing. The nursing theorist Katie Eriksson describes the suffering in life and everything it means to be a human among humans which makes the pandemic a part of the humans suffering.  Nurses have many ethic codes and core competencies to apply in their work to prevent suffering. Aim: To illustrate the impact of social isolation on the elderly's health during the covid-19 pandemic from a nursing perspective Method: A systematic literature study including 13 scientifically articles that related to the aim. Result: Three themes and five subthemes were identified. These indicate a reduced health among older people, mostly regarding loneliness, worrying, anxiety but also subjective age, ageism and resources and the use of resources among the elderly in order to handle the situation. Conclusion: The health among the elderly have decreased due to the social isolation which, according to Katie Eriksson is part of the human suffering in life. Nurses have, with support from their core competencies and ethics codes a big responsibility to reduce the suffering and encourage health during the pandemic

Background: ICD deactivation at end-of-life is technically uncomplicated. However, it may present a psychological challenge to healthcare professionals, patients, and next-of-kin. Objective: This study explored patients' experiences of complex issues of battery replacement and deactivation of the ICD. Methods: Semistructured interviews were administered to 37 medically stable ICD-recipients. Results: The ICD-recipients lived with an uncertain illness trajectory, but the majority had not reflected on battery replacement or elective ICD deactivation. Healthcare professionals had rarely discussed these issues with patients. However, this was consistent with the ICD-recipients' wishes. Many patients had misconceptions about the lifesaving capacity of the ICD and the majority stated that they would not choose to deactivate the ICD, even if they knew they were terminally ill, and it meant they would receive multiple shocks. Conclusion: The ICD-recipients tended not to think about end-of-life issues, which imply that many patients reach the final stages of life unaware of the option of ICD deactivation. © 2013 Elsevier Inc.

Aim. To explore future reflections of spouses living with an implantable cardioverter defibrillator recipient with focus on the end-of-life phase in an anticipated palliative phase.

Background. A history of or risk for life-threatening arrhythmias may require an implantable cardioverter defibrillator. Despite the life-saving capacity of the device, eventually life will come to an end. As discussion about preferences of shock therapy at end-of-life phase seldom takes place in advance, the implantable cardioverter defibrillator recipients may face defibrillating shocks in the final weeks of their lives, adding to stress and anxiety in patients and their families.

Design. Qualitative study with in-depth interviews analysed with a content analysis.

Methods. Interviews were performed with 18 spouses of medically stable implantable cardioverter defibrillator recipients during 2011–2012.

Results. The spouses described how they dealt with changes in life and an uncertain future following the implantable cardioverter defibrillator implantation. Six subcategories conceptualized the spouses' concerns: Aspiring for involvement; Managing an altered relationship; Being attentive to warning signs; Worries for deterioration in the partner's health; Waiting for the defibrillating shock; and Death is veiled in silence.

Conclusion. Despite the partner's serious state of health; terminal illness or death and the role of the device was seldom discussed with healthcare professionals or the implantable cardioverter defibrillator recipient. Open and honest communication was requested as important to support coping with an unpredictable life situation and to reduce worries and uncertainty about the future and end-of-life. © 2013 John Wiley & Sons Ltd.

Background: Despite high demand, mental health services in primary care in Ireland are underdeveloped. People with mild/moderate anxiety, depression and unspecified psychological distress are frequently seen in primary care settings, mostly by general practitioners (GPs). Occupational therapists have the potential to contribute to service-provision with interventions specially designed for the targeted group e.g. the Redesigning Daily Occupations programme (ReDO-10).Aims/objectivesThis study aimed to explore the feasibility of a future RCT of the ReDO-10 programme in Ireland and the contextual factors that would influence future implementation.

Material and methods: Using a multi-phase, mixed-method design, qualitative and quantitative data were gathered from key stakeholders: ReDO-10 participants (n = 10), GPs (n = 9) and occupational therapists (n = 2). Acceptability, satisfaction, cultural fit and demand were explored, as well as methodological issues such as appropriateness of recruitment methods, outcome measures and randomization.

Results: ReDO-10 was acceptable to participants who reported improvements in their occupational patterns and valued the group-based format. GPs and occupational therapists welcomed the intervention, but acknowledged the limitations of time and resources in the Irish primary care context.

Conclusions: ReDO-10 is feasible to explore in a future RCT in Ireland and this study provides important context for future implementation and/or research. © 2021 Scandinavian Journal of Occupational Therapy Foundation.

Palliative care is an approach which has the main emphasis on the patient’s quality of life. It is characterized by a holistic view towards the patient’s physical, psychological, social and existential need. The nurse can work with palliative care in many different contexts, and to various degrees. Nonetheless, the nurse who conducts palliative care will always have a relation building function, and the relation between the nurse and the patient will have large impact of the patient’s perceived well-being. A nurse’s professional approach to palliative care is generally thought of as her taking on a compassionate role against her patients. The purpose of this paper was to describe the nurse’s experience of establishing and keeping a professional approach to her patients in palliative care. The study was conducted as a scientific literature review with a systematic gathering and scrutinizing of data. In total, eleven qualitative scientific articles were included in the review. Three main conclusions could be drawn. First, the nurses experienced that the relations within palliative care were characterized by closeness and emotional engagement. The close relationship between the nurse and her patients was regarded as being positive, although it constituted a risk of emotional overload. Second, it was found to be necessary for the nurse to maintain a professional distance to the patient to be able to separate work from private life. Third, many nurses identified a challenge of striking an appropriate balance between closeness and distance in order to be able to be personal without being private.

Background: In health promotion should nurses encourage and support patients own resources and respect their autonomy to a lifestyle change. Studies showed that nurses experienced barriers and knowledge gaps in the work of health promotion as Motivational Interviewing and was not a priority to the same extent as the disease -oriented work. Purpose: was to describe nurse's experiences of the Motivational interviewing in health promotion oriented work. Method: A literature review was conducted with an inductive approach to answer the purpose. Searches were made in the databases PubMed, CINAHL and Academic Search Elite and a total of 16 articles were included that met the objective. Results: It was revealed five categories: Nurses experience of lifestyle changes  in the use  of Motivational Interviewing, opportunities and barriers in the use of Motivational Interviewing, education in the use of Motivational Interviewing, changed approach in the use of Motivational Interviewing and frustration at the use of Motivational interviewing.                                                                                                                                                   Conclusion: The nurse experienced Motivational interviewing as a useful method in health promotion. It needs more resources in terms of time for the training of Motivational Interviewing. Support from colleagues and the leadership was important in order to implement Motivational Interviewing in an organization. Further qualitative empirical studies of nurses and patients experiences of Motivational interviewing could provide more sustainable methods in health promotion.

Knee and hip arthroplasty are among the most common surgeries available today and have a great impact on the quality of life of the individual. Several care models have been developed for patients having had knee or hip arthroplasty, not only to address the cost of healthcare, but also to improve the quality of the care itself. However, more knowledge about a patients experience following surgery is required as the care is continually progressing. The purpose of this study was to document the experience of a patient following a knee or hip arthroplasty. We aim to document their experiences returning home from a specialized elective unit, their first day post operation, as well as the initial period of recovery. Phone call interviews were carried out with 12 patients, and analyzed according to qualitative content analysis with inductive approach. The results were divided into five main categories, each with their own sub-categories. The main categories were; the importance of the home environment, information from the hospital, the necessity of help, challenges of recovery and health promotion contact. The participants reported a positive experience returning home after the first postoperative day and were able to handle potential issues in an adequate manner; on their own, with support from informative documentation, with help from relatives or through contact with the hospital. The experience of returning home the first day post operation, after a knee or hip arthroplasty is considered comfortable.

Regelbunden fysisk aktivitet motverkar en rad fysiska och mentala sjukdomar. Hälsovinster av fysisk aktivitet är bland annat en högre funktionell muskulär- och kardiovaskulär kapacitet samt en högre livskvalitet. Stillasittande och inaktivitet kan leda till övervikt, kardiovaskulära sjukdomar, cancer, psykosociala problem och metaboliska sjukdomar.

Mellan män och kvinnor finns fysiologiska skillnader som visar sig i kroppsstorlek och muskelmassa. Detta ger generellt sett kvinnor mer flexibel fysik medan män är fysiskt starkare.

WHOs rekommendationer om daglig fysisk aktivitet är 150 min/vecka av moderat aerobisk träning eller 75 min mer ansträngande aerobisk träning. Styrketräning som involverar större muskelgrupper rekommenderas i åldrarna 18-64.  

Till hjälp att undersöka hypotesen har två oberoende test används. En skriftlig enkät, SF-36v2 Health Survey, samt ett fysiskt test, Functional Movement Screen.

I denna studie undersöks huruvida det finns ett samband mellan en ökad träningsmängd och ett högre FMS-resultat samt om en högre ålder ger lägre FMS-resultat, oavsett kön. Vi tror oss även se ett samband mellan högre FMS-poäng och ett högre uppskattat mentalt och fysiskt mående.

Testpersonerna (N:30) som deltog i studien var arbetande eller studerande män (N:15) och kvinnor (N:15) i åldrarna 20-65år.

FMS-resultaten visade ingen signifikant skillnad mellan kön eller stigande ålder. Däremot ser vi signifikanta skillnader mellan könen vid specifika styrke- eller rörlighetstester i FMS. Kvinnorna visar tydligt via resultaten att de generellt har en mer flexibel fysik medan männen är starkare.

Som slutsats av denna studie kan vi konstatera att FMS som testmetod är könsneutralt och kan användas på blandade populationer. Detta ger testmetoden en bred användbarhet på just en blandad population.

Fler studier krävs för att få fram normerande poängsättning om FMS skall användas på medelmotionären. 

Med åldern ökar risken för åldersrelaterad makuladegeneration (AMD), som är en av de vanligaste orsakerna till synnedsättning hos äldre. Individer med AMD är mindre benägna att delta i sociala och fysiska aktiviteter, vilket innebär att risken för psykisk ohälsa ökar och att de kan gå miste om lärande i sociala sammanhang. Fysisk aktivitet kan förebygga utveckling av AMD, men det finns en brist på interventioner som främjar fysisk aktivitet för personer med synnedsättning. Syftet med studien var att utforska vilka innebörder som personer med AMD har givit uttryck för under ett empowermentbaserat fysiskt aktivitetsprogram (EFA). En kvalitativ metod användes i form av deltagande observationer av deltagarna i forskningsprojektet Kan du se framtiden? som pågick två dagar i veckan under sex månader. 11 personer mellan 65 och 95 år med torr AMD deltog i studien. Resultatet visar att deltagarnas välbefinnande kom till uttryck genom upplevelse av trygghet och trivsel samt genom att de gav uttryck för att vara nöjda och glada. Lärande kom till uttryck genom att de utbytte erfarenheter samt genom att de upptäckte resurser för att vara fysiskt aktiva. Utifrån resultatet kan EFA förstås ha varit en resurs för såväl välbefinnande som lärande. 

OBJECTIVE: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated.

DESIGN: Multicentre prospective observational study in 4 European countries.

METHODS: HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed.

RESULTS: Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients.

CONCLUSION: Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation. © 2014 The Authors

Aim: This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this.

Method: In total, 14 individuals (mean-74.2 years; range-68-86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method.

Results: The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life.

Conclusion: The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being. © 2011 A.-S. Helvik et al.

Transition to adulthood is a period in life when women encounter conflicts, ambiguities and rapidly expanding roles that may be stressful and difficult to manage. The aim of this study was to compare stress in daily life, health complaints and self-confidence in 26-year old women in two different cultures. A health survey study was performed among Swedish women (n = 386) and American women (n = 201) living in urban areas at the West coast of Sweden and in Minnesota. Both Swedish and American women reported stress in their everyday life, with higher figures for the Americans. Overall health was rated lower by the Swedish women and they reported more health complaints such as headache, general tiredness, irritability, depression and sleeping disorders. There was a difference between groups in self-confidence with higher figures for excellent self-confidence among American women. However, low self-confidence was reported by more American than Swedish women. A good work situation predicted self-confidence in Swedish women and financial confidence in American women. Physical fitness was associated with self-confidence in both groups. Young women in both cultures experienced high level of stress but health related complaints were more common among Swedish women. High stress and health complaints must be taken seriously and interventions to support young women in the midst of transition to adulthood should contain stress reduction as well as empowerment performed in a more effective way than today in different health care settings and at place of work.

Rapid Sequence Induction (RSI) är en induktionsstrategi   som används när det föreligger risk för aspiration. Metoden syftar till att   tiden från anestesiinduktion till säkrad luftväg blir så kort som möjlig.   Snabbverkande läkemedel ges i följd, patienten har höjd huvudända och   ventileras inte innan luftvägen är säkrad pga. risken för aspiration.   Krikoidtryck kan ingå i RSI och är en metod som kan minimera risken för   aspiration. Delar av RSI har under senare år ifrågasatts, framförallt är det   val av läkemedel och användandet av krikoidtryck som har diskuterats i   senaste forskning. Syftet med studien var att beskriva   anestesisjuksköterskans erfarenheter av att utföra RSI utifrån aktuell   evidens. Studien baseras på intervjuer av sex verksamma   anestesisjuksköterskor och analyserades med hjälp av kvalitativ   innehållsanalys. Resultatet visade att anestesisjuksköterskorna erfor att   utförandet av RSI varierade trots att gällande kliniks uppdaterade riktlinjer   bygger på senaste evidens. Anledningen till denna variation berodde bl.a. på   att anestesiläkarna i sina ordinationer frångick riktlinjerna. Även   anestesisjuksköterskornas vana och trygghet med ett specifikt läkemedel   påverkade deras sätt att utföra RSI.

Vidare är det svårt att ta till sig ny kunskap och   implementera nya arbetssätt och rutiner. Trots uppdaterade riktlinjer enligt   senaste evidens fanns svårigheter att följa dessa hos gällande klinik.  Forskning och verksamhet bör inrikta sig på   hur man på bästa sätt implementerar ny kunskap.

Women's experiences of turning points and change through art therapy 

The aim of this study was to explore possible experiences of turning points and changes during individual art therapy. The question addressed was: how would you describe your experience of a turning point in the context of art therapy?

Seventeen women who have attended art therapy were consecutively recruited from four different art therapists.  After group information the patients were asked to choose pictures they wanted to talk about during an individual interview. The images were photographed. Twelve woman described changes that can be viewed as a turning point and the other five described a more gradual unclear change.

Background: Art therapy is based on the conception that image making in a therapeutic context may facilitate processes of change.

Methods: A semi-structured interview with focus on the image was conducted with 17 women in order to explore change, after which a qualitative content analysis was performed.

Results: The women experienced internal change as a sudden, unexpected turning point or as a more gradual process, although some reported no internal change whatsoever. Five themes reflecting the women’s experiences of what was important for internal change emerged: Trust in the therapist, Belief in the method, Creative impulse, Meaning of the image and The art therapy process.

Conclusions: Art therapy may contribute to change in the sense of moving from an inadequate to a healthier state. Even when art therapy does not lead to internal change it may be supportive and provide short-term help in everyday life.

© 2016 Informa UK Limited, trading as Taylor & Francis Group

The aim of this study was to describe the occurrence of vitality affects and basic affects and to shed light on their importance in terms of patients’ inner change through art therapy. In an earlier study, where 17 women were interviewed about inner change through art therapy, a secondary deductive content analysis of images and statements was performed exploring the presence of vitality affects and basic affects. Nine of the 17 interviews contained clear descriptions of vitality affects and basic affects in the intersubjective communication between the patient and the therapist; these affects were also mirrored in the patients’ painted images. Three cases are used to illustrate the result and how affects are related to inner change. These three cases differ from each other in that they describe vitality affects either; arising from the art therapist’s empathetic verbal or non-verbal response, from a particular experience in nature, or from the interpreted symbolic language of the image. The common denominator identified as uniting the three cases was the intersubjective communication with the therapist. This study indicates that image making in art therapy gives rise to vitality affects and basic affects that contribute to inner change. It also indicates the importance of having trust in both the method and the art therapist. © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Background:

Sickness absence has represented a growing public health problem in many Western countries over the last decade. In Sweden disorders of the musculoskeletal system cause approximately one third of all sick leave. The Social Insurance Agency (SIA) and the health care system are important actors in handling the sickness absence process. The objective was to study how patients with personal experience of sickness absence due to musculoskeletal disorders perceived their contact with these actors and what they considered as obstructing or facilitating factors for recovery and return to work in this situation.

Methods:

In-depth interviews using open-ended questions were conducted with fifteen informants (aged 33-63, 11 women), all with experience of sickness absence due to musculoskeletal disorders and purposefully recruited to represent various backgrounds as regards diagnosis, length of sick leave and return to work. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis.

Results:

The informants' perceived the interaction with the SIA and health care as ranging from coherent to fragmented. Being on sick leave was described as going through a process of adjustment in both private and working life. This process of adjustment was interactive and included not only the possibilities to adjust work demands and living conditions but also personal and emotional adjustment. The informants' experiences of fragmented interaction reflected a sense that their entire situation was not being taken into account. Coherent interaction was described as facilitating recovery and return to work, while fragmented interaction was described as obstructing this. The complex division of responsibilities within the Swedish rehabilitation system may hamper sickness absentees' possibilities of taking responsibility for their own rehabilitation.

Conclusions:

This study shows that people on sick leave considered the interaction with the SIA and health care as an important part of the rehabilitation process. The contact with these actors was perceived as affecting recovery and return to work. Working for a more coherent process of rehabilitation and offering professional guidance to patients on sick leave might have an empowering effect.

During the last three decades, increased attention has been devoted towards psychological variables influencing injury risk (Hackfort & Kleinert, 2007). Of these prediction studies, a majority have used prospective designs with one single measurement point and continuous injury recording over a number of weeks. In order to grasp the changes in those variables, the use of repeated measure designs with multiple measurement points is warranted. Obtaining data from multiple points will enable use of advanced statistics, such as latent growth curve analysis. Unlike regular analyses (e.g., ANOVAs), growth curve analyses focus on within-person change and how within-person changes in state variables could affect injury risk. Based on findings from injury prediction research, investigators have targeted such variables (e.g., daily hassles, coping) in experimental studies aimed at preventing injuries. A meta-analysis, covering seven experimental studies, showed most studies to be effective in decreasing the number of injuries in the experimental groups (overall Hedges g Effect size = .81; Tranaeus, Ivarsson & Johnson, submitted). Even if the experimental studies have used true or quasi-experimental designs, several methodological issues can be addressed. First, in most of the studies a number of different mental skills are included in the intervention approach leading to difficulties in differentiating which specific mental skills may be responsible for producing reductions in injury. Second, since most of the experimental studies conducted used no-attentional control groups (i.e., the participants in these groups will not be given a placebo treatment), it is likely that large effects could be explained by the Hawthorn effect. Third, in most studies, researchers discuss the importance of their results based on suggested cut-off criteria for the p-values and/or effect sizes (ES). This procedure could be addressed as a limitation since p-values and/or effect sizes do not indicate anything about the results’ clinical significance (e.g., Ivarsson, Andersen, Johnson & Lindwall, 2013). Also, the fact that non-adjusted ES, which were reported in all studies providing ES, are positively biased due to sampling error (Synder & Lawson, 1993) might have led to overestimation of the intervention effects. This presentation will (a) highlight the designs of previous prediction studies while focusing on advantages of longitudinal repeated-measure designs (b) discuss different experimental designs that have been used in injury prevention research and, (c) suggest methodological and statistical considerations for future research on injury prevention.

The monotonous and strenuous shoulder moving pattern during throwing may result in microtrauma and fibrous adhesions between the layers of fascia among athletes. In the last decade, self myofascial release (SMR) has gained good reputation as a way to treat these adhesions. However, there is limited data demonstrating the effects on upper body performance among athletes. PURPOSE: The purpose was to examine the effects from an acute bout of upper body SMR or from dynamic stretch (DS), on shoulder range of motion (ROM), throwing velocity and throwing accuracy. Also to examine correlations between shoulder ROM and throwing velocity/accuracy and between playing experience (PE) and changes in throwing velocity/accuracy and ROM. METHODS: 20 elite male handball players (age 20 ± 5 years, weight 84 ± 9 kg) were included in the study. The study had an experimental cross-over design in which participants first performed baseline measures. They also performed SMR and DS in two different trials. The trials were supervised and separated by 14 days. During SMR, the athletes performed a series of foam rolling exercises during two minutes for the muscles surrounding the shoulder joint. The same muscles were stretched for two minutes during the DS trial. Directly after foam rolling and DS, shoulder ROM, throwing velocity and throwing accuracy were measured using a gravity reference goniometer, radar gun and a high speed videocamera. ANOVA with repeated measures and t-tests were used to analyze differences between and within groups. RESULTS: There were no statistically significant differences in either shoulder ROM, throwing velocity or throwing accuracy between the three trials. There was a moderate correlation between shoulder extension and mean accuracy (r = 0.62; p = 0.004) after DS. When dividing the group into high and low experienced players, among the players in the PE-low group, the most experienced players elicited the greatest increase in peak throwing velocity after DS (r = 0.58; p = 0.10). Change in peak accuracy showed moderate but conflicting correlations after SMR (r = -0.53; p = 0.09) and DS (r = 0.50; p = 0.11) for the players in the PE-high group, indicating a better result after SMR. CONCLUSION: An acute bout of upperbody SMR does not affect ROM and does not improve throwing velocity or throwing accuracy compared to baseline or DS among elite male handball players. Nor could any correlation between ROM and throwing velocity or throwing accuracy be observed. The associations between PE and throwing performance was inconclusive. Further studies is needed to define if PE should be taken into consideration when using SMR or DS in order to improve throwing performance.

We report on electrical and optical properties of p+-i-n+ photodetectors/solar cells based on square millimeter arrays of InP nanowires grown on InP substrates. The study includes a sample series where the p+-segment length was varied between 0 and 250nm, as well as solar cells with 9.3% efficiency with similar design. The electrical data for all devices display clear rectifying behavior with an ideality factor between 1.8 and 2.5 at 300K. From spectrally resolved photocurrent measurements, we conclude that the photocurrent generation process depends strongly on the p+-segment length. Without p+-segment, photogenerated carriers funneled from the substrate into the NWs contribute strongly to the photocurrent. Adding a p+-segment decouples the substrate and shifts the depletion region, and collection of photogenerated carriers, to the nanowires, in agreement with theoretical modeling. In optimized solar cells, clear spectral signatures of interband transitions in the ZB and WZ InP layers of the mixed-phase i-segments are observed. Complementary electroluminescence, TEM as well as measurements of the dependence of the photocurrent on angle of incidence and polarization, support our interpretations. © 2014 Tsinghua University Press and Springer-Verlag Berlin Heidelberg.

The palliative care aims to achieve a good and peaceful death. A good death has proven to be an unique and varied experience why the patient should have an opportunity to comment on his impending death. Research has pointed out that there are different perceptions of what a good death means, from the patients’, relatives’ and nursing staff perspectives. The purpose of this study was therefore to elucidate knowledge about perceptions of a good death, in order to improve nursing care in a palliative context. This literature review is based on 15 scientific articles. The results showed that there are common perceptions of a good death, but also differences that are important from a nursing perspective. A good death can be summarized as symptom control, autonomy, social relationships, self image, synthesis and consent. Foremost it was conversation about the existential dimension, which was missing from the patients’ perspective. From the relatives’ perspective it was more desirable with information about the dying process in order to prepare for their relatives’ death. Palliative care philosophy aims to give the patients a holistic approach, where the promotion of quality of life is the focus, despite the fact that death is imminent. Holistic care was also the approach which emerged as the main idea of a good death from the nursing staff perspective. A good death in a palliative context is a research area that needs to be investigated further, especially concerning to the different views obtained about a good death from different perspectives.

För många kvinnor kan det vara en förlust att förlora det ena eller båda brösten. Detta kan leda till att kvinnornas upple-velse av den kvinnliga identitet förändras vilket även påver-kar kvinnornas psykiska välbefinnande. Kvinnors psykiska behov blir inte alltid tillgodosedda i hälso- och sjukvården. Syftet med studien var att belysa vad som påverkar kvinnor att uppnå ökat psykiskt välbefinnande efter mastektomi. En litteraturstudie genomfördes där 14 vetenskapliga artiklar bearbetades utifrån studiens syfte. Resultatet visade på att kvinnornas känsla av normalitet, helhet och kvinnlig identitet var känslor som kvinnorna ville uppnå genom sina val av bröstrekonstruktion eller användning av bröstprotes. I kvin-nornas beslutfattningsprocess framkom det att stöd från när-stående och sjuksköterska, delaktighet i behandling och in-formation var viktiga komponenter för att kvinnorna skulle uppnå högre psykiskt välbefinnande efter mastektomin. Det framkom i flera studier att kvinnor hade velat få mer infor-mation och träffa kvinnor som genomgått bröstrekonstruk-tion för att få råd och stöd. Det är viktigt som sjuksköterska att vara medveten om kvinnornas behov av stöd och att kun-na ge adekvat information som leder till att kvinnorna kan vara delaktiga i sin behandling och ta autonoma beslut. Mer forskning om protesanvändning behövs då det inte fanns mycket tillgängligt.

ABSTRACTINTRODUCTION: Aging is an unstoppable phenomenon which starts fromconception to last until death. During person’s life goes through certain changes suchas biological, psychological, sociological, and environmental. From all periods of life, Old age is one of important part of person’s life when psychological and sociologicalrelations drifts. It can be defined by three ways (1) chronology, (2) shift in socialstatus, and (3) change in capacity. In a nutshell, aging is a dynamic process that leadsto physical and mental shifts. The change cannot be stopped or reversed, but it may bedelayed by aiding older people in continuing to live their existing lifestyles. AIM: For Nordic countries, aging population is the most pressing challenge incontemporary period. The aim is to assess the psychological wellbeing of old agepeople staying in care home or institution care. METHODS AND ANALYSIS: By using scooping methodology and old age peopleage limit 65 to 84 yrs took data from secondary validated sources in which explainabout good and very good health countries such as Sweden and Norway and Finlandwith lower percentage of good health in both genders and also how decrease mortalityrate increase the dependency ratio in these countries. CONCLUSION: In Nordic countries, Government provide numerous facilities fortheir residents such as home care, institution care for their well being. But even aftergood care, old people suffer from psychological problems such as loneliness, depression and suicide. The conclusion of this study include some interventions whichcan improve their mental as social health such lifelong learning participation , activeaging policies to stay active at their own capacity, identify the vulnerable groups anduse compensatory strategies to stay active and participate in social activities.This ideais not only explain the individual's right and responsibility to remain active, but alsothe government's responsibility to create an age-friendly social system andcommunity environment. Moreover, I focus on quality of health care provided toresidents and also on emotional well being of old people.

Aim: To describe the self assessed dental health and utilization of dental care during the period 2004- 2008 and study patterns of prediction.

Material and Methods: To describe the self assessed dental health and utilization of dental care during the period 2004-2008 and study patterns of prediction.

Results: Very good and rather good dental health was on average reported by 73% of the responders. Variation over the period and between genders was small, but with a significant increase over time. Proportion with visit to a dentist or dental hygienist during the last two years was 88%, with small change over the studied period. The lowest proportion was obser- ved in age group 25-44, 80%. Seventeen percent had not visited a dentist/hygienist during the last three months although they reported need for treatment. This proportion decreased significantly over time independent of age and gender. Twelve percent of the participants reported that they had experienced need for dental care but had abstained for economic reasons, a change from 13% to 10%, with a most marked trend in the youngest group, 14% to 8%. Impaired dental health and low utilization of dental care was associated with low social and economic levels, life style factors as smoking, low physical ac- tivity, unfavourable dietary habits and prevalence of chronic disease and experience of lower well-being.

Conclusion: A large majority of the population report good dental health and high utilization of dental care, but approximately one in ten claims to have abstained from seeking dental care due to economic reasons. A comparison of the areas of explanatory factors, show that impaired dental health is equally well predicted by all. For models with utilization as dependent, the socio-economic factors had best predictive ability. Highest odds ratios were found in models for abstaining from needed dental care, with socio-economic factors as best predictors, and with better prediction among people above 45 years of age.

Young adults in Sweden have grown up with dental care free of charge until the age of twenty. Their self-perceived oral health has been reported as being good, but rapid changes in society have led to a weaker economic situation for many young adults, which may influence their dental attendance and priorities concerning oral health and oral health care. The overall aim of this thesis was to explore the views of young adults on dental care, oral health and Oral Health-Related Quality of Life (OHRQoL).

The thesis is based on four scientific papers which all apply a qualitative approach. In Paper I, the views of young adults on dental care were explored. Paper II investigated the views of young adults on their oral health and OHRQoL. In Paper III, measures of OHRQoL were described and analysed from a public health perspective, and in Paper IV, the views of young adults on the relevance of three measures of OHRQoL were explored. In Paper I, II, and IV, data collection was performed through qualitative interviews. The selection of informants was strategic with reference to age (21-29 years), sex and education. For Paper III, a literature search for OHRQoL measures was made in the PubMed database. The data in Paper I was analysed in accordance with the constant comparative method (inspired by Grounded Theory), and in Papers II, III and IV, qualitative content analysis was used.

The results showed that young adults were satisfied with the dental care that they had received but reported specific views and demands on dental care (Paper I). They perceived their oral health as good, but an array of oral health problems was described (Paper II). The young adults’ perceived control of their OHRQoL depended on their future prospects of oral health, in relation to their perceptions of their past and present oral health. In Paper III, the search for measures of OHRQoL in the PubMed database generated 22 measures. The measures were analysed with regard to their theoretical framework and in relation to four principles of health promotion. Some elements of public health principles were found in all the measures, but most of them originated in disease-oriented theories. The occurrence of oral problems was reflected in young adults’ views on the measures of OHRQoL (Paper IV). The analysed measures were deemed to have both advantages and disadvantages but to be fairly equal.

The conclusions are that young adults’ OHRQoL was dependent on their earlier experiences of dental care and their former and present oral health, as well as their future prospects regarding oral health. Elements of public health principles were present to a varying degree in all the measures of OHRQoL. Young adults regarded the frequently used measures of OHRQoL as being equal. The measures were mainly disease-oriented and no specific measures had been developed for young adults.

Objective

The aim of this study was to explore the views of young adults on the relevance of three measures of oral health-related quality of life (OHRQoL).

Methods

Sixteen young adults aged 21–29 years were interviewed. The selection was strategic with reference to age (21–25 years.; 26–30 years), sex and education (university degree; upper secondary school). The interview guide covered areas on the content and construction of the measures: The Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the Oral Health-Related Quality of Life UK (OHRQoL-UK). The data were analysed using qualitative content analysis.

Results

A theme expressing the latent content was formulated during the data analysis: ‘young adults' own experiences were reflected in their views on the OHRQoL measures’; that is, the experiences of young adults of own oral problems and aspects that were found to be especially important for their age group influenced their view on the measures. The self-reported ability to understand and answer the questions varied and the perceived advantages and disadvantages were almost equally distributed among the three measures.

Conclusions

The OHIP, OIDP and OHRQoL-UK were evaluated as being equal by the young adults in this study, with regard both to their pros and cons. The clarity of the measures was regarded as the most important factor, while the length and assessment period were less significant.

© 2014 John Wiley & Sons A/S.

The living conditions of young adults in Sweden have changed during the last decades due to the economic and employment situation in society. Although oral health is mainly considered to be good in this age group, their use of dental care has decreased and their priorities and opportunities regarding oral health are little known. The purpose of this study was to describe the views of Swedish young adults on their oral health and oral health-related quality of life (OHRQoL). The design of the study was qualitative, using content analysis. Sixteen young adults, aged 21-29 years, were interviewed. The findings from the interviews were summarized under the theme "Young adults reflected on their OHRQoL in a time perspective" consisting of three categories: "Past experiences, Present situation, and Future prospects." The OHRQoL of young adults is dependent not only on their own experiences of oral health during childhood and their received dental care but also on their present self-perceived oral health, oral health habits, and social life; together with their expectations of future oral health. The findings in this study indicate that the oral health awareness and needs of young adults, as well as their expectations of oral care, merit further follow-up. © 2015 G. Johansson & A.-L. Östberg.

The living conditions of young adults in Sweden have changed during the last decades, due to the economic and employment situation in society. Although oral health is mainly considered to be good in this age group, their use of dental care has decreased and their priorities and opportunities regarding oral health are little known. The purpose of this study was to describe and explore the views of Swedish young adults on their oral health and oral health-related quality of life (OHRQoL). The design of the study was qualitative, using content analysis. Sixteen young adults, aged 21 to 29 years, were interviewed. The findings from the interviews were summarized under the theme “The perceived control of OHRQOL of young adults is dependent on their future prospects of oral health, in relation to their perceptions of past and present own oral health,” consisting of three categories: Past experience, Present situation and Future prospects. The OHRQoL of young adults is dependent on their experiences of own oral health during childhood and their received dental care, but also on their present self-perceived oral health, oral health habits and social life together with their expectations of future oral health. The findings in the study indicate that the oral health awareness and needs of young adults, as well as their expectations of oral care, merit further follow-up.