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  • 251.
    Almeida, Teresa
    et al.
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Mehrnezhad, Maryam
    Royal Holloway University of London, UK.
    Cook, Stephen
    Royal Holloway University of London, UK.
    The importance of collective privacy in digital sexual and reproductive health2024Manuscript (preprint) (Other academic)
  • 252.
    Almevall, Albin D.
    et al.
    Department of Health, Learning and Technology, Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden; Department of Development, Region Norrbotten, Luleå, Sweden.
    Nordmark, Sofi
    Department of Development, Region Norrbotten, Luleå, Sweden.
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Zingmark, Karin
    Department of Health, Learning and Technology, Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
    Experiences of home as an aspect of well-being in people over 80 years: a mixed method study2022In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, no 1, p. 252-263Article in journal (Refereed)
    Abstract [en]

    Aims: To (1) describe experiences of home from a well-being perspective, (2) describe participant characteristics and well-being measures in relation to housing type (3) and how the aforementioned aspects may affect well-being in very old persons.

    Design: Cross-sectional, convergent parallel-results mixed method design with semi-structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well-being outcome measures related to home.

    Methods: A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well-being, along with collection of participant characteristics and well-being measures related to home.

    Results: Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well-being. Housing type seemed of importance with higher measures of well-being for participants in single-living housing compared with those living in apartment.

    Conclusion: Home is increasingly central to well-being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well-being.

    Impact: As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well-being for this age-group. This study describes aspects of home that contribute to, or has adverse impact on well-being. These aspects need thorough consideration in policy-making and planning of health care that can affect experiences of home.

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  • 253. Almevall, Albin D.
    et al.
    Zingmark, Karin
    Nordmark, Sofi
    Forslund, Ann-Sofie
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Accepting the inevitable: A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study2021In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 92, article id 104275Article in journal (Refereed)
    Abstract [en]

    Background: As the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).

    Method: In a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.

    Results: Quantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.

    Conclusion: When using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.

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  • 254.
    Almevall, Albin Dahlin
    et al.
    Department of Health Science, Luleå University of Technology, Luleå, Sweden; Department of Healthcare, Region Norrbotten, Luleå, Sweden.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Zingmark, Karin
    Department of Health Science, Luleå University of Technology, Luleå, Sweden.
    Öhlin, Jerry
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Nordmark, Sofi
    Department of Health Science, Luleå University of Technology, Luleå, Sweden.
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Associations between everyday physical activity and morale in older adults2022In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 48, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.

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  • 255.
    Almgren, Simon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Danielsson, Andreas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Påverkan av Muskeltrötthet på Motorisk Kontroll hos Kvinnliga Innebandyspelare2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Non-contact injuries are a big part of overall injuries in floorball. Deficits in motor control due to muscle fatigue may be a factor that causes non-contact injuries. We analyzed movement changes with The Functional Movement ScreenTM (FMS) with and without muscle fatigue on women floorball players. Method: A pilot study with a cross-sectional structure. FMS test was used to measure changes in movements and to reach fatigue a 5-10 min running ramp protocol on treadmill was used. The borg RPE-scale was used to measure perceived exhaustion. Participants: Seven female floorball players playing in teams at the highest two leagues in Sweden. The participants age was 19.7 (±SD 3,2) years, length 166.4 cm (±SD 7,2) and weight 63.1 kg (±SD 4,5). Results: Through observations of the participants we noted a different movement pattern while obtaining muscle fatigue. The results of FMS total score shows no significant difference (p=0,504) before and after the VO2max running test. The FMS results from exercises that includes the lower extremities (deep squat, hurdle step, in-line lunge and straight leg raise) does not either confirm a significant difference (p=0,132). Discussion: Our subjective analyze of the movements confirms a different movement strategy with and without muscle fatigue. The non-parametric statistical analyze does not confirm this change in movements as significant. The Functional Movement Screen might not be a good tool to measure changes in movement because the movement change has to be in a specific criteria to get a lower point. Even though we saw a different movement strategy after the ramp running test, the deficit in movements was not in the specific criteria that was necessary to get a lower point. Conclusion: Through the test results and our observations we conclude that movement pattern change after an exercise that causes fatigue, does not completely show how much the movement patterns changes and what the consequences are. More research has to be done in this area to confirm such results.

  • 256.
    Almlöf, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Haffling Carlsson, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Svenska elitidrottares studie- och privatlivssituation - Relaterat till stress och skador2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion:Ett fåtal idrottare kommer kunna livnära sig till följd av sitt idrottande under resten av livet, därför måste de ta beaktning till deras post-idrottsliga karriär vilket ofta resulterar i behovet av en akademisk utbildning. Ett uppmärksammat problem är hur de ska prioritera idrott, studier och privatliv på ett effektivt sätt. Detta är en påfrestande livssituation och kan ligga till grund för stress och skador hos individerna.

    Syfte:Syftet med studien var att kartlägga svenska elitidrottares studie- och privatlivssituation och relatera till stress och skador.

    Metod:Studiepopulationen bestod av 139 elitidrottare som är potentiella och aktuella landslagsidrottare som studerar på akademisk nivå på ett lärosäte i Sverige som erbjuder studieanpassning. Data samlades in genom en webbenkät som innehöll frågor som upplevd återhämtning och priatlivssituation och även generella frågor om studier och elitidrottande, samt frågeformuläret “The athlete burnout questionnaire”.

    Resultat:Det huvudsakliga resultatet var att majoriteten (71,9%) av deltagarna nådde upp till gränsen för medelhöga respektive höga symptom för idrottslig utbrändhet samt att majoriteten ofrivilligt tvingats avstå från ordinarie träning till följd av skada och/eller sjukdom det senaste året. Den självupplevda stressnivån var även signifikant associerad med låg nivå av upplevd privatlivssituation och låg nivå av upplevd återhämtning.

    Konklusion:Det finns en brist i forskningen som inkluderar alla de huvudområden vi undersöker: elitidrott, akademiska studier och privatliv. Något som bör fokuseras på i kommande undersökningar är kombinationen av anpassad studietakt och möjligheten till CSN då det inte undersöks så ingående i denna studie. 

  • 257. Almon, Ricardo
    et al.
    Alvarez-Leon, Eva E
    Engfeldt, Peter
    Serra-Majem, Lluís
    Magnuson, Anders
    Nilsson, Torbjörn K
    Department of Clinical Chemistry, Örebro University Hospital.
    Associations between lactase persistence and the metabolic syndrome in a cross-sectional study in the Canary Islands2010In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 49, no 3, p. 141-146Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The single nucleotide polymorphism (SNP) LCT -13910 C>T, associated with genetically determined phenotypes of lactase persistence (LP) or non-persistence (LNP), was studied in relation to the metabolic syndrome (MS).

    AIM OF THE STUDY: The aim was to determine if milk intake and MS are associated. We applied Mendelian randomization (MR). The SNP, LCT -13910 C>T, with the genotypes LP (TT/CT) and LNP (CC), was taken as a proxy for milk consumption.

    METHODS: A representative sample of adults belonging to the Canary Islands Nutrition Survey (ENCA) in Spain aged 18-75 years (n = 551) was genotyped for the LCT -13910 C>T polymorphism. We used the International Diabetes Federation (IDF) criteria to define MS.

    RESULTS: 60% of the population was LP and 40% LNP. One hundred seven LP subjects (35.0%) and 53 LNP subjects (25.6%) showed MS (chi (2) = 5.04, p = 0.025). LP subjects showed a significantly higher odds ratio (OR) for MS than LNP subjects computed for the whole population: both the crude OR (1.56; 95% CI 1.06-2.31) and adjusted OR for sex, age, daily energy intake, physical activity and educational level (1.57; 95% CI 1.02-2.43). Adjusted OR for women with LP was 1.93; 95% CI 1.06-3.52.

    CONCLUSIONS: The T allele of the SNP might constitute a nutrigenetic factor increasing the susceptibility of LP subjects, especially women, to develop MS in the Canary Islands.

  • 258. Almon, Ricardo
    et al.
    Patterson, Emma
    Nilsson, Torbjörn K
    Department of Clinical Chemistry, Örebro University Hospital.
    Engfeldt, Peter
    Sjöström, Michael
    Body fat and dairy product intake in lactase persistent and non-persistent children and adolescents2010In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 54, no 5141Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Lactase non-persistent (LNP) individuals may be lactose intolerant and therefore on a more restricted diet concerning milk and milk products compared to lactase persistent (LP) individuals. This may have an impact on body fat mass.

    OBJECTIVE: This study examines if LP and LNP children and adolescents, defined by genotyping for the LCT-13910 C > T polymorphism, differ from each other with regard to milk and milk product intake, and measures of body fat mass.

    DESIGN: Children (n=298, mean age 9.6 years) and adolescents (n=386, mean age 15.6 years), belonging to the Swedish part of the European Youth Heart Study, were genotyped for the LCT-13910 C > T polymorphism. Dietary intakes of reduced and full-fat dairy varieties were determined.

    RESULTS: LNP (CC genotype) subjects consumed less milk, soured milk and yoghurt compared to LP (CT/TT genotype) subjects (p<0.001). Subsequent partitioning for age group attenuated this observation (p=0.002 for children and p=0.023 in adolescents). Six subjects were reported by parents to be 'lactose intolerant', none of whom were LNP. LNP children and adolescents consumed significantly less reduced fat milk and milk products than LP children and adolescents (p=0.009 for children and p=0.001 for adolescents).

    CONCLUSIONS: We conclude that LP is linked to an overall higher milk and dairy intake, but is not linked to higher body fat mass in children and adolescents.

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  • 259. Almon, Ricardo
    et al.
    Sjöström, Michael
    Nilsson, Torbjörn K
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry. Department of Laboratory Medicine, Örebro University Hospital and Department of Biomedicine, School of Health and Medical Sciences, Örebro University.
    Lactase non-persistence as a determinant of milk avoidance and calcium intake in children and adolescents2013In: Journal of nutritional science, ISSN 2048-6790, Vol. 2, no e26, p. 1-5Article in journal (Refereed)
    Abstract [en]

    This study examines if lactase non-persistent (LNP) children and adolescents differ from those who are lactase persistent (LP) as regards milk avoidance and Ca intake. We also studied potential differences in anthropometric features related to obesity, and examined if milk avoidance is associated with lactasepersistence status. Additionally, we aimed to determine if heterozygous subjects showed an intermediary phenotype as regards Ca intake. Furthermore, we tested if LP and LNP influence vitamin D intake. The European Youth Heart Study is an ongoing international, multi-centre cohort study primarily designed to address CVD risk factors. Children (n 298, mean age 9·6 years) and adolescents (n 386, mean age 15·6 years) belonging to the Swedish part of the European Youth Heart Study were genotyped for the LCT-13910 C > T polymorphism. Mendelian randomisation was used. Milk avoidance was significantly more common in LNP adolescents (OR 3·2; 95% CI 1·5, 7·3). LP subjects had higher milk consumption (P < 0·001). Accordingly, energy consumption derived from milk and Ca intake was lower in LNP (P < 0·05 and P < 0·001, respectively). Heterozygous subjects did not show an intermediary phenotype concerning milk consumption. LP or LNP status did not affect vitamin D intake or anthropometric variables. LNP in children and adolescents is associated with reduced intake of milk and some milk-product-related nutritional components, in particular Ca. This reduced intake did not affect the studied anthropometric variables, indicators of body fat or estimated vitamin D intake. However, independently of genotype, age and sex, daily vitamin D intake was below the recommended intakes. Milk avoidance among adolescents but not children was associated with LNP.

  • 260. Almquist, Ylva B
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Associations between social support and depressive symptoms: social causation or social selection-or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects.

    METHODS: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately.

    RESULTS: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time.

    CONCLUSION: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women's capability to increase their levels of social support.

  • 261. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, J.
    Rajaleid, K.
    Westerlund, H.
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 47-47Article in journal (Other academic)
    Abstract [en]

    Background: Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods: The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results: Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions: There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.
    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.
  • 262. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, Josephine
    Rajaleid, Kristiina
    Westerlund, Hugo
    Hammarstrom, Anne
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

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  • 263.
    Almroth, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sondell, Sara
    Umeå University, Faculty of Medicine, Department of Nursing.
    eHealth literacy among primary healthcare nurses: a descriptive and correlational study2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: eHälsa är användandet av digitala verktyg och digital information för att uppnå och bibehålla hälsa. Förmågan att använda eHälsa kan beskrivas genom eHälsolitteracitet. Distriktssköterskan är ofta patientens första kontakt med hälso-sjukvården, och kan spela en medlande roll mellan patient och eHälsa, till förmån för patienten.

    Motiv: För att verkligen förstå fenomenet med eHälsolitteracitet inom primärvården behövs mer studier kring distriktssköterskans egna eHälsolitteracitet.

    Syfte: Syftet med studien var att undersöka distriktssköterskans eHälsolitteracitet och faktorer som kan påverka eHälsolitteracitet bland distriktssköterskor i Västerbotten. 

    Metod: Sjuttioåtta distriktssköterskor deltog i studien. Datainsamlingen gjordes genom en enkätundersökning utförd av Umeå universitet. Datat analyserades i Jamovi, där korrelationer gjordes. 

    Resultat: Inom domäner 1) Ha förmåga att använda teknik för att processa information, 2) Ha förmåga att förstå hälsokoncept och språk och 3) Ha förmåga till aktivt engagemang kring digitala tjänster, har distriktssköterskor högre medelvärden än domäner 4) Känna att de har full kontroll och är trygga, 5) Vara motiverade att engagera sig i digitala tjänster, 6) Ha tillgång till digitala tjänster som fungerar och 7) De digitala tjänsterna är anpassade till deras individuella förmåga. Resultatet visade en negativ korrelation mellan ålder/erfarenhet och domän 1, samt en positiv korrelation mellan ålder/erfarenhet och domän 3, samt en positiv korrelation mellan internetanvändning och domän 1. Vidare fynd visar på att distriktssköterskor upplever problem med datasystemet.  

    Konklusion: eHälsolitteractiet är ett komplext och outforskat område. Det behövs utbildning och bättre anpassade datasystem. Detta kan vara värdefullt för organisationen för att rikta utbildning där det behövs. För distriktssköterskan skapas möjligheter för professionell utveckling vilket även kan gagna patienten, då högre eHälsolitteracitet hos distriktssköterskor kan göra att eHälsa kan fortskrida med kvalitet och jämställdhet i fokus. 

  • 264.
    Almroth Diab, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ungdomars erfarenheter av att leva med diabetes typ 1: En litteraturstudie2020Independent thesis Basic level (degree of Bachelor), 15 credits / 22,5 HE creditsStudent thesis
    Abstract [sv]

     Bakgrund: Allt fler barn och ungdomar insjuknar i typ 1-diabetes varje år. Denna obotliga sjukdom kräver ett stort egenansvar av patienten och kan innebära både akuta och långsiktiga komplikationer. I den personcentrerade omvårdnaden är det viktigt att lyfta fram ungdomarnas känslor och erfarenheter, för att främja hälsa under hela livet.

    Syfte: Syftet med denna litteraturstudie är att beskriva ungdomars erfarenheter av att leva med diabetes typ 1.

    Metod: Åtta kvalitativa studier har granskats, analyserats och sammanställts i en litteraturstudie. Sökningar har gjorts i Cinahl och Pubmed.

    Resultat: Analysen resulterade i två kategorier ”Att uppleva betungande förändringar” och ”Att behöva stöd trots att det kan vara tärande”.

    Konklusion: Resultatet visar att ungdomarna upplevde svåra känslor av att få diagnosen. Det visar också att ungdomarna upplevde en förändrad vardag och olika hinder till egenvården. Resultatet visar att ungdomarna beskrev att acceptera sjukdomen krävde mognad, självständighet och en positiv inställning. Ungdomarna upplevde stöd från föräldrar som viktigt, men också som påfrestande. Även stöd från vänner ansågs som viktigt. Resultatet visar att ungdomarna upplevde stöd från skolpersonal och sjukvårdspersonal som viktigt, men bristfälligt.

    Nyckelord: diabetes typ 1, erfarenheter, ungdomar

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  • 265.
    Almroth, Melody
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Music therapy and adolescents with emotional and behavioral disorders: A literature review on the effects of music therapy2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 266. Alping, Peter
    et al.
    Piehl, Fredrik
    Langer-Gould, Annette
    Frisell, Thomas
    Burman, Joachim
    Fink, Katharina
    Fogdell-Hahn, Anna
    Gunnarsson, Martin
    Hillert, Jan
    Kockum, Ingrid
    Lycke, Jan
    Nilsson, Petra
    Olsson, Tomas
    Salzer, Jonatan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Svenningsson, Anders
    Virtanen, Suvi
    Vrethem, Magnus
    Validation of the Swedish Multiple Sclerosis Register Further Improving a Resource for Pharmacoepidemiologic Evaluations2019In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 30, no 2, p. 230-233Article in journal (Refereed)
    Abstract [en]

    The Swedish Multiple Sclerosis Register is a national register monitoring treatment and clinical course for all Swedish multiple sclerosis (MS) patients, with high coverage and close integration with the clinic. Despite its great value for epidemiologic research, it has not previously been validated. In this brief report, we summarize a large validation of >3,000 patients in the register using clinical chart review in the context of the COMBAT-MS study. While further improving the data quality for a central cohort of patients available for future epidemiologic research, this study also allowed us to estimate the accuracy and completeness of the register data.

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  • 267.
    Alrawashdeh, Hamzeh Mohammad
    et al.
    Sharif Eye Centers, Irbid, Jordan.
    Al-Tammemi, Ala'a B
    Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Alzawahreh, Mohammad Kh.
    Department of Special Surgery, Division of Urology, Al Bashir Hospital, Ministry of Health, Amman, Jordan.
    Al-Tamimi, Ashraf
    Department of Radiology, King Hussein Hospital, Jordanian Royal Medical Services, Amman, Jordan.
    Elkholy, Mohamed
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Al Sarireh, Fawaz
    Department of Ophthalmology, College of Medicine, Mutah University, Karak, Jordan.
    Abusamak, Mohammad
    Department of General and Special Surgery, Division of Ophthalmology, Faculty of Medicine, Al Balqa Applied University, Salt, Jordan.
    Elehamer, Nafisa M. K.
    Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Faculty of Public and Environmental Health, University of Khartoum, Khartoum, Sudan.
    Malkawi, Ahmad
    School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Health Promotion, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.
    Al-Dolat, Wedad
    Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
    Abu-Ismail, Luai
    Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
    Al-Far, Ali
    Department of Orthopedic and Trauma Surgery, Jordan Hospital, Amman, Jordan.
    Ghoul, Imene
    Department of Pediatrics, Ibn Al Haytham Hospital, Amman, Jordan.
    Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 811Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis.

    METHODS: This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively.

    RESULTS: A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown.

    CONCLUSION: A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.

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  • 268. Al-Rubaye, Ali K. Q.
    et al.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Alrubaiy, Laith
    The association of health behavioral risk factors with quality of life in northern Sweden: A cross-sectional survey2020In: Journal of general and family medicine, ISSN 2189-7948, Vol. 21, no 5, p. 167-177Article in journal (Refereed)
    Abstract [en]

    Background: It is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL).

    Methods: Data were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ‐5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL.

    Results: Data from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ‐5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables.

    Conclusions: The results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.

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  • 269.
    Al-Samraye, Ali
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Arbetsterapeutiska interventioner för barn med autismspektrumtillstånd och dess effekter.: En litteraturöversikt2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Autismspektrumtillstånd (AST) är en neuropsykiatrisk funktions­nedsättning som bland annat innebär svårigheter i social interaktion, sensorisk hantering och bearbetning samt motoriska färdigheter för individen. Barn med AST löper högre risk än andra barn att inte utveckla nödvändiga färdigheter som behövs för att vara delaktig i olika aktiviteter samt i utveckling mot självständighet. Syftet med denna litteraturöversikt är att redogöra för arbetsterapeutiska interventioner för barn med AST och interventionernas effekter. Litteraturöversikt valdes som metod för studien och artiklar hämtades från databaserna PubMed och CINAHL. Sju kvantitativa originalartiklar som var publicerade mellan år 2010 och 2018 har granskats, analyserats och redovisats i fyra olika kategorier; Interventioner för motoriska färdigheter, Interventioner för bearbetning och integrering av sensorisk information, Interventioner för social interaktion samt Intervention för arbetsminne. I studiens resultat framkommer det att samtliga interventioner hade effekt på olika färdigheter hos barnen. Artiklarna som inkluderades i resultatet hade alla en ojämn könsfördelning, studier med jämnare könsfördelning eller flickor och pojkar var för sig är därför väsentligt i framtida studier. Slutsatsen är att arbetsterapeutiska interventioner är effektiva för barn med AST avseende färdigheter inom sensorik, motorik, sociala och arbetsminne, men att ytterligare forskning inom området behövs för att öka kunskapen om effektiva interventioner för barn med AST. 

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    ARBETSTERAPEUTISKA INTERVENTIONER FÖR BARN MED AUTISMSPEKTRUMTILLSTÅND OCH DESS EFFEKTER
  • 270.
    Alseddig, Suha
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Covid 19 vaccine dilemma: an exploration of vaccine perceptions among health care workers in Sudan.2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 271.
    Alseddig, Suha
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Health and Lifestyle of preschool children with migrant background in Sweden: An outcome-wide epidemiology study2022Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: The immigrant population and Swedish population with a migrant background in Sweden has grown considerably in recent decades. A comprehensive assessment of the health profile and lifestyle characteristics of this population becomes a necessity in order to develop a policy and strategy that targets this population. The aim of this study was to investigate the relationships between children’s migrant background (parents born outside Sweden) and a variety of outcomes, such as health and lifestyle indicators.

    Methods: In this study, the outcome-wide epidemiology approach was used to examine the effects of one exposure (children whose parents were born outside Sweden) on several outcome variables, including health and lifestyle. The study population included 9099 children aged between 33 and 42 months of age. The data were secondary data collected by the SALUT program between 2014 and 2018. Outcome variables were dichotomized. The data were analyzed using descriptive statistics. Simple logistic and linear regressions were used to analyse the associations between parents' place of birth and each outcome variable, whereas multiple logistic and linear regressions were used to control for the effects of parents' income and education. The odds ratios (OR) and confidence intervals (CI) were reported. The P-value was used to support or reject the null hypothesis. The test result was considered statistically significant if the P-value was ≤ 0.05 and the 95% confidence interval was used (95%CI).

    Results: This study found that children whose parents were born outside of Sweden had lower parent-rated health and more socio-emotional problems than children whose parents were born in Sweden. There were no significant differences in BMI between children of immigrants and those of Swedish descent.

    In terms of lifestyle characteristics, children whose parents were born outside of Sweden spent more time playing outdoors during the weekdays and weekends. In contrast, they spent less time watching television during the weekdays and using screens. In spite of this, the screen time spent during the weekend did not differ significantly between children whose parents were born outside of Sweden and those whose parents were born in Sweden.

    On the other hand, migrant children exhibit poorer lifestyle characteristics, such as drinking less than one glass of milk per day, eating less vegetables, eating sweets at least once per day, and brushing their teeth only once per day. Neither fruit nor fish consumption differed significantly between migrant and native-born children.

    Conclusion: The results of this study provide a deeper understanding and a comprehensive insight into the strengths and weaknesses related to health and lifestyle of children of parents with immigrant backgrounds living in Västerbotten, Sweden. Hopefully, this study will assist policy and decision makers in identifying problematic areas in order to reduce inequalities among migrants. Moreover, this study demonstrates the heterogeneity of foreign-born and native children aged three in the country of Västerbotten. Therefore, it is recommended that more research be conducted in order to understand the heterogeneity among migrants’ children.

  • 272. Al-Shamkhi, N.
    et al.
    Alving, K.
    Dahlen, S. E.
    Hedlin, G.
    Middelveld, R.
    Bjerg, A.
    Ekerljung, L.
    Olin, A. C.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, C.
    Malinovschi, A.
    Important non-disease-related determinants of exhaled nitric oxide levels in mild asthma: results from the Swedish GA(2)LEN study2016In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 46, no 9, p. 1185-1193Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exhaled nitric oxide (FeNO) has a potential clinical role in asthma management. Constitutive factors such as age, height and male gender, as well as individual characteristics, as IgE sensitisation and smoking, affect levels of FeNO in population-based studies. However their effect on FeNO in subjects with asthma has been scarcely studied.

    OBJECTIVE: To study the effects on FeNO of these commonly regarded determinants, as demonstrated in healthy subjects, as well as menarche age and parental smoking, in a population of asthmatics.

    MATERIAL AND METHODS: FeNO was measured in 557 subjects with asthma from the Swedish GA2LEN study. Allergic sensitisation was assessed by skin prick tests to most common aeroallergens. Upper airway comorbidities, smoking habits, smoking exposure during childhood, hormonal status (for women) were questionnaire-assessed.

    RESULTS: Male gender (p<0.001), greater height (p<0.001) and sensitisation to both perennial allergens and pollen (p<0.001) related to higher FeNO levels. Current smoking (p<0.001) and having both parents smoking during childhood, vs having neither (p<0.001) or only one parent smoking (p=0.002), related to lower FeNO. Women with menarche between 9-11 years of age had lower FeNO than those with menarche between 12-14 years of age (p = 0.03) or 15-17 years of age (p=0.003).

    CONCLUSIONS AND CLINICAL RELEVANCE: Interpreting FeNO levels in clinical practice is complex and constitutional determinants, as well as smoking and IgE sensitization, are of importance in asthmatic subjects and should be accounted for when interpreting FeNO levels. Furthermore, menarche age and parental smoking during childhood and their effects on lowering FeNO deserve further studies.

  • 273.
    AlShurman, Bara’ Abdallah
    et al.
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada; School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Nanyonjo, Agnes
    Lincoln International Institute for Rural Health, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln, United Kingdom.
    Butt, Zahid Ahmad
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Waite, Nancy M.
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Vernon-Wilson, Elizabeth
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Wong, Ginny
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Grindrod, Kelly
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Understanding the COVID-19 vaccine policy terrain in Ontario Canada: a policy analysis of the actors, content, processes, and context2023In: Vaccines, E-ISSN 2076-393X, Vol. 11, no 4, article id 782Article in journal (Refereed)
    Abstract [en]

    (1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework.

    (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context.

    (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities.

    (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

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  • 274. Alssema, M
    et al.
    Vistisen, D
    Heymans, M W
    Nijpels, G
    Glümer, C
    Zimmet, P Z
    Shaw, J E
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stehouwer, C D A
    Tabák, A G
    Colagiuri, S
    Borch-Johnsen, K
    Dekker, J M
    Risk scores for predicting type 2 diabetes: using the optimal tool2011In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 54, no 9, p. 2468-2470Article in journal (Refereed)
  • 275.
    Alstam, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Franck, Thomas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anestesisjuksköterskors erfarenheter av oväntade akuta situationer på operationssal2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Any unexpected emergency situation in the operating room is unique, pose a great challenge, associated with risk of patient injures, difficult to predict and is depended on experience in assessing severity of the situation and the patient's health history, symptoms, signs and risks before and during anesthesia. Preparedness for an unexpected emergency is found in anesthetists’ nurse expected requirements to limit its negative consequences. It is therefore important to investigate nurse anesthetists’ experiences of unexpected acute situations in the operating room.

    Aim: The aim of the study is to illustrate nurse anesthetists’ experiences of unexpected acute situations in the operating room.

    Methods: The study is based on interviews with ten nurse anesthetists’, working at two different hospitals in Sweden; Hospital of Halland Varberg and Umeå University hospital. Interviews were analyzed using qualitative content analysis.

    Result: The four categories that emerged were: Events, Actions, Stresses, Lessons. Focusing on events was described as a measure to deal with unexpected emergency situations. Nurse anesthetists’ sought help, communicate problems and work towards the same goal to solve situations. Experiencing unexpected emergency situations was described in various personal stresses, which also implies different needs for processing support. The unexpected emergency that occurs is also described as jeopardizing patient safety. Learning was taken through reflection on situations that contributed to increased readiness for action.

    Conclusion: The result shows that unexpected emergency situations can occur suddenly. Seeking help for increased security in situations is considered important. By communicating problems and working towards the same goal, there is a hope to solve the situation. Unexpected emergency situations can be experienced and handled differently. Lesson is taken through reflection. A proposal for further research, it is important to highlight in a larger staff group whether feedback of unexpected emergency situations can actually dampen negative emotions and can increase the safety of the anesthetic nurse in future similar situations.

  • 276.
    Alstergren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Benavand, Laven
    Umeå University, Faculty of Medicine, Department of Nursing.
    Operations- och anestesisjuksköterskors erfarenheter av att arbeta tillsammans med olika yrkeskategorier under operation - en intervjustudie2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Operating room nurses’ and anaesthetic nurses’ experience of working together with different professional categories during surgery – an interview study

    Abstract  

    Background: In the National Board of Health and Welfare's report from 2019, just over 13,000 care-related injuries were identified between the years 2013–2018. Of these, 213 led to deaths, of which 53% of patients underwent surgery. The causes of death varied between surgical injuries, healthcare-associated infections and failing organs. The report also showed that 39% of care-related deaths could have been avoided. Research shows that the operating room is a particularly vulnerable environment for healthcare injuries because the multi-professional team works together under great pressure and where the patient is often in a vulnerable and helpless state. The teamwork between the professionals is therefore important to be able to perform a safe and effective surgery. However, shortcomings in teamwork are one of the most common reasons why complications occur during surgery.

    Motive: Research shows that good collaboration between professionals is the basis for safe and effective surgery. However, shortcomings in teamwork have shown an increased risk of complications during surgery, postoperative care injuries, mortality and increased care costs. Much of the current research is focused on teamwork within the entire operative team and not much from the nurse's perspective. This study may result in increased knowledge about surgery and anesthesia nurses' experiences of teamwork during surgery and how it affects their work situation. 

    Aim: To examine operating room nurses´ and anaesthetic nurses´ experience of working together with different professional categories during surgery. 

    Methods: Individual semi-structured interviews with four surgical nurses and four anesthesia nurses. The interviews were analyzed with a qualitative content analysis.

    Result: Three main categories: the Nurse's experiences of good teamwork, the Nurse's experiences of poor teamwork and The different roles of the team in the operationgroom, with ten subcategories arose based on the participants' experiences

    Conclusion: The study shows that experiences of good teamwork were related to having an understanding of the different professions, having good communication and a good team spirit. The experiences of bad teamwork was related to hierarchy inside the operating room, stress and personal issues depended on who they worked with depended on personal characters.

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  • 277.
    Al-Surimi, Khaled
    et al.
    King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen.
    Alhayek, Zahra
    King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Al-Khateeb, Badr
    King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
    Shaheen, Naila
    King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
    Person-centered-care climate in a tertiary hospital: Staff perspective2021In: Risk Management and Healthcare Policy, E-ISSN 1179-1594, Vol. 14, p. 4269-4279Article in journal (Refereed)
    Abstract [en]

    Introduction: Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers’ perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate.

    Methods: A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model.

    Results: Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96±15.36 (range 0–70). Subscale scores were Safety 20.15±5.0 (range 0–30), Everydayness 12.02±3.52 (range 0–20) and Community 13.79±3.34 (range 0–20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master’s degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers’ years of experience.

    Conclusion: There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs’ perception of PCC were higher age and female gender, and these factors would benefit from further research.

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  • 278.
    Alt Murphy, Margit
    et al.
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Kinematic analysis of the upper extremity after stroke: how far have we reached and what have we grasped?2015In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 20, no 3, p. 137-155Article in journal (Refereed)
    Abstract [en]

    Background: Consequences of stroke frequently comprise reduced movement ability of the upper extremity (UE) and subsequent long-term disability. Clinical scales are used to monitor and evaluate rehabilitation but are often insufficient, while technological advances in 3D motion capture provide detailed kinematics to more objectively quantify and interpret movement deficits. Objectives: To provide a comprehensive overview of research using kinematic movement analysis of the UE in individuals post-stroke with focus on objectives, methodology and findings while highlighting clinical implications and future directions. Major Findings: A literature search yielded 93 studies categorised into four groups: comparative (healthy, stroke, task condition), intervention (clinical trials), methodological and longitudinal. The majority of studies used optoelectronic systems, investigated discrete reaching and involved mainly individuals with moderate or mild stroke impairment in chronic stage. About 80% of the studies were published after year 2004. Speed-related variables were most frequently addressed followed by smoothness indicators, joint angles and trunk displacement. Movements in the hemiparetic side are generally slower, less smooth and show a compensatory movement pattern. Task specificity is crucial for kinematic outcomes. Tables summarising the main characteristics, objectives and results of all included studies are provided. Conclusions: There is still a lack of studies addressing reliability and responsiveness and involving more complex, everyday UE tasks with ecological validity. To facilitate the use of UE kinematic movement analysis in clinics, a research-based simpler data handling with pre-defined output for the results, as commonly used in gait analysis, is warranted.

  • 279.
    Altahhan, Fatma
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors upplevelser av mastektomi och dess påverkan på livskvalitén2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

     

    Background: Breast cancer is a disease that affects many women. There are different treatment methods, one of them is mastectomy, which involves surgical intervention and removal of the breast. This intervention can lead to strong feelings in women with an altered view of the body and of the women's femininity.

    Aim: The purpose of the study was to highlight women's experiences of mastectomy as a result of breast cancer.

     

    Methods: Literature study with inductive design based on empirical studies. Searches have been made through, CINAHL, PubMed, APA PsycInfo.  Ten qualitative studies were chosen for analysis.

     

    Results:  The analysis resulted in three main categories and their associated subcategories. Three main categories were identified: Consequences of impaired physical ability, Psychological aspects and Social aspects.

     

    Conclusion: Losing a breast can have physical, emotional and social impact. There were   mainly negative influences on identity, femininity, and sexuality. The experiences are both individual and general.

    Keywords:  Breast cancer, Life experience, Mastectomy, Women.

  • 280.
    Al-Tammemi, Ala'a B.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 188Article in journal (Refereed)
    Abstract [en]

    Since the initial spark of the COVID-19 outbreak in December 2019, which was later declared by the World Health Organization (WHO) to be a global pandemic, all affected countries are implementing various preventive and control measures to mitigate the spread of the disease. The newly emerging virus brings with it uncertainty-not only regarding its behavior and transmission dynamics but also regarding the current lack of approved antiviral therapy or vaccines-and this represents a major challenge for decision makers at various levels and sectors. This article aims to provide an early overview of the COVID-19 battle within the Jordanian context, including general reflections and conclusions on the value of collaborative efforts in crises management.

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  • 281.
    Al-Tammemi, Ala'a B.
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Akour, Amal
    Alfalah, Laith
    Is It Just About Physical Health?: An Online Cross-Sectional Study Exploring the Psychological Distress Among University Students in Jordan in the Midst of COVID-19 Pandemic2020In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 11, article id 562213Article in journal (Refereed)
    Abstract [en]

    Background: Since the spread of COVID-19 on a global scale, most of efforts at national and international levels were directed to mitigate the spread of the disease and its physical harm, paying less attention to the psychological impacts of COVID-19 on global mental health especially at early stages of the pandemic.

    Objectives: This study aimed to assess and explore (i) The levels of psychological distress and its correlates (ii) Motivation for distance learning (iii) Coping activities and pandemic related concerns, among university students in Jordan in the midst of COVID-19 pandemic.

    Methods: A cross-sectional study was conducted using an online self-administered questionnaire. The measure of psychological distress was obtained using the 10-item Kessler Psychological Distress Scale, while other questions have explored our study’s second and third aims.

    Results: A total of 381 completed questionnaires were included in the analysis. Female participants slightly predominated the sample (n = 199, 52.2%). The respondents aged 18–38 years (mean 22.6 years, SD: 3.16). Concerning distress severity, most of respondents were regarded as having severe psychological distress (n = 265, 69.5%). 209 students (54.9%) reported that they had no motivation for distance learning. Ordinal logistic regression revealed a significant correlation between distress severity and many predictors. Among the predictors that were found to act as protective factors against higher levels of distress included older age (aOR = 0.64, P = 0.022; 95% CI: 0.44–0.94), and having a strong motivation for distance learning (aOR = 0.10, P = 0.048; 95% CI: 0.01–0.96). In contrary, being a current smoker (aOR = 1.99, P = 0.049; 95% CI: 1.10–3.39), and having no motivation for distance learning (aOR = 2.49, P = 0.007; 95% CI: 1.29–4.80) acted as risk factors for having higher levels of psychological distress among the students. The most common coping activity reported was spending more time on social media platforms (n = 269, 70.6%), and 209 students (54.9%) reported distance learning as their most distressing concern.

    Conclusion: The COVID-19 pandemic and related control measures could impact the mental health of individuals, including students. We recommend a nationwide psychological support program to be incorporated into Jordan’s preparedness plan and response strategy in combating the COVID-19 pandemic.

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  • 282.
    Al-Tammemi, Ala'a Bahjat Mohammad Ali
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The Era of Electronic Cigarettes: A Protocol for a Convergent Parallel Mixed-Method Study Exploring the Use of Electronic Cigarettes in Jordan2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 283.
    Altmejd, Adam
    et al.
    Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden; Department of Finance, Stockholm School of Economics, Stockholm, Sweden.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Heidelberg Institute of Global Health (HIGH), Interdisciplinary Centre for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany.
    Wallin, Jonas
    Department of Statistics, Lund University, Lund, Sweden.
    Nowcasting COVID-19 statistics reported with delay: A case-study of Sweden and the UK2023In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 4Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic has demonstrated the importance of unbiased, real-time statistics of trends in disease events in order to achieve an effective response. Because of reporting delays, real-time statistics frequently underestimate the total number of infections, hospitalizations and deaths. When studied by event date, such delays also risk creating an illusion of a downward trend. Here, we describe a statistical methodology for predicting true daily quantities and their uncertainty, estimated using historical reporting delays. The methodology takes into account the observed distribution pattern of the lag. It is derived from the "removal method"-a well-established estimation framework in the field of ecology.

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  • 284.
    Altundal, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Arbetsterapeutiska interventioner för vuxna med depression: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Depression är en av de vanligast förekommande diagnoserna inom psykisk ohälsa, och i Sverige är idag över 4 % av befolkningen diagnostiserad med depression. Depression ger bland annat symptom i form av nedstämdhet, intresseförlust, sömnsvårigheter, förändrad aptit, koncentrationssvårigheter och suicidtankar och påverkar livskvalitén och arbetsförmågan i stor utsträckning. Syftet med denna studie var att beskriva arbetsterapeutiska interventioner för vuxna diagnosticerade med depression och dess effekter utifrån arbetsterapeuters och klienters perspektiv. För att besvara frågeställningen gjordes en litteraturstudie baserad på sju kvalitativa artiklar. De i studien identifierade arbetsterapeutiska interventionsmetoderna var UWaT (Using Writing as Therapy), CW (Creative Writing), TTM (Tree Theme Method) Remotivationsprocessen, gruppterapi samt kreativt skapande. Från klienternas perspektiv beskrevs effekter i form av ökad självkänsla, bättre självinsikt, ökad motivation att delta i det vardagliga livet samt i vissa fall en ökad aktivitetsnivå. Arbetsterapeuternas upplevelser var att metoderna var krävande att arbeta med men givande för klienterna såväl som lärorika att arbeta med. Således föreslår denna studie att dessa arbetsterapeutiska interventioner kan användas som redskap inom behandlingen av vuxna med depression men vidare forskning behövs för att med studier designade att studera effekter av interventioner skapa belägg och riktlinjer för arbetsterapeuter som arbetar i området.

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    Sara Altundal-Examensarbete
  • 285. Alvariza, Anette
    et al.
    Årestedt, Kristofer
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Family members' experiences of integrated palliative advanced home and heart failure care: a qualitative study of the PREFER intervention2018In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 3, p. 278-285Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic heart failure is a disease with high morbidity and symptom burden for patients, and it also places great demands on family members. Patients with heart failure should have access to palliative care for the purpose of improving quality of life for both patients and their families. In the PREFER randomized controlled intervention, patients with New York Heart Association classes III–IV heart failure received person-centered care with a multidisciplinary approach involving collaboration between specialists in palliative and heart failure care. The aim of the present study was to describe family members' experiences of the intervention, which integrated palliative advanced home and heart failure care.

    Method: This study had a qualitative descriptive design based on family member interviews. Altogether, 14 family members participated in semistructured interviews for evaluation after intervention completion. The data were analyzed by means of content analysis.

    Results: Family members expressed gratitude and happiness after witnessing the patient feeling better due to symptom relief and empowerment. They also felt relieved and less worried, as they were reassured that the patient was being cared for properly and that their own responsibility for care was shared with healthcare professionals. However, some family members also felt as though they were living in the shadow of severe illness, without receiving any support for themselves.

    Significance of results: Several benefits were found for family members from the PREFER intervention, and our results indicate the significance of integrated palliative advanced home and heart failure care. However, in order to improve this intervention, psychosocial professionals should be included on the intervention team and should contribute by paying closer attention and providing targeted support for family members.

  • 286.
    Alvarsson, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Edwall, Josefin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lärarstudenters tankar kring att jobba med rörelse i skolan: En kvalitativ studie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Två av tio barn och ungdomar når rekommendationen för fysisk aktivitet och den fysiskaaktiviteten minskar med ökande ålder. Då barn och ungdomar spenderar mycket tid i skolanfinns det möjlighet att genom tidiga insatser redan under skolgången lägga grunden förelevernas aktiva vanor. En skolmiljö som främjar fysisk aktivitet kombinerat med aktiv lek ochfritid ger förutsättningar för en hälsosam utveckling och uppväxt för barn och ungdomar. Syftetmed studien var att undersöka lärarstudenters tankar kring att jobba med rörelse i skolan.Frågeställningarna var därför; vad ser de för utmaningar med att jobba med rörelse i skolan, vadhar de för idéer och strategier för att öka rörelse i skolan och vad får de lära sig om rörelse undersin utbildning till lärare. Datainsamlingen omfattade tre semistrukturerade intervjuer med tvåfokusgrupper och en enskild intervju. Totalt intervjuades elva lärarstudenter. Materialetanalyserades genom kvalitativ innehållsanalys. Studien resulterade i tre kategorier: Informationkring rörelsens roll i skolan efterfrågas, Rörelse i skolan ger olika effekter och Strategier för attöka rörelse kräver flexibilitet. Slutsatsen var att lärarstudenterna ser positivt på att jobba medrörelse i skolan men de efterfrågar kunskap om hur och när rörelse ska appliceras för att det skagagna eleverna på bästa möjliga sätt.

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  • 287.
    Alvehus, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Niklas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Söderlund, Karin
    Svensson, Michael B.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Buren, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Metabolic adaptations in skeletal muscle, adipose tissue, and whole-body oxidative capacity in response to resistance training2014In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 114, no 7, p. 1463-1471Article in journal (Refereed)
    Abstract [en]

    The effects of resistance training on mitochondrial biogenesis and oxidative capacity in skeletal muscle are not fully characterized, and even less is known about alterations in adipose tissue. We aimed to investigate adaptations in oxidative metabolism in skeletal muscle and adipose tissue after 8 weeks of heavy resistance training in apparently healthy young men. Expression of genes linked to oxidative metabolism in the skeletal muscle and adipose tissue was assessed before and after the training program. Body composition, peak oxygen uptake (VO2 peak), fat oxidation, activity of mitochondrial enzyme in muscle, and serum adiponectin levels were also determined before and after resistance training. In muscle, the expression of the genes AdipoR1 and COX4 increased after resistance training (9 and 13 %, respectively), whereas the expression levels of the genes PGC-1 alpha, SIRT1, TFAM, CPT1b, and FNDC5 did not change. In adipose tissue, the expression of the genes SIRT1 and CPT1b decreased after training (20 and 23 %, respectively). There was an increase in lean mass (from 59.7 +/- A 6.1 to 61.9 +/- A 6.2 kg), VO2 peak (from 49.7 +/- A 5.5 to 56.3 +/- A 5.0 ml/kg/min), and fat oxidation (from 6.8 +/- A 2.1 to 9.1 +/- A 2.7 mg/kg fat-free mass/min) after training, whereas serum adiponectin levels decreased significantly and enzyme activity of citrate synthase and 3-hydroxyacyl-CoA dehydrogenase did not change. Despite significant increases in VO2 peak, fat oxidation, and lean mass following resistance training, the total effect on gene expression and enzyme activity linked to oxidative metabolism was moderate.

  • 288. Alverbratt, Catrin
    et al.
    Berlin, Johan
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Health and Culture, University West, Trollhättan.
    Kauffeldt, Anders
    Carlström, Eric
    A New Working Method in Psychiatric Care: The Impact of Implementation2017In: International Journal of Public Administration, ISSN 0190-0692, E-ISSN 1532-4265, Vol. 40, no 3, p. 295-304Article in journal (Refereed)
    Abstract [en]

    An equal mix of organizational cultures is important for a successful implementation process. The aim of this study was to examine the implementation of a new working method in psychiatric hospital wards, representing different cultural characteristics. Descriptive quantitative data were collected at two hospitals (intervention and control). The results revealed one ward characterized by a mix of organizational cultures. This ward, compared with other intervention wards, showed the best results regarding patient assessed empowerment and participation. The result shows tentatively that organizational culture may have an impact on the implementation processes.

  • 289.
    Alvlilja, Lena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Bildterapigrupper inom primärvården: - Vad ger en utvärdering av deltagares erfarenheter av interventionen för svar?2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Summary: Art therapy is a creative treatment method that can be used for both preventive and rehabilitative purposes when psychological factors affect the development and experience of ill health. This paper describes the results of a clinical experience evaluation of art therapy groups conducted at a health center during 2010 - 2014. 

     

    Purpose: To describe patients' experiences of participating in group art therapy in primary care.

    Method: Evaluation of 44 art therapy participants' experiences with art therapy via open question questionnaires. The questions were about lessons learned, goals, and what they missed or would like to change in the art therapy and their experiences in relation to any other treatments. Grounded Theory was used to analyze the answers, which clarified participants' experiences of what was valuable to them in their participation in art therapy.

    The results showed that group art therapy helped participants express and explore emotions that increased insight and provided catharsis. Art therapy created awareness and understanding of how the individual's own situation affects the experience of health. Through communication with and about the image, messages about the life situation were conveyed, which facilitated change in activity patterns and the ability to see oneself as valuable. Changing activity patterns enabled activity balance. The group helped participants understand their illness and see that they were not "weird," but responded normally to heavy loads. Art therapists with a basic profession as occupational therapist can work purposefully with activity balance in art therapy. 

    Conclusion: Art therapy can, based on this study, be effective for patients in primary care. The art therapist who also is an occupational therapist, can work purposefully with activity balance. The art therapy can be combined with occupational therapy theory and the value dimensions of the ValMO model: concrete, socio-symbolic and self-rewarding value. Art therapy could thus fill a gap and be complementary to other treatment in primary care. The participants' increased understanding of their disease could secondarily lead to reduced medicalization.

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  • 290.
    Alvros, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktsköterskors erfarenheter av arbetssituationen efter omorganisation2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Backgrund: Reorganizations are common in health care, although the goals with reorganizations are good, it can lead to negative consequences for those affected.

    Aim: The aim of the study was to explain district nurses' experiences of the work situation after a reorganization and the hope is to increase the knowledge of what meaning a reorganization can have for daily work.

    Metod: An empirical qualitative study has been performed. Data was collected through interviews with seven district nurses. The interviews was performed in the spring of 2019. The interviews were analysed with qualitative content analysis.

    Result: Following analysis of the interviews, three themes occurred: To not feel involved in the implementation process, To work more alone and To work in a heavily rooted organization. The result shows that reorganization at the relevant health center negatively affected the district nurses' work situation and the experience of the new work situation was described by the district nurses as stressful and unstructured.

    Conclusion: In order for a reorganization to be successful, it is necessary for the employees to be involved in the implementation process. The management should be responsive to the staff's thoughts and ideas. Encouragement, support and information from the management is important because otherwise there may be resistance to the reorganization. When the reorganization is completed and new working methods are implemented, the district nurses need routines and guidelines for how the work in the new reorganization should be conducted.

    Keywords: District nurses, reorganization, job satisfaction, primary care

  • 291.
    Aléx, Jonas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Patients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.

    Aim

    The overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.

    Method

    Study I:

    Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.

    Study II:

    In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.

    Study III:

    Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.

    Study IV:

    A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.

    Results

    Study I:

    Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.

    Study II:

    Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.

    Study III:

    A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.

    Study IV:

    Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.

    Conclusion

    The ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia

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  • 292.
    Aléx, Jonas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care -an intervention studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be a major factor leading to an overall sensation of discomfort. As far as we have seen, there is still little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care.

    Methods:

    A quantitative intervention study conducted in ambulance care in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with a heated mattress on the stretcher compared to the control group (n=30) where no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), finger, ear, and air temperatures along with subjective comments on cold experiences.

    Results:

    Thermal comfort, measured by CDS, was improved during the ambulance transport to the Emergency Department (ED) in the intervention group (p= 0.001) but decreased in the control group (p=<0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down on compared to three percent in the intervention group (p<0.001). Concerning finger, ear, and compartment air temperature no significant difference between groups was found. Mean transport time was approximately 15 minutes.

    Conclusion:

    The use of active heat, from underneath, increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.

  • 293.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brister i systematiskt omhändertagande på olycksplatser: en studie av traumasimuleringar inom ambulanssjukvården2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EWFHArticle in journal (Refereed)
    Abstract [en]

    Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

  • 294.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Center for Disaster Medicine, Umeå University, Umeå, Sweden.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study2015In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 74, article id 28878Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care.

    METHODS: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures.

    RESULTS: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes.

    CONCLUSIONS: The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

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  • 295.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' experiences of cold exposure during ambulance care2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 21, article id 44Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors.

    METHOD: During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation.

    RESULTS: In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C.

    CONCLUSION: Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

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  • 296.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundgren, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Henriksson, Otto
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Being cold when injured in a cold environment: patients' experiences2013In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    Background: Patients in prehospital care, irrespective of diseases or trauma might experience thermal discomfort because of a cold environment and are at risk for decreasing body temperature which can increase both morbidity and mortality.

    Objective: To explore patients' experiences of being cold when injured in a cold environment.

    Method: Twenty persons who had been injured in a cold environment in northern Sweden were interviewed. Active heat supply was given to 13 of them and seven had passive heat supply. The participants were asked to narrate their individual experience of cold and the pre- and post-injury event, until arrival at the emergency department. The interviews were transcribed verbatim, then analyzed with qualitative content analysis.

    Results: Patients described that they suffered more from the cold than because of the pain from the injury. Patients who received active heat supply experienced it in a positive way. Two categories were formulated: Enduring suffering and Relief of suffering.

    Conclusion: Thermal discomfort became the largest problem independent of the severity of the injuries. We recommend the use of active heat supply to reduce the negative experiences of thermal discomfort when a person is injured in a cold environment.

  • 297.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundin, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Joansson, Charlotta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Preparedness of Swedish EMS Personnel for Major Incidents in Underground Mines2017In: Journal of Health Science, E-ISSN 2328-7136, Vol. 5, p. 239-243Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to survey the EMS (emergency medical services) personnel preparedness for major incidents in the underground mining industry in Sweden. Every year, a high number of incidents, workplace accidents and fires are reported from the Swedish mining industry. Taking care of patients located in an underground mine represents a challenge to EMS personnel. Today, knowledge about EMS personnel preparedness for major incidents in the mining industry is limited. The study design was a cross-sectional survey. The questionnaires were distributed to EMS personnel working in ambulance stations geographically located near an underground mine. Thirteen ambulance stations were included and 137 of 258 personnel answered. Demographic data were analyzed using descriptive statistics. Differences among groups were analyzed with the Chi-Squared test, continuity correction and t-test. Results showed about half of the participants reported that they do not feel prepared to work in a major incident in an underground mine. The majority wished to receive educational training to enhance their preparedness. The most commonly requested type of education was practical drills on the scene, in an underground mine. The reported preparedness was significantly higher among the participants who had received some kind of education, or had authentic experience of a mission in an underground mine than those who did not. This study reveals shortcomings in the preparedness of EMS personnel. The perceived low preparedness of EMS personnel may affect their ability to work in a major incident in the mining industry. Study findings may be used in planning the future education, including practical drills, of EMS personnel.

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  • 298.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Uppstu, Tom
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Nursing.
    The opinions of ambulance personnel regarding using a heated mattress for patients being cared for in a cold climate - An intervention study in ambulance care2017In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 76, article id 1379305Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to describe the opinions of ambulance personnel regarding differences between using a heated mattress and a standard ambulance mattress. This study was an intervention study with pre- and post-evaluation. Evaluations of the opinions of personnel regarding the standard unheated mattress were conducted initially. After the intervention with new heated mattresses, follow-up evaluations were conducted. Ambulance personnel (n=64) from an ambulance station in northern Sweden took part in the study, which ran from October 2014 until February 2016. There were differences in opinions regarding the standard unheated mattress and the new heated mattress. The evaluation of the proxy ratings by the personnel showed that the heated mattress was warmer than the standard mattress, more pleasant to lie on and that patients were happier and more relaxed than when the standard mattress was used. The ambulance personnel in this study rated the experience of working with the heated mattress as very positive and proxy rated that it had a good effect on patient comfort. A heated mattress can be recommended for patients in ambulance care, even if more research is needed to receive sufficient evidence.

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  • 299.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att balansera mellan olika diskurser: konsten att leva som gammal samisk kvinna2008In: Människor i norr: samisk forskning på nya vägar / [ed] Sköld, Peter, Umeå: Centrum för samisk forskning , 2008, p. 287-301Chapter in book (Other academic)
  • 300.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Shift in power during an interview situation: methodological reflections inspired by Foucault and Bourdieu2008In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 15, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    This paper presents methodological reflections on power sharing and shifts of power in various interview situations. Narratives are said to be shaped by our attempts to position ourselves within social and cultural circumstances. In an interview situation, power can be seen as something that is created and that shifts between the interviewer and the interviewed. Reflexivity is involved when we as interviewers attempt to look at a situation or a concept from various perspectives. A modified form of discourse analysis inspired by subject positioning was used to reflect on power relations in four different interview situations. The analyses indicate that reflection on the power relations can lead to other forms of understanding of the interviewee. The main conclusion that can be drawn from this study is that power relations are created within an interview situation and therefore it is important to be aware of dominant perspectives. Researchers and nurses face the challenge of constantly raising their level of consciousness about power relationships, and discursive reflexivity is one way of doing this. Thus, reflexivity is an important part of the qualitative research process.

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