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  • 1.
    Bielecka-Dabrowa, Agata
    et al.
    Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
    Gasiorek, Paulina
    Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
    Wittczak, Andrzej
    Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
    Sakowicz, Agata
    Department of Medical Biotechnology, Medical University of Lodz, Lodz, Poland.
    Bytyci, Ibadete
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
    Banach, Maciej
    Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
    Left ventricular diastolic dysfunction as predictor of unfavorable prognosis after ESUS2021In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 14, p. 617-627Article in journal (Refereed)
    Abstract [en]

    Objective: Identification of echocardiographic, hemodynamic and biochemical predictors of unfavorable prognosis after embolic strokes of undetermined etiology (ESUS) in patients at age <65.

    Patients and Methods: Out of 520 ischemic stroke patients we selected 64 diagnosed with ESUS and additional 36 without stroke but with similar risk profile. All patients underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer and measurements of selected biomarkers. Follow-up time was 12 months.

    Results: Nine percent of patients died, and recurrent ischemic stroke occurred in 9% of patients only in the ESUS group. Atrial fibrillation (AF) occurred in 10% of patients and the ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization. The outcome of re-hospitalization was 28% in the ESUS group and 17% in the control group. In the multivariate analysis mean early diastolic (E’) mitral annular velocity (OR 0.75, 95% CI: 0.6–0.94; p=0.01) was significantly associated with cardiovascular hospitalizations. The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E’ was independently associated with composite endpoint (death, hospitalization and recurrent stroke) (OR 1.90, 95% CI 1.1–3.2, p=0.01).

    Conclusion: The indices of diastolic dysfunction are significantly associated with unfavorable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during the first 2 months after ESUS to detect potential AF.

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  • 2.
    Johansson, Helene
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Ersboda Health Care Centre, Umeå, Sweden.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lundström, Lena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reorientation to more health promotion in health services: a study of barriers and possibilities from the perspective of health professionals2010In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 3, p. 213-224Article in journal (Refereed)
    Abstract [en]

    Aim: The objective of this study is to analyze the commitment to a more health-promoting health service and to illuminate important barriers for having a health-promoting role in daily practice, among Swedish health care professionals.

    Material and method: Out of a total of 3751 health professionals who are working daytime in clinical practice in the province of Västerbotten, 1810 were invited to participate in a survey. The health professionals represented eight different occupational groups: counselors, dieticians, midwives, nurses, occupational therapists, physical therapists, psychologists, and physicians. A questionnaire that operationalized perceptions found in a previous qualitative study was mailed to residential addresses of the participants.

    Results: The majority believed that health services play a major role in long-term health development in the population and saw a need for health orientation as a strategy to provide more effective health care. Willingness to work more in health promotion and disease prevention was reported significantly more often by women than men, and by primary health care personnel compared to hospital personnel. Among the professional groups, psychologists, occupational therapists, and physiotherapists most frequently reported willingness. The most common barriers to health promotion roles in daily practice were reported to be heavy workload, lack of guidelines, and unclear objectives.

    Conclusions: This study found strong support for reorientation of health services in the incorporation of a greater health promotion. A number of professions that are not usually associated with health promotion practices are knowledgeable and wish to focus more on health promotion and disease prevention. Management has a major role in creating opportunities for these professionals to participate in health promotion practices. Men and physicians reported less positive attitudes to a more health-promoting health service and often possess high positions of power. Therefore, they may play an important role in the process of change toward more health promotion in health services.

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  • 3.
    Johansson, Helene
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Ersboda Health Care Centre, Umeå, Sweden.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    “If we only got a chance.” Barriers to and possibilities for a more health-promoting health service2010In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 3, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Aim: With the overall objective to develop future strategies for a more health-promoting health service in Sweden, the aim of this paper was to describe how health personnel view barriers and possibilities for having a health-promoting role in practice.

    Materials and methods: Seven focus group discussions were carried out with a total of 34 informants from both hospital and primary health care settings in Sweden. The informants represented seven professional groups; counselors, occupational therapists, assistant nurses, midwives, nurses, physicians, and physiotherapists. The data were analyzed using qualitative content analysis.

    Results: The analysis resulted in one major theme "If we only got a chance". The theme captures the health professionals' positive view about, and their willingness to, develop a health-promoting and/or preventive role, while at the same time feeling limited by existing values, structures, and resources. The four categories, "organizational commitment to a paradigm shift", "recognition of staff as health-promoting instruments", "a balance between resources and tasks", and "freedom of action" capture what is needed for implementing and increasing health promotion and preventive efforts in the health services.

    Conclusions: The study indicates that an organizational setting that support health promotion is still to be developed. There is a need for a more explicit leadership with a clear direction towards the goal of "a more health-promoting health service" and with enough resources for achieving this goal.

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  • 4.
    Köpsén, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Krokom Health Care Center, Region Jämtland Härjedalen, Krokom, Sweden.
    Sjöström, Rita
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Unit of Research, Education and Development, Region Jämtland Härjedalen, Östersund, Sweden.
    Patients' Experiences of a Stress-Management Programme in Primary Care2020In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 13, p. 207-216Article in journal (Refereed)
    Abstract [en]

    Introduction: Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy. Purpose: To describe participant's experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

    Methods: In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41-57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.

    Results: The analysis resulted in the theme "Process of change for a sustainable everyday living". The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants' identification with the others in the group.

    Conclusion: The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.

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  • 5.
    Olsson Möller, Ulrika
    et al.
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Ekstrand, Joakim
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
    Haak, Maria
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
    The content of physiotherapy and factors impacting on reablement: a national study2023In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 16, p. 3075-3088Article in journal (Refereed)
    Abstract [en]

    Purpose: Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions’ actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions.

    Methods: Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression.

    Results: Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95–4.49). About 50% (n=517) of the cases involved 1–2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases.

    Conclusion: Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients’ needs and wishes, or conversely an expression of limited resources, remains to be investigated.

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  • 6. Sandberg, Linda
    et al.
    Borell, Lena
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Heidelberg, VIC, Australia.
    Rosenberg, Lena
    Boström, Anne-Marie
    Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services2018In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 11, p. 255-266Article in journal (Refereed)
    Abstract [en]

    Introduction: An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff's well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited.

    Aim: To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors.

    Methods: The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study.

    Results: Home care staff perceived job strain - particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate.

    Conclusion: The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.

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  • 7. Sørbye, Liv W
    et al.
    Hamran, Torunn
    Henriksen, Nils
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Home care patients in four Nordic capitals: predictors of nursing home admission during one-year followup2010In: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 3, p. 11-18Article in journal (Refereed)
    Abstract [en]

    The aim was to predict nursing home admission (NHA) for home care patients after a 12-month follow-up study. This Nordic study is derived from the aged in home care (AdHOC) project conducted in 2001–2003 with patients at 11 sites in Europe. The participants in the cohort study were randomly selected individuals, aged 65 years or older, receiving homecare in Oslo, Stockholm, Copenhagen, and Reykjavik. The Resident Assessment Instrument for Home Care (version 2.0) was used. Epidemiological and medical characteristics of patients and service utilization were recorded for 1508 home care patients (participation rate 74%). In this sample 75% were female. The mean age was 82.1 (6.9) years for men and 84.0 (6.6) for women. The most consistent predictor of NHA was receiving skilled nursing procedures at baseline (help with medication and injections, administration or help with oxygen, intravenous, catheter and stoma care, wounds and skin care) (adjusted odds ratio = 3.7, 95% confidence interval: 1.7–7.8; P < 0.001). In this Nordic material, stronger emphasizing on higher qualified nurses in a home care setting could prevent or delay NHA.

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