Older adults' experiences of participation in daily activities in Swedish assisted living.

BACKGROUND: According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS: A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS: The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION: Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.

Tobacco impact on quality of life, a cross-sectional study of smokers, snuff-users and non-users of tobacco.

BACKGROUND: Tobacco smoking is a major public health issue, and also affects health-related quality of life. There has been considerable debate as to whether oral moist snuff, a form of tobacco placed in the oral cavity between the upper lip and gum as in sublabial administration, can be considered a safe alternative to smoking. The aim of this study was to investigate the association between health-related quality of life and smoking, snuff use, gender and age. METHOD: This cross-sectional study included 674 women and 605 men aged 18 to 65 recruited through a Swedish population database. Subjects completed a questionnaire about tobacco use and the 36-item Short Form Health Survey (SF-36). Multivariable logistic regression analyses were performed for the association between health-related quality of life and tobacco use, gender and age. The median perceived health-related quality of life (SF-36) for an age-matched Swedish population was used as the cutoff: above the cutoff indicated better-than-average health coded as 1, or otherwise coded as 0. The independent variables were smoking (pack-decades), snuff-use (box-decades), gender and age in decades. The outcome was presented as the Odds Ratio (OR) with a 95% confidence interval (CI) for each independent variable. RESULTS: The experience of cigarette smoking is associated with decreased physical functioning (PF), general health (GH), vitality (VT), social functioning (SF) and mental health (MH) as well as both lower physical component summary (PCS) and mental component summary (MCS). Further, the experience of snuff use is associated with bodily pain (BP), lower VT, and lower PCS. In the study population older age is associated with lower PF,GH, VT, MH, PCS and MCS. Female gender is associated with lower PF and VT. CONCLUSION: This study shows that smoking is associated with lower health-related quality of life. The results also illuminate the detrimental health effects of using snuff, implying that snuff too is a health hazard. As studies on the bodily effects of snuff are relatively scarce, it is imperative that we continue to address and investigate the impact on the population using snuff on a regular basis. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05409963 05251022 08/06/22.

Lung cancer research and its citation on clinical practice guidelines.

BACKGROUND: The impact of medical research is usually judged on the basis of citations in the serial literature. A better test of its utility is through its contribution to clinical practice guidelines (CPGs) on how to prevent, diagnose, and treat illness. This study aimed to compare the parameters of lung cancer research papers with those cited as references in lung cancer CPGs from 16 countries, and the Cochrane Collaboration. These comparisons were mainly based on bibliographic data compiled from the Web of Science (WoS). METHODOLOGY: We examined 7357 references (of which 4491 were unique) cited in a total of 77 lung cancer CPGs, and compared them with 73,214 lung cancer papers published in the WoS between 2004 and 2018. RESULTS: References used by lung CPGs were much more clinical than the overall body of research papers on this cancer, and their authors predominantly came from smaller northern European countries. However, the leading institutions whose papers were cited the most on these CPGs were from the USA, notably the MD Anderson Cancer Center in Texas, the Memorial Sloan Kettering Cancer Center, New York, and the Mayo Clinic in Rochester, Minnesota. The types of research cited by the CPGs were primarily clinical trials, as well as three treatment modalities (chemotherapy, radiotherapy and surgery). Genetics, palliative care and quality of life were largely neglected. The median time gap between papers cited on a lung CPG and its publication was 3.5 years longer than for WoS citations. CONCLUSIONS: Analysis of the references on CPGs allows an alternative means of research evaluation, and one that may be more appropriate for clinical research than citations in academic journals. Own-country references show the direct contribution of research to a country's health care, and other-country references show the esteem in which this research has been held internationally.

Providing Mothers with a Pedometer and Subsequent Effect on the Physical Activity of Their Children: A Randomized Controlled Trial of Children with Obesity.

Background: Obesity continues to rise, particularly among children, and is one of the greatest public health challenges of the 21st century. Physical activity may reduce weight and increase well-being. A pedometer study from the United States, Australia, and Sweden showed that boys need to walk 15,000 steps/day, and girls 12,000 steps/day to maintain a healthy profile. Research shows children with obesity have limited physical activity and they may need parent support to increase their physical activity level. Objective: The aim of this randomized controlled study was to estimate the effect of mothers using pedometers on their children's daily number of steps. Methods: Children/adolescents aged 6-16 years were included and all of them received a pedometer and a step diary. In the intervention group, their mothers received pedometers but not so in the control group. Fifty children were randomized and 32 could be followed-up for 24 weeks. There was no difference in outcome between groups in intention to treat analysis. A complete case analysis showed that the intervention group increased their daily steps (2400, 95% confidence interval 430-4500) compared with the control group (p = 0.019). Conclusions: Involving and activating mothers may increase the children and adolescent's physical activity if implemented more successfully than was done in this study.

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial.

PURPOSE: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. METHOD: We recruited 113 patients suffering from chronic WAD grades I-III and several years' duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. RESULTS: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR = 15) more than the ET group (median = 0, IQR = 15), p = 0.032, effect size -0.54. Three months after the end of treatment, the BAT group had less bodily pain (m = 17.5, 95% CI 6.9-17.6) than the ET group (m = 4.9, 95% CI -0.1 to 9.8), p = 0.044, effect size -0.4. The BAT group had also increased their social functioning (m = 13.3, 95% CI 6.6-19.9) more than the ET group (m = 3.5, 95% CI -3 to 9.9), p = 0.037, effect size -0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. CONCLUSIONS: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD. IMPLICATIONS FOR REHABILATION: Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work. Exercise therapy (ET) may alleviate symptoms of chronic WAD. Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs. In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.

From resistance to rescue--patients' shifting attitudes to antihypertensives: a qualitative study.

OBJECTIVE: The objective of this study was to gain a deeper knowledge and understanding of experiences of antihypertensive drug treatment. DESIGN: Interview study. SETTING: A primary health care centre in western Sweden. METHOD: Qualitative interviews and analyses through systematic text condensation described by Malterud. SUBJECTS: Ten informants in pharmacological treatment for high blood pressure (six men and four women). MAIN OUTCOME MEASURE: Experiences of hypertension drug treatment. RESULTS: The findings revealed a process starting with resistance to drug treatment related to lack of control, side effects, and unwanted awareness of impaired health. These negative feelings then changed into a positive desire for lifestyle changes caused by a fear of cardiovascular disease which in turn changed the attitude towards drugs into seeing them as a rescue remedy and something normal and this then evoked health care trust. CONCLUSION: Despite initial resistance to treatment, the experience of antihypertensive drug treatment became more positive with time. Confidence in the health care system is important for adherence to treatment. General practitioners have a key role in this regard.

Value of qualitative research in polycystic ovary syndrome.

OBJECTIVE: This article aims to introduce the benefits of qualitative research and to discuss how such research can be applied to the study of polycystic ovary syndrome (PCOS). DATA SOURCES: Relevant articles were published in English as of May 2013 from Pubmed. Terms "polycystic ovary syndrome/PCOS, qualitative research and methodology" were used for searching. STUDY SELECTION: Articles studying PCOS with qualitative methods were reviewed. Articles associated with the use of qualitative research in clinical research were cited. RESULTS: Six qualitative studies related to PCOS were found in the literature search. These studies addressed different aspects in PCOS women including their womanhood, lived experience, information need, and experience of treatment with acupuncture. Five of these six studies used phenomenology as guiding theory. CONCLUSION: Quantitative research has been the dominant approach in the field so far, qualitative research is relevant to the advancement of PCOS.

The experience of disagreement between students and supervisors in PhD education: a qualitative study.

BACKGROUND: PhD supervision is mostly individual and disagreement between supervisors and PhD students is a seldom-discussed topic at universities. The present study aimed to describe the experience of disagreement between PhD students and supervisors. METHODS: Nine supervisors and seven PhD students from Sweden and England were interviewed using a video recorder. The recorded material was analysed using inductive content analysis. RESULTS: Disagreements in PhD education can be described with the overarching theme: the nature of the disagreements changes over time. Five categories emerged to describe the variations of the experiences: involvement in important decisions, supervisors not being up-to-date, dubious advice from supervisors, mediating between supervisors, and interpersonal relationships. CONCLUSIONS: There is a gradual shift in competence where PhD students may excel supervisors in subject knowledge. Early disagreements may indicate immaturity of the student while disagreements later may indicate that the student is maturing making their own decisions. Consequently, disagreements may need to be addressed differently depending on when they occur. Addressing them inappropriately might slow the progressions and result in higher attrition rate among PhD students. The five categories may be elements in future PhD supervisor training programs and should be further evaluated for their importance and impact on PhD education.

Mandibular bone structure, bone mineral density, and clinical variables as fracture predictors: a 15-year follow-up of female patients in a dental clinic.

OBJECTIVE: To compare three mandibular trabeculation evaluation methods, clinical variables, and osteoporosis as fracture predictors in women. STUDY DESIGN: One hundred and thirty-six female dental patients (35-94 years) answered a questionnaire in 1996 and 2011. Using intra-oral radiographs from 1996, five methods were compared as fracture predictors: (1) mandibular bone structure evaluated with a visual radiographic index, (2) bone texture, (3) size and number of intertrabecular spaces calculated with Jaw-X software, (4) fracture probability calculated with a fracture risk assessment tool (FRAX), and (5) osteoporosis diagnosis based on dual-energy-X-ray absorptiometry. Differences were assessed with the Mann-Whitney test and relative risk calculated. RESULTS: Previous fracture, gluco-corticoid medication, and bone texture were significant indicators of future and total (previous plus future) fracture. Osteoporosis diagnosis, sparse trabeculation, Jaw-X, and FRAX were significant predictors of total but not future fracture. CONCLUSION: Clinical and oral bone variables may identify individuals at greatest risk of fracture.

Occupational therapists' experiences of rehabilitation of patients with limited awareness after stroke.

AIM: The aim of this study was to describe occupational therapists' experiences of rehabilitation of patients with limited awareness after stroke. METHODS: To capture occupational therapists' experiences, a qualitative approach was chosen using five focus groups consisting of 22 participants engaged in group discussions with open-ended questions based on the aim. Discussions were taped, transcribed verbatim, and analysed according to Kreuger's method. The analysis revealed one general description, constant adjustment, with three themes emerging during the analysis: adjustments in choice of activity, adjustments in choice of environment, and therapeutic adjustments. These themes interacted and were dependent on the desired effect of the interventions. Adjustments were made continuously depending on their effect. The occupational therapists strove for patients to avoid unnecessary risks, make realistic decisions, and live as independently as possible.

Acupuncture with manual and low frequency electrical stimulation as experienced by women with polycystic ovary syndrome: a qualitative study.

BACKGROUND: Polycystic ovary syndrome (PCOS) affects 5-10 percent of all fertile women and is associated with anovulation/oligoovulation, hyperandrogenism, and polycystic ovaries. Pharmacological treatment is often effective but associated with unwanted side effects. Acupuncture treatments have been shown to improve menstrual bleeding patterns and ovulation as well as hyperandrogenism, without side effects. The purpose of the present study was to describe the experience of acupuncture for women diagnosed with PCOS. METHODS: Eight women with PCOS living in western Sweden, were interviewed following repeated acupuncture treatments. Data was analyzed using systematic text condensation as described by Malterud. RESULTS: The experience of acupuncture for women diagnosed with PCOS can be described in five categories; the experience of hope, getting results, feelings of responsibility, skepticism and proof of effect, and feeling normal. CONCLUSION: Since acupuncture is a promising treatment for the symptoms of the common syndrome PCOS, the present study adds to the knowledge base by providing the important experiences of patients receiving the treatment. Acupuncture provides a possibility for patients to gain hope as the treatment shows results. The results show that acupuncture empowers the patients to take responsibility for their future well-being, although they may have been initially skeptical to the treatment. Because the syndrome had affected them for some time, even small changes offered a chance for them to feel that their bodies were capable of normal function.

Lifestyle changes - a continuous, inner struggle for women with type 2 diabetes: a qualitative study.

OBJECTIVE: The objective of this study was to describe how women handle necessary lifestyle changes due to a chronic disease using diabetes as a model. DESIGN: Interview study. SETTING: Ten women living in western Sweden were interviewed. METHOD: In-depth interviews and analysis were performed using the phenomenological ideas of Giorgi. SUBJECTS: Ten women diagnosed with type 2 diabetes, mean age 65. All were either on disability pension or retired with varying complications ranging from none to stroke. RESULTS: The findings revealed five themes: the ambiguous feeling of others' involvement, becoming a victim of pressurizing demands, experiencing knowledge deficits, experiencing an urge, and finding reasons to justify not changing. The invariant meaning of a continuous inner struggle illuminates the experience of making lifestyle changes for women with type 2 diabetes. CONCLUSION: The findings of the present study show that it is vital for health care professionals to treat women diagnosed with type 2 diabetes with great respect and understanding regarding the struggle that they are going through. By being aware of the everyday burden for these women, acknowledging the fact that they want their lives to go on as before, may serve as a "key" to assist women in changing attitudes towards living in accordance with the disease and appreciating the lifestyle changes as a challenge as they become healthier and improve their quality of life.

"I couldn't do this with opposition from my colleagues": a qualitative study of physicians' experiences as clinical tutors.

BACKGROUND: Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors. METHODS: Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method. RESULTS: In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult. CONCLUSIONS: It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.

Light pressure massage for patients with severe anxiety.

Generalised anxiety disorder (GAD) is common in the western world with a lifetime prevalence of 4.3 to 5.9% and is twice as common in women as in men. GAD can have a decisive impact on a patient's everyday life as it is surrounded by unfocused worries and the severe anxiety may interfere with normal social functions. The treatments include cognitive behavioural therapy and/or psychopharmacological drugs. In previous studies the positive effects of massage on anxiety have been shown. The present study described the experience of receiving massage for eight patients with GAD. Findings revealed that the patients were able to rediscover their own capacity during the massage period. This was illuminated by the experience of being relaxed in body and mind, the experience of unconditional attention, the experience of decreased anxiety and the experience of increased self-confidence. The paper ends with a discussion of clinical implications.

The experience of massage during chemotherapy treatment in breast cancer patients.

This study aimed to describe the experience of massage for breast cancer patients during chemotherapy treatment. Ten patients received massage at five occasions. They were interviewed and analysis was conducted using Giorgi's ideas of phenomenological research. The essential meaning of getting massage during chemotherapy was described as a retreat from the feeling of uneasiness toward chemotherapy. Results revealed five themes: the patients experienced distraction from the frightening experience, a turn from negative to positive, a sense of relaxation, a confirmation of caring, and finally they just felt good. In conclusion, the findings of this study show that massage offered a retreat from uneasy, unwanted, negative feelings connected with chemotherapy treatment. It is a treatment that can be added to the arsenal of treatment choices available to the oncological staff.

Massage relieves nausea in women with breast cancer who are undergoing chemotherapy.

OBJECTIVES: The aim of the present study was to examine the effect of massage on nausea, anxiety, and depression in patients with breast cancer undergoing chemotherapy. DESIGN: This work was a single-center, prospective, randomized, controlled trial. SETTINGS/LOCATION: This study was conducted in an oncology clinic, in a hospital in southwestern Sweden. SUBJECTS: Thirty-nine (39) women (mean age = 51.8) with breast cancer undergoing chemotherapy were enrolled. INTERVENTIONS: The patients were randomly assigned to a massage therapy group (20 minutes of massage on five occasions) or a control group (five 20-minute visits). OUTCOME MEASURES: All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention. They also completed the Hospital Anxiety and Depression Scale. RESULTS: Massage treatment significantly reduced nausea compared with control treatment (p = 0.025) when improvement was measured as a percentage of the five treatment periods. Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated. CONCLUSIONS: This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients.

Strength of motherhood: nonrecurrent breast cancer as experienced by mothers with dependent children.

The experience of breast cancer in mothers of dependent children and the strategies these women use to handle their situation of illness in relation to the children was the focus of this study. Ten women with nonrecurrent breast cancer were interviewed using phenomenology as a theoretical framework. The findings reveal that the women needed to balance themselves from being needed and perhaps not existing, balancing between demands, a will to be strong and allowing herself to be sick, and balancing between telling the truth and protecting the children from the truth. The women had strategies to help them in this struggle. To carry on as usual and continue everyday life became very important to them. To do this they had to combine their own strength with support from others and try to turn things into a positive perspective. The essential meaning of living with breast cancer and having dependent children implied using the strength of motherhood to balance conflicting forces and thereby continuing everyday life. The clinical implications include awareness and support to maintain everyday routines and generate strength.