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  • 1.
    Ahlander, Britt-Marie
    et al.
    Ryhov Cty Hosp.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Engvall, Jan
    Linköping University.
    Maret, Eva
    Karolinska Univ Hosp ; Karolinska Inst.
    Ericsson, Elisabeth
    Univ Örebro.
    Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 6, 1368-1380 p.Article in journal (Refereed)
    Abstract [en]

    Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients' anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients' experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach's alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach's alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

  • 2.
    Andreae, C.
    et al.
    Linköping University.
    Stromberg, A.
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Factors associated with appetite among patients with symptomatic heart failure2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, S53-S54 p.Article in journal (Other academic)
  • 3. Andreae, C.
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Stromberg, A.
    The association between depressive symptoms and appetite among patients with chronic heart failure2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, S52-S52 p.Article in journal (Other academic)
  • 4.
    Andreae, Christina
    et al.
    Linköping University ; Uppsala University.
    Strömberg, Anna
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Prevalence and associated factors for decreased appetite among patients with stable heart failure2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, 1703-1712 p.Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure.

    BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group.

    DesignObservational, cross-sectional study.

    MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite.

    ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance.

    ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

  • 5.
    Benzein, Eva
    et al.
    University of Kalmar, School of Human Sciences.
    Johansson, Pauline
    University of Kalmar, School of Human Sciences.
    Årestedt, Kristofer
    University of Kalmar, School of Human Sciences.
    Berg, Agneta
    Saveman, Britt-Inger
    University of Kalmar, School of Human Sciences.
    Families' Importance in Nursing Care: Nurses' Attitudes An Instrument Development2008In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 14, no 1, 97-114 p.Article in journal (Refereed)
  • 6.
    Benzein, Eva
    et al.
    University of Kalmar, School of Human Sciences.
    Johansson, Pauline
    University of Kalmar, School of Human Sciences.
    Årestedt, Kristofer
    University of Kalmar, School of Human Sciences.
    Saveman, Britt-Inger
    University of Kalmar, School of Human Sciences.
    Nurses' Attitudes About the Importance of Families in Nursing Care: A Survey of Swedish Nurses2008In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 14, no 2, 162-180 p.Article in journal (Refereed)
  • 7. Berg, Katarina
    et al.
    Idvall, Ewa
    Nilsson, Ulrica
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    Unosson, Mitra
    Psychometric evaluation of the post-discharge surgical recovery scale.2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, 794-801 p.Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: RATIONALE, AIM AND OBJECTIVES: Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness.

    METHODS: Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change.

    RESULTS: Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63).

    CONCLUSIONS: The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 8. Berg, Katarina
    et al.
    Kjellgren, Karin
    Unosson, Mitra
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patients.2012In: BMC Nursing, ISSN 1472-6955, Vol. 11, no 1, Article ID: 24- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.

    METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

    RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

  • 9. Berg, Katarina
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings universitet, Ersta Sköndal University College .
    Kjellgren, Karin
    Postoperative recovery from the perspective of day surgery patients: A phenomenographic study.2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, 1630-1638 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patients' own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home. OBJECTIVE: To explore day surgery patients' different perceptions of postoperative recovery. DESIGN: A qualitative design with a phenomenographic approach was used. METHODS AND SETTINGS: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face to face at the patients' homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital. RESULTS: The patients perceived postoperative recovery as comprising internal and external prerequisites and implying changes in ordinary life with varying levels of support. The effective production at the day surgery unit was perceived as having an impact on patients' prerequisites for recovery. The results are elucidated in three descriptive categories: 'Conditions for recovery at home', 'The rollback to ordinary life' and 'Being a cog in a flow of care'. CONCLUSIONS: The postoperative phase seems to be a weak link in day surgery care. From the patients' perspective, postoperative recovery following day surgery implies extensive responsibility at home. Patients need knowledge and understanding concerning what constitutes the normal range in recovery and how to manage self-care following their specific surgical procedure.

  • 10. Bergman, Eva
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Fridlund, Bengt
    Jönköping University.
    Karlsson, Jan-Erik
    Malm, Dan
    The impact of comprehensibility and sense of coherence in the recovery of patients with myocardial infarction: a long-term follow-up study2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 3, 276-283 p.Article in journal (Refereed)
    Abstract [en]

    Background: After being through a myocardial infarction (MI), a severe recovery period ensues for the patient. Longterm follow-ups are helpful, but what this should include differs between patients. Today there is no established approach to identify needs for support after an MI. Aim: The aim was to describe sense of coherence (SOC) over time in relation to sex, as well as further SOC in relation to quality of life (QoL) and treatment satisfaction in patients with an MI. Methods. This study had an observational and longitudinal design and followed 18 women and 60 men with an acute MI for 49-67 months after the onset of MI. Instruments used were the SOC-13 and the Seattle Angina Questionnaire. Results: Women scored lower SOC than men. A main effect of time was shown for comprehensibility which increased significantly from baseline to the long-term follow-up. Women increased from a lower level to an equal level as men at the long-term follow-up. The total SOC was significantly associated with QoL and treatment satisfaction. Conclusion: High comprehensibility and high SOC give the patient a better basis to handle life after MI. Thus, healthcare professionals should keep in mind that SOC and especially comprehensibility have meaning for the patient's ability to handle her or his recovery. Healthcare professionals need to together with the patient identify and work with lifestyle factors that contribute to increased comprehensibility about the disease, which gives the patient the foundation to preserve and promote her or his health both in the short and long term.

  • 11. Borendal Wodlin, Ninnie
    et al.
    Nilsson, Lena
    Linköpings universitet.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Kjølhede, Preben
    Linköpings universitet.
    Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting.2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 4, 369-379 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine.

    DESIGN: Secondary analysis from a randomized, open, multicenter study.

    SETTING: Five hospitals in south-east Sweden.

    POPULATION: One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia.

    METHODS: The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively.

    MAIN OUTCOME MEASURES: Occurrence, intensity and duration of postoperative symptoms.

    RESULTS: Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching.

    CONCLUSIONS: Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy.

  • 12.
    Broström, Anders
    et al.
    Jönköping University ; Linköping University Hospital.
    Nilsen, Per
    Linköping University.
    Gardner, Benjamin
    University College London, UK.
    Johansson, Peter
    Linköping University Hospital.
    Ulander, Martin
    Linköping University Hospital ; Linköping University.
    Fridlund, Bengt
    Jönköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University ; Ersta Sköndal University College ; Ersta Hospital.
    Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea.2014In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, 929057Article in journal (Refereed)
    Abstract [en]

    Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of "habit" in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42-0.93), item-total correlations (0.58-0.91), and reliability ( α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.

  • 13.
    Broström, Anders
    et al.
    Jönköping University ; Linköping University Hospital.
    Sunnergren, Ola
    Linköping University ; Ryhov Hospital, Jönköping.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Johansson, Peter
    Linköping University ; Linköping University Hospital.
    Nilsen, Per
    Linköping University.
    Fridlund, Bengt
    Jönköping University.
    Svanborg, Eva
    Jönköping University ; Linköping University.
    Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care: Associations with sleep complaints, depressive symptoms and global perceived health2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 6, 445-452 p.Article in journal (Refereed)
    Abstract [en]

    Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.

  • 14. Broström, Anders
    et al.
    Sunnergren, Ola
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    Johansson, Peter
    Ulander, Martin
    Riegel, Barbara
    Svanborg, Eva
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients.2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, 107-113 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA.

    DESIGN: Cross-sectional.

    SETTING: Four primary care health centres in Sweden.

    PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP >140/90).

    MAIN OUTCOME MEASURES: Occurrence of OSA as measured by the apnoea hypopnoea index (AHI).

    RESULTS: Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m2, snoring, witnessed apnoeas, and sleep duration >8 hours were determinants of obstructive sleep apnoea.

    CONCLUSION: Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 15. Broström, Anders
    et al.
    Ulander, Martin
    Nilsen, Per
    Svanborg, Eva
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment.2011In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, no 3, 460-471 p.Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbach's alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 16. Broström, Anders
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    Nilsen, Per
    Strömberg, Anna
    Ulander, Martin
    Svanborg, Eva
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, 603-611 p.Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

  • 17. Broström, Anders
    et al.
    Årestedt, Kristofer
    University of Kalmar, School of Human Sciences.
    Strömberg, Anna
    Ståhlkrantz, Anna
    Alberts, Jan
    Svanborg, Eva
    The Informational Needs to CPAP treatment Inventory: A description of a new self-assessment tool in CPAP-treated patients with obstructive sleep apnoea2008Conference paper (Refereed)
  • 18. Broström, Anders
    et al.
    Årestedt, Kristofer
    University of Kalmar, School of Human Sciences.
    Strömberg, Anna
    Ståhlkrantz, Anna
    Alberts, Jan
    Svanborg, Eva
    Validity and reliability of the Side Effects to CPAP treatment Inventory: A tool for measuring side-effects to CPAP treatment in patients with obstructive sleep apnoea2008Conference paper (Refereed)
  • 19.
    Bylund, Ami
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institute ; Ersta Hospital.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. ..
    Thorell, Anders
    Karolinska Institute ; Ersta Hospital.
    Persson, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Assessment of family functioning: evaluation of the General Functioning Scale in a Swedish Bariatric Sample2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, 614-622 p.Article in journal (Refereed)
    Abstract [en]

    BackgroundThe General Functioning Scale (GFS) was developed to assess self-perceived overall family functioning. The scale has satisfactory psychometric properties, is internationally recognised and has been used in different contexts. However, no validated Swedish version is available. Healthy family functioning can support patients and help them adhere to treatment regimens. Moreover, it maintains the physical and emotional health and that of the family as a unit. Yet, there is limited information regarding family functioning postgastric bypass surgery. Thus, it is important to use validated instruments to understand family functioning in bariatric contexts. AimTo evaluate aspects of reliability and validity in GFS in a Swedish bariatric sample, focusing on factor structure. MethodThe Swedish version of the GFS (S-GFS) was administered on two occasions to 163 participants who had undergone gastric bypass surgery 6-8 weeks prior to testing. Internal consistency, temporal stability and construct validity were assessed. ResultsData were positively skewed. The S-GFS showed good internal consistency (ordinal = 0.92) with a sufficient overall mean interitem correlation (0.500) and adequate temporal stability (intraclass correlation coefficient = 0.833). After modifying response alternatives, confirmatory factor analysis indicated acceptable fit for a one-factor model. ConclusionThe scale is a promising tool for assessing family functioning in bariatric settings. The S-GFS showed satisfactory reliability - consistent with prior research - and acceptable validity in the study sample. This study contributes to the limited research on the scale's validity. However, the S-GFS needs to be evaluated in different cultural and clinical contexts, focusing on various aspects of validity and responsiveness (sensitivity to detect significant change over time) in different samples.

  • 20.
    Dalteg, Tomas
    et al.
    Jönköping University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sandgren, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Malm, Dan
    Jönköping University ; County Hospital Ryhov.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Associations of Emotional Distress and Perceived Health in Persons With Atrial Fibrillation and Their Partners Using the Actor–Partner Interdependence Model2016In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, no 3, 368-391 p.Article in journal (Refereed)
    Abstract [en]

    Individual behavior affects and is affected by other people. The aim of this study was to examine if emotional distress in patients with atrial fibrillation (AF) and their spouses was associated with their own and their partner’s perceived health. Participants included 91 dyads of patients and their spouses. Emotional distress was measured using the Hospital Anxiety and Depression Scale and perceived health was measured with the Short Form 36 Health Survey. The Actor–Partner Interdependence Model was used for dyad-level analyses of associations, using structural equation modeling. Higher levels of anxiety and depression were associated with lower levels of perceived health in patients and spouses. Higher levels of depression in patients were associated with lower levels of vitality in spouses and vice versa. As AF patients and their spouses influence each other, health-care interventions should consider the dyad to address dyadic dynamics. This may benefit the health of the individual patient and of the couple.

  • 21.
    Djukanovic, Ingrid
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital ; Linköping University.
    Is the Hospital Anxiety and Depression Scale (HADS) a valid measure in a general population 65-80 years old?: A psychometric evaluation study2017In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 15, 1-10 p., 193Article in journal (Refereed)
    Abstract [en]

    Background: The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. There is also a lack of psychometric evaluations of the HADS in non-clinical samples of older people. The aim of the study was to evaluate the factor structure of the HADS in a general population 65-80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex. Methods: This study was based on data from a Swedish sample, randomized from the total population in the age group 65-80 years (n = 6659). Confirmatory factor analyses (CFA) were performed to examine the factor structure. Ordinal regression analyses were conducted to detect DIF for sex. Reliability was examined by both ordinal as well as traditional Cronbach's alpha. Results: The CFA showed a two-factor model with cross-loadings for two items (7 and 8) had excellent model fit. Internal consistency was good in both subscales, measured with ordinal and traditional alpha. Floor effects were presented for all items. No indication for meaningful DIF regarding sex was found for any of the subscales. Conclusions: HADS Anxiety and HADS Depression are unidimensional measures with acceptable internal consistency and are invariant with regard to sex. Despite pronounced ceiling effects and cross-loadings for item 7 and 8, the hypothesized two-factor model of HADS can be recommended to assess psychological distress among a general population 65-80 years old.

  • 22.
    Edback, Maria Palmetun
    et al.
    University Hospital Örebro ; Örebro University ; Örebro County Council.
    Lindberg, Magnus
    University Hospital Örebro ; Örebro University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Örebro University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University ; Ersta Sköndal University College ; Ersta Hospital.
    Social support: an important factor for quality of life in women with hirsutism2014In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 12, 183Article in journal (Refereed)
    Abstract [en]

    Background: Women with hirsutism have reported imparied health and health-related quality of life (HRQoL). Social support is a factor that might increase HRQoL in chronic diseases, but little is known about this association among women with hirsutism. Aim: The aim of the study was to describe social support and explore its association with HRQoL among women with hirsutism. A further aim was to compare HRQoL in women with hirsutism with a Swedish normal population. Methods: A questionnaire including socio-demographic questions, Short-Form Health Survey (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS), and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was answered by 127 women with hirsutism. Results: Multiple regression analyses showed significant associations between social support and all health dimensions in the SF-36, also after the model was adjusted for age, hairiness and body mass index. Compared to the normal Swedish population, women with hirsutism reported significantly lower HRQoL in all dimensions of the SF-36 (p < 0.01). Conclusions: There is a significant positive association between social support and HRQoL, demonstrating its importance for the ability to adapt to problems associated with hirsutism. As women with hirsutism reported poorer HRQoL compared to the normal population, social support may be a factor to consider in clinical practice.

  • 23.
    Ekback, Maria
    et al.
    University Hospital Örebro ; Örebro University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Lindberg, Magnus
    University Hospital Örebro ; Örebro University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University ; Ersta Sköndal University College ; Ersta hospital.
    The Swedish version of the multidimensional scale of perceived social support (MSPSS): a psychometric evaluation study in women with hirsutism and nursing students2013In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 11, 168Article in journal (Refereed)
    Abstract [en]

    Background: The Multidimensional Scale of Perceived Social Support (MSPSS) is a short instrument, developed to assess perceived social support. The original English version has been widely used. The original scale has demonstrated satisfactory psychometric properties in different settings, but no validated Swedish version has been available. The aim was therefore to translate, adapt and psychometrically evaluate the Multidimensional Scale of Perceived Social Support for use in a Swedish context. Method: In total 281 participants accepted to join the study, a main sample of 127 women with hirsutism and a reference sample of 154 nursing students. The MSPSS was translated and culturally adapted according to the rigorous official process approved by WHO. The psychometric evaluation included item analysis, evaluation of factor structure, known-group validity, internal consistency and reproducibility. Results: The original three-factor structure was reproduced in the main sample of women with hirsutism. An equivalent factor structure was demonstrated in a cross-validation, based on the reference sample of nursing students. Known-group validity was supported and internal consistency was good for all scales (alpha = 0.91-0.95). The test-retest showed acceptable to very good reproducibility for the items (kappa(w) = 0.58-0.85) and the scales (ICC = 0.89-0.92; CCC = 0.89-0.92). Conclusion: The Swedish version of the MSPSS is a multidimensional scale with sound psychometric properties in the present study sample. The simple and short format makes it a useful tool for measuring perceived social support.

  • 24.
    Elmerstig, Eva
    et al.
    Malmö University.
    Wijma, Barbro
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Being “good in bed”: body concerns, self-perceptions and gender expectations among Swedish heterosexual female and male senior high-school students2017In: Journal of sex & marital therapy, ISSN 0092-623X, E-ISSN 1521-0715, Vol. 43, no 4, 326-342 p.Article in journal (Refereed)
    Abstract [en]

    We investigated gender differences regarding body perceptions, self-perceptions, values and expectations in sexual situations, and factors associated with expectations, among Swedish heterosexual female and male high-school students. A total of 2,765 students (aged 18 to 22) completed questionnaires. Women reported lower satisfaction with themselves and their body appearance (p < 0.001), and felt more inferior to their partner (p < 0.001). Men felt more superior to their partner, and felt higher expectations (p < 0.001). Male sex, difficulty saying no to sex, dissatisfaction with the body, feeling inferior or superior to partner, and considering partner's satisfaction as more important, were all associated with feeling expectations during sex.

  • 25.
    Eriksson, Kerstin
    et al.
    Jönköping Univ.
    Wikstrom, Lotta
    Jönköping Univ.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings Universitet, Ersta Sköndal Univ Coll.
    Fridlund, Bengt
    Jönköping Univ.
    Broström, Anders
    Jönköping Univ.
    Numeric rating scale: patients' perceptions of its use in postoperative pain assessments2014In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 27, no 1, 41-46 p.Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study was to describe how patients perceive the use of the numeric rating scale in postoperative pain assessments. Background: There are recommendations to use a pain scale to follow patients' postoperative pain. Most patients prefer the NRS but there is a discrepancy between patients and healthcare professionals how to interpret the ratings from the pain assessments. Methods: A descriptive design with a phenomenographic approach was used. Semi structured interviews were held with 25 patients. Results: Three description categories emerged that illustrate patients' perceptions; use of the NRS facilitated communication of pain, it put demands on healthcare professionals and care routines and it contained interpretation difficulties. Conclusion: The NRS has a place in pain management according to the patients but there is a need for a dialogue to give the patients the opportunity to describe their pain and set a common goal. (C) 2014 Elsevier Inc. All rights reserved.

  • 26.
    Eriksson, Kerstin
    et al.
    Jönköping Univ;Ryhov Cty Hosp.
    Wikström, Lotta
    Jönköping Univ;Ryhov Cty Hosp.
    Fridlund, Bengt
    Jönköping Univ.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University;University Hospital Linköping.
    Brostrom, Anders
    Jönköping Univ;University Hospital Linköping.
    Patients' experiences and actions when describing pain after surgery - A critical incident technique analysis2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, 27-36 p.Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. Objective: The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. Methods: An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Findings: Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals' large work load. (C) 2015 Elsevier Ltd. All rights reserved.

  • 27.
    Flink, Maria
    et al.
    Karolinska Institutet ; Karolinska University Hospital.
    Lindblad, Marlene
    Karolinska Institutet ; KTH, Royal Institute of Technology.
    Frykholm, Oscar
    Karolinska Institutet.
    Kneck, Asa
    Karolinska Institutet.
    Nilsen, Per
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet ; KTH, Royal Institute of Technology.
    The Supporting Patient Activation in Transition to Home (sPATH) intervention: a study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, e014178Article in journal (Refereed)
    Abstract [en]

    Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n= 145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge selfmanagement. Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/149831/ 2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences.

  • 28.
    Franzén, Kristofer (current name Årestedt, Kristofer)
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,. Lund University.
    Blomqvist, Kerstin
    Kristianstad University.
    Saveman, Britt-Inger
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Impact of Chronic Heart Failure on Elderly Persons' Daily Life: A Validation Study2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 2, 137-145 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge about how elderly persons perceive the impact of chronic heart failure (CHF) on daily life is important when planning nursing care. For this purpose, disease specific instruments are needed. However, few instruments have been developed or tested specifically on elderly persons.

    AIM: To validate a Swedish version of the Minnesota Living with Heart Failure Questionnaire (LHFQ) on elderly persons with CHF, and use it to describe the impact of CHF on daily life in the same population.

    METHODS: The sample comprised of 357 persons, aged between 65 and 99, diagnosed with CHF. A questionnaire including background data, the LHFQ and the SF-12 was used.

    RESULTS: A factor analysis resulted in four dimensions: physical, emotional, treatment and pleasure. LHFQ showed convergent validity and ability to discriminate between known groups. Cronbach's alpha for the total scale was 0.94. Impairments in the physical dimension were most common, especially fatigue (88%) and shortness of breath (87%).

    CONCLUSIONS: The LHFQ showed satisfying psychometric properties in an elderly Swedish population with CHF and can, with minor alterations, be recommended for research and clinical use. The impact of chronic heart failure on daily life was mostly physical, but other impairments were also common.

  • 29.
    Franzén, Kristofer (current name Årestedt, Kristofer)
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Social Work.
    Johansson, Patrik
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Social Work.
    ”Tvingad och tvingad. Jag behövde mina pengar ju…”: En studie om arbetslösa ungdomars upplevelser av kompetenshöjande insatser2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 30.
    Franzén, Kristofer (current name Årestedt, Kristofer)
    et al.
    University of Kalmar, School of Human Sciences. Lunds universitet.
    Saveman, Britt-Inger
    University of Kalmar, School of Human Sciences.
    Blomqvist, Kerstin
    Predictors for health related quality of life in persons 65 years or older with chronic heart failure.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 2, 112-120 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A main goal in nursing care of persons with chronic heart failure (HF) is to strengthen their health related quality of life (HRQoL). This presupposes knowledge about the relation between heart failure and HRQoL. Existing studies have shown incongruent results about whether HRQoL is affected differently depending on age or sex of elderly persons with chronic HF.

    AIM: This study aimed to investigate if age, sex, disease severity, comorbidity and living conditions predict health related quality of life among persons 65 years or older with chronic HF.

    METHODS: The study included a sample of 357 persons. HRQoL was measured by the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. Multiple regression analyses were performed to analyse the relation between the predictors and HRQoL.

    RESULTS: The main finding was that self-rated disease severity was strongly associated with HRQoL, but also age, sex, diabetes and respiratory diseases was associated with some of the dimensions of HRQoL.

    CONCLUSIONS: Interventions aimed at delaying the progress of the disease, assist persons' to cope with the disease and maintain the domains of HRQoL that are still feasible could be important to improve HRQoL in elderly persons with chronic HF.

  • 31.
    Hagell, Peter
    et al.
    Kristianstad University.
    Alvariza, Anette
    Ersta Sköndal University College ; Capio Palliative Care Unit, Stockholm, Sweden.
    Westergren, Albert
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal University College ; Kalmar County Hospital.
    Assessment of Burden Among Family Caregivers of People With Parkinson's Disease Using the Zarit Burden Interview2017In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 53, no 2, 272-278 p.Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Previous studies have supported the psychometric properties of the 22-Item Zarit Burden Interview (ZBI-22) scale among family caregivers of people with various disorders, including Parkinson's disease (PD). However, its short forms have not been psychometrically tested among PD family caregivers, and available psychometric analyses have not accounted for the ordinal nature of item-level data.

    OBJECTIVES: To assess the psychometric properties of the ZBI-22 and its short forms among family caregivers of people with PD, while taking account for the ordinal nature of data.

    METHODS: Cross-sectional postal survey ZBI-22 data from 66 family caregiver members (59% women; mean age 69.6 years) of a local Swedish PD society branch were analyzed according to classical test theory methods based on polychoric/polyserial correlations.

    RESULTS: Missing item responses were ≤ 5%. Corrected item-total correlations were ≥ 0.42 and floor/ceiling effects were <20%, besides for the briefest (4- and 1-item) short forms (20% and 40% floor effects, respectively). Reliability was good for all scales (ordinal alpha 0.89-0.95). External construct validity was in general accordance with a priori expectations. Short forms demonstrated good criterion-related validity (rs 0.87-0.99) and discriminative ability (area under the curve, 0.91-0.98) relative to the full ZBI-22.

    CONCLUSION: This study provides support for the reliability and validity of the ZBI-22 and its various short forms for use among PD family caregivers. In studies where caregiver burden is a central outcome, either ZBI-22 or ZBI-12 is suggested for use; other short forms can be used when caregiver burden is of less central focus or for clinical screening.

  • 32.
    Hagell, Peter
    et al.
    Kristianstad University.
    Westergren, Albert
    Kristianstad University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar Cty Hospital ; Linköping University.
    Beware of the origin of numbers: Standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations2017In: Research in Nursing & Health, ISSN 0160-6891, E-ISSN 1098-240X, Vol. 40, no 4, 378-386 p.Article in journal (Refereed)
    Abstract [en]

    The 12-item Short Form Health Survey (SF-12) is a generic health rating scale developed to reproduce the Physical and Mental Component Summary scores (PCS and MCS, respectively) of a longer survey, the SF-36. The standard PCS/MCS scoring algorithm has been criticized because its expected dimensionality often lacks empirical support, scoring is based on the assumption that physical and mental health are uncorrelated, and because scores on physical health items influence MCS scores, and vice versa. In this paper, we review the standard PCS/MCS scoring algorithm for the SF-12 and consider alternative scoring procedures: the RAND-12 Health Status Inventory (HSI) and raw sum scores. We corroborate that the SF-12 reproduces SF-36 scores but also inherits its problems. In simulations, good physical health scores reduce mental health scores, and vice versa. This may explain results of clinical studies in which, for example, poor physical health scores result in good MCS scores despite compromised mental health. When applied to empirical data from people with Parkinson's disease (PD) and stroke, standard SF-12 scores suggest a weak correlation between physical and mental health (r(s). 16), whereas RAND-12 HSI and raw sum scores show a much stronger correlation (r(s). 67-.68). Furthermore, standard PCS scores yield a different statistical conclusion regarding the association between physical health and age than do RAND-12 HSI and raw sum scores. We recommend that the standard SF-12 scoring algorithm be abandoned in favor of alternatives that provide more valid representations of physical and mental health, of which raw sum scores appear the simplest.

  • 33. Henriksson, A.
    et al.
    Andershed, B.
    Benzein, Eva
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Adaptation and psychometric evaluation of the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale in a sample of Swedish family members of patients with life-threatening illness2012In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 26, no 7, 930-938 p.Article in journal (Refereed)
    Abstract [en]

    Background: Family members often take on many caring responsibilities, with complex issues and challenges to consider. Feelings of preparedness, competence and reward are identified as concepts that may protect caregiver wellbeing and decrease negative outcomes related to caregiving. Aim: This study aimed to translate, adapt and psychometrically evaluate the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale in Swedish family members of patients with life threatening illness. Design: Correlational. Setting/participants: The study took place in four settings including advanced palliative care. The scales were tested in a sample of 125 family members of persons with life-threatening illness. All three scales were tested in relation to distribution of item and scale scores, missing data patterns, dimensionality, convergent validity and reliability. Results: The results in this study indicate that the Swedish versions of The Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale are valid, reliable and user-friendly scales. Confirmatory factor analysis showed that the scales were unidimensional and all demonstrated Cronbach's alpha values of ≥0.9. Conclusions: As a result of this study it is anticipated that the Preparedness for Caregiving Scale, Caregiver Competence Scale and Rewards of Caregiving Scale could provide a basis for collaborative research between different countries and make international studies more comparable and generalizable despite differences in language and culture. © 2011 The Author(s).

  • 34.
    Henriksson, Anette
    et al.
    Ersta Sköndal Univ Coll, Sweden ; Karolinska Inst, Sweden.
    Carlander, Ida
    Ersta Sköndal Univ Coll, Sweden ; Karolinska Inst, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping Univ, Sweden ; Ersta Sköndal Univ Coll, Sweden.
    Factors associated with feelings of reward during ongoing family palliative caregiving2015In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 3, 505-512 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Of the few studies that have paid attention to feelings of reward in family palliative caregiving, most are retrospective and examine the experiences of bereaved family caregivers. Although feeling rewarded has been described as an influence that may facilitate the way family caregivers handle the caregiving situation, no study has sought to identify the factors associated with feelings of reward while providing ongoing family palliative care. The aim of this study, therefore, was to identify influential factors in feelings of reward experienced by family palliative caregivers. Method: Our study had a correlational cross-sectional design. Family caregivers (n = 125) of patients receiving specialized palliative care were consecutively recruited from four settings. These caregivers answered a questionnaire that included the Rewards of Caregiving Scale (RCS). This questionnaire included questions about demographic background and scales to measure preparedness for caregiving, feelings of hope, perceived health, and symptoms of anxiety and depression. Correlation and regression analyses were conducted to identify factors associated with rewards. Results: The results demonstrated that the more prepared caregivers with higher levels of hope felt more rewarded, while caregivers with higher levels of anxiety and those in a spousal relationship with the patient felt less rewarded by caregiving. Significance of results: It seems reasonable that feeling rewarded can be a significant contributor to the overall experience of providing ongoing palliative care. The situation of family caregivers has been shown to be multifaceted and complex, and such covariant factors as preparedness, anxiety, hope, and being in a spousal relationship with the patient to influence this experience.

  • 35.
    Henriksson, Anette
    et al.
    Ersta Sköndal Univ Collage ;Ersta Hosp. ; Dalens Hosp. ; Karolinska Inst .
    Carlander, Ida
    Ersta Sköndal Univ Collage ; Karolinska Inst.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal Univ Collage ; Ersta Hosp. ; Linköping University.
    Feelings of rewards among family caregivers during ongoing palliative care2015In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 6, 1509-1517 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: Palliative family caregivers appear to experience the rewards of caregiving concurrent with burdens and negative feelings. Relatively few studies have attended to the positive and rewarding aspects in palliative family caregiving. In addition, most studies on rewards are retrospective and examine the experiences of bereaved family caregivers. The present study aimed at describing feelings of reward among family caregivers during ongoing palliative care. A further aim was to compare the experience of rewards in relation to sex and age. Methods: The sample consisted of 125 family caregivers and took place in three specialist palliative care units and one hematology unit. Participants answered a questionnaire including demographic background questions and the Rewards of Caregiving Scale (RCS). Descriptive statistics were employed to describe characteristics of the participants and the level of rewards. A Mann-Whitney U test was used to compare differences between groups of different sex and age. Results: Palliative family caregivers reported general high levels of reward. The greatest source of rewards involved feelings of being helpful to patients. This was closely followed by giving something to patients that brought them happiness and being there for them. The smallest sources of rewards were related to personal growth, self-satisfaction, and personal meaning. There was also an association between rewards and age but not between men and women. Significance of results: Family caregivers experienced the rewards of caregiving during ongoing palliative care despite their unique and stressful situation. Feelings of reward seem to be about handling a situation in a satisfying way, feeling competent and confident to take care of the patient and thereby feeling proud. Support could preferably be designed to improve a family caregiver's ability to care and to facilitate the positive aspects and rewards of caregiving and focus on strengths and resources.

  • 36.
    Henriksson, Anette
    et al.
    Ersta Sköndal Univ Coll.
    Hudson, Peter
    Univ Melbourne, Australia.
    Ohlen, Joakim
    Ersta Sköndal Univ Coll.
    Thomas, Kristina
    Univ Melbourne, Australia.
    Holm, Maja
    Ersta Sköndal Univ Coll.
    Carlander, Ida
    Karolinska Inst.
    Hagell, Peter
    Kristianstad Univ.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Use of the Preparedness for Caregiving Scale in Palliative Care: A Rasch Evaluation Study2015In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 50, no 4, 533-541 p.Article in journal (Refereed)
    Abstract [en]

    Context. Studies have shown that family carers who feel more prepared for the caregiver role tend to have more favorable experiences. Valid and reliable methods are needed to identify family carers who may be less prepared for the role of supporting a person who needs palliative care. Objectives. The aim of this study was to evaluate the measurement properties of the original English version and a Swedish version of the Preparedness for Caregiving Scale (PCS). Methods. The sample (n = 674) was taken from four different intervention studies from Australia and Sweden, all focused on improving family carers' feelings of preparedness. Family carers of patients receiving palliative home care were selected, and baseline data were used. The measurement properties of the PCS were evaluated using the Rasch model. Results. Both the English and Swedish versions of the PCS exhibit sound measurement properties according to the Rasch model. The items in the PCS captured different levels of preparedness. The response categories were appropriate and corresponded to the level of preparedness. No significant differential item functioning for age and sex was detected. Three items demonstrated differential item functioning by language but did not impact interpretation of scores. Reliability was high (>0.90) according to the Person Separation Index. Conclusion. The PCS is valid for use among family carers in palliative care. Data provide support for its use across age and gender groups as well as across the two language versions. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  • 37. Henriksson, Anette
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Exploring factors and caregiver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care: A correlational, cross-sectional study2013In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 27, no 7, 639-646 p.Article in journal (Refereed)
    Abstract [en]

    Background: Family caregivers in palliative care often report feeling insufficiently prepared to handle the caregiver role. Preparedness has been confirmed as a variable that may actually protect family caregiver well-being. Preparedness refers to how ready family caregivers perceive they are for the tasks and demands in the caregiving role. Aim: The aim of this study was to explore factors associated with preparedness and to further investigate whether preparedness is associated with caregiver outcomes. Design: This was a correlational study using a cross-sectional design. Setting/participants: The study took place in three specialist palliative care units and one haematology unit. A total of 125 family caregivers of patients with life-threatening illness participated. Result: Preparedness was significantly associated with higher levels of hope and reward and with a lower level of anxiety. In contrast, preparedness was not associated with depression or health. Being female and cohabiting with the patient were significantly associated with a higher level of preparedness. The relationship to the patient was significantly associated with preparedness, while social support, place of care, time since diagnosis and age of the patients showed no association. Conclusion: Feelings of preparedness seem to be important for how family caregivers experience the unique situation when caring for a patient who is severely ill and close to death. Our findings support the inclusion of preparedness in support models for family caregivers in palliative care. Psycho-educational interventions could preferably be designed aiming to increase family caregiver's preparedness to care, including practical care, communication and emotional support.

  • 38. Henriksson, Anette
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ternestedt, Britt-Marie
    Andershed, Birgitta
    Effects of a support group programme for patients with life-threatening illness during ongoing palliative care2013In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 27, no 3, 257-264 p.Article in journal (Refereed)
    Abstract [en]

    Background: Health care systems in many countries are moving towards outpatient care in which family members are central in providing care for patients with life-threatening illness. Several studies show that family members report a lack of preparation, knowledge and the ability to handle the caregiver role, and a need for information and psychosocial support. Aim: The aim was to investigate the effects of a support group programme for family members of patients with life-threatening illness during ongoing palliative care. Design: A prospective quasi-experimental design, including an intervention group and a comparison group, was used. Settings/participants: A support group programme was offered to family members during ongoing palliative care at three intervention settings: two specialist palliative care units and one haematology unit. A fourth setting, a specialist palliative care unit, was used for comparisons. Results: Family members taking part in the support group programme significantly increased their perceptions of preparedness for caregiving, competence for caregiving, and rewards of caregiving. Hope, anxiety, depression symptoms and health showed no significant changes. Conclusions: The intervention, including a support group programme delivered to family members of patients with life-threatening illness during ongoing palliative care, proved to be effective in certain domains of caregiving. No negative outcomes were detected. The results indicate that this intervention could be implemented and delivered to family members during ongoing palliative care.

  • 39. Hjelm, C.
    et al.
    Broström, A.
    Riegel, B.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Strömberg, A.
    A conceptual model of the relationship between self-care and cognitive function in patients with chronic heart failure2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, S15-S16 p.Article in journal (Other academic)
  • 40.
    Hjelm, Carina M.
    et al.
    Linköping University ; County Council of Östergötland.
    Broström, Anders
    County Council of Östergötland ; Jönköping University.
    Riegel, Barbara
    Linköping University ; University of Pennsylvania, USA.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Strömberg, Anna
    Linköping University ; County Council of Östergötland.
    The association between cognitive function and self-care in patients with chronic heart failure2015In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 2, 113-119 p.Article in journal (Refereed)
    Abstract [en]

    Background: Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression.

    Methods: This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses.

    Results: Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression.

    Conclusions: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.

  • 41. Hjelm, Carina
    et al.
    Strömberg, Anna
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Broström, Anders
    Association between sleep-disordered breathing, sleep-wake pattern, and cognitive impairment among patients with chronic heart failure2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 5, 496-504 p.Article in journal (Refereed)
    Abstract [en]

    Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction. In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoeahypopnoea index (AHI) 15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68 male, median age 72 years, 58 NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI 15). The SDB group had significantly higher saturation time below 90, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition. The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition.

  • 42.
    Holm, Maja
    et al.
    Karolinska Institutet ; Ersta Sköndal University College.
    Carlander, Ida
    Ersta Sköndal University College ; Karolinska Institutet.
    Furst, Carl-Johan
    Lund University.
    Wengstrom, Yvonne
    Karolinska Institutet ; Örebro University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Öhlen, Joakim
    Ersta Sköndal University College ; University of Gothenburg.
    Henriksson, Anette
    Karolinska Institutet ; Ersta Sköndal University College ; Dalen Hospital.
    Delivering and participating in a psycho-educational intervention for family caregivers during palliative home care: a qualitative study from the perspectives of health professionals and family caregivers2015In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 14, 16Article in journal (Refereed)
    Abstract [en]

    Background: Family caregivers in palliative care have a need for knowledge and support from health professionals, resulting in the need for educational and supportive interventions. However, research has mainly focused on the experiences of family caregivers taking part in interventions. To gain an increased understanding of complex interventions, it is necessary to integrate the perspectives of health professionals and family caregivers. Hence, the aim of this study is to explore the perspectives of health professionals and family caregivers of delivering and participating in a psycho-educational intervention in palliative home care. Methods: A psycho-educational intervention was designed for family caregivers based on a theoretical framework describing family caregiver's need for knowing, being and doing. The intervention was delivered over three sessions, each of which included a presentation by healthcare professionals from an intervention manual. An interpretive descriptive design was chosen and data were collected through focus group discussions with health professionals and individual interviews with family caregivers. Data were analysed using framework analysis. Results: From the perspectives of both health professionals and family caregivers, the delivering and participating in the intervention was a positive experience. Although the content was not always adjusted to the family caregivers' individual situation, it was perceived as valuable. Consistently, the intervention was regarded as something that could make family caregivers better prepared for caregiving. Health professionals found that the work with the intervention demanded time and engagement from them and that the manual needed to be adjusted to suit group characteristics, but the experience of delivering the intervention was still something that gave them satisfaction and contributed to them finding insights into their work. Conclusions: The theoretical framework used in this study seems appropriate to use for the design of interventions to support family caregivers. In the perspectives of health professionals and family caregivers, the psycho-educational intervention had important benefits and there was congruence between the two groups in that it provided reward and support. In order for health professionals to carry out psycho-educational interventions, they may be in need of support and supervision as well as securing appropriate time and resources in their everyday work.

  • 43.
    Holm, Maja
    et al.
    Karolinska Institutet ; Ersta Sköndal University College.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlander, Ida
    Ersta Sköndal University College ; Karolinska Institutet.
    Furst, Carl-Johan
    Lund University.
    Wengström, Yvonne
    Karolinska Institutet ; Örebro University.
    Ohlen, Joakim
    Ersta Sköndal University College ; University of Gothenburg.
    Alvariza, Anette
    Karolinska Institutet ; Ersta Sköndal University College ; Dalens Hospital.
    Short-term and long-term effects of a psycho-educational group intervention for family caregivers in palliative home care - results from a randomized control trial2016In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no 7, 795-802 p.Article in journal (Refereed)
    Abstract [en]

    BackgroundFamily caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers. This study evaluates short-term and long-term effects of a psycho-educational group intervention aiming to increase preparedness for family caregiving in specialized palliative home care. MethodsThe study design was a randomized control trial where family caregivers were allocated either to an intervention or control group. The intervention was delivered as a program including three sessions by health professionals (physician, nurse, and social worker/priest). Family caregivers from 10 specialized palliative home care settings were included. Questionnaires with validated instruments at baseline, upon completion, and 2 months following the intervention were used to measure effects of the intervention. The primary outcome was preparedness for caregiving in family caregivers. ResultsIn total, 21 intervention programs were delivered, and 119 family caregivers completed all three measurements. The intervention group had significantly increased their preparedness for caregiving in both the short-term and long-term follow-up compared with the control group. The intervention group also reported significantly increased competence for caregiving in short-term but not long. No effects of the intervention were found on rewards for caregiving, caregiver burden, health, anxiety, or depression. ConclusionsThe psycho-educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms.

  • 44.
    Holm, Maja
    et al.
    Karolinska Institutet ; Ersta Sköndal University College.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Carlander, Ida
    Ersta Sköndal University College ; Karolinska Institutet.
    Wengström, Yvonne
    Karolinska Institutet ; University of Örebro.
    Ohlen, Joakim
    Ersta Sköndal University College ; University of Gothenburg.
    Alvariza, Anette
    Karolinska Institutet ; Ersta Sköndal University College ; Dalen Hosp, Stockholm.
    Characteristics of the Family Caregivers Who Did Not Benefit From a Successful Psychoeducational Group Intervention During Palliative Cancer Care A Prospective Correlational Study2017In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 40, no 1, 76-83 p.Article in journal (Refereed)
    Abstract [en]

    Background: Although there has been a steady increase in intervention studies aimed toward supporting family caregivers in palliative cancer care, they often report modest effect sizes and there is a lack of knowledge about possible barriers to intervention effectiveness. Objective: The aim of this study is to explore the characteristics of family caregivers who did not benefit from a successful psychoeducational group intervention compared with the characteristics of those who did. Intervention/Methods: A psychoeducational intervention for family caregivers was delivered at 10 palliative settings in Sweden. Questionnaires were used to collect data at baseline and following the intervention. The Preparedness for Caregiving Scale was the main outcome for the study and was used to decide whether or not the family caregiver had benefited from the intervention (Preparedness for Caregiving Scale difference score <= 0 vs >= 1). Results: A total of 82 family caregivers completed the intervention and follow-up. Caregivers who did not benefit from the intervention had significantly higher ratings of their preparedness and competence for caregiving and their health at baseline compared with the group who benefited. They also experienced lower levels of environmental burden and a trend toward fewer symptoms of depression. Conclusions: Family caregivers who did not benefit from the intervention tended to be less vulnerable at baseline. Hence, the potential to improve their ratings was smaller than for the group who did benefit. Implications for Practice: Determining family caregivers in cancer and palliative care who are more likely to benefit from an intervention needs to be explored further in research.

  • 45. Israelsson, J.
    et al.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Is gender associated with survival after in-hospital cardiac arrest?2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, S14-S14 p.Article in journal (Other academic)
  • 46.
    Israelsson, Johan
    et al.
    Kalmar County Hospital.
    Bremer, Anders
    University of Borås.
    Axelsson, Åsa
    University of Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet.
    Herlitz, Johan
    University of Borås.
    Kristofferzon, Marja-Leena
    University of Gävle.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University.
    Sunnerhagen, Katarina S
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University.
    Åkerman, Eva
    Skane University Hospital.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Neurologic outcome, health-related quality of life, anxiety and symptoms of depression among in-hospital cardiac arrest survivors2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no S1, 101-101 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: Most cardiac arrest research has focused on survival in an out-of-hospital context. The knowledge of health and quality of life is sparse, especially regarding in-hospital cardiac arrest (IHCA) survivors. The aim of the current study was therefore to describe neurologic outcome, health-related quality of life (HRQoL), anxiety and symptoms of depression among IHCA survivors.

    Materials and methods: This study has a cross-sectional design. Data from the Swedish Register of Cardiopulmonary Resuscitation was used. In the register, data is collected 3–6 months after resuscitation by using a questionnaire including two questions about activities in daily life and mental/intellectual recovery, the EQ-5D-5L and the Hospital Anxiety and Depression Scale (HADS). In addition, Cerebral Performance Category (CPC)-scoring is performed.

    Results: Between the 11th of June 2013 and the 7th of May 2015, 488 IHCA survivors with a mean age of 69 ± 13 were included. A majority were men (62%), had a cerebral function of CPC 1 (87%) and no need of assistance from other people in daily life (71%). A large proportion had not made a complete mental/intellectual recovery (27%). Pain/discomfort was the dimension in EQ-5D-5L where most survivors reported problems (64%), while least problems were reported in the dimension self-care (24%). The individual variations of present health state (EQ-VAS) were substantial (range 0–100), with a mean value of 66 ± 22. Anxiety and symptoms of depression were reported by 16% and 15% respectively.

    Conclusions: Although the majority of the IHCA survivors reported good neurologic outcome, satisfactory HRQoL, no anxiety or symptoms of depression, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of structured post resuscitation care and follow-up, in order to identify and support those in need.

  • 47.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital ; Linköping University.
    Bremer, Anders
    University of Borås ; Kalmar County Hospital.
    Herlitz, Johan
    University of Borås.
    Axelsson, Åsa B.
    University of Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet ; Karolinska University Hospital.
    Kristofferzon, Marja-Leena
    University of Gävle ; Uppsala University.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University .
    Sunnerhagen, Katharina S.
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University ; County Council of Östergötland.
    Åkerman, Eva
    Skåne University Hospital ; Karolinska Institutet.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal University College ; Kalmar County Hospital.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, 27-33 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p&lt;0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p&lt;0.001) and symptoms of depression (p&lt;0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 48.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Bremer, Anders
    Högskolan i Borås.
    Herlitz, Johan
    Högskolan i Borås.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex2016In: Presented at EuroHeart, Dubrovnik, Croatia, June 14-15, 2015, 2016, Vol. 134Conference paper (Refereed)
    Abstract [en]

    Introduction: Previous studies have demonstrated differences in characteristics and outcome between men and women in cardiac arrest (CA) populations. However, most studies have focused only on survival outcome. Knowledge about patient reported health and psychological distress among CA survivors is sparse, in particular among those suffering in-hospital cardiac arrest (IHCA). The aim was to describe health status and psychological distress among IHCA survivors in relation to sex. Methods: This national register study presents follow-up data of IHCA survivors from 64% of the eligible hospitals in Sweden. A questionnaire was sent to the survivors, 3-6 months post CA, including measures of health status (EQ-5D) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included. Women reported more problems in all dimensions of EQ-5D, except for Self-care. They also had worse health status (EQ-index) (0.75 vs 0.79, p&lt;0.001). The median value for EQ-VAS was 70 (q1-q3=50-80), significantly lower for women compared to men (65 vs 75, p&lt;0.001). A majority reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (median 3 vs 2, p&lt;0.001) and symptoms of depression (median 3 vs 2, p&lt;0.001) compared to men. Being women was significantly associated with lower health status and more psychological distress in the regression models. No interaction effects for sex and age were found. Conclusions: Although the majority of the survivors reported acceptable health status and no psychological distress, a substantial group reported serious problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. All IHCA survivors should be screened for health problems during the post cardiac arrest follow-up, and offered support when needed.

  • 49.
    Israelsson, Johan
    et al.
    Kalmar County Hospital.
    Bremer, Anders
    University of Borås.
    Herlitz, Johan
    University of Borås.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health-related quality of life among in-hospital cardiacarrest survivors2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 1 suppl, 174Article in journal (Refereed)
    Abstract [en]

    Purpose: A cardiac arrest can cause brain injury with cognitive dysfunctions, emotional reactions and negative effects on activities in daily life. However, most research has focused on survival and the knowledge about health-related quality of life (HRQoL) among survivors is limited. In addition, almost all studies are performed in an out-of-hospital context. The aim of the current study was therefore to describe HRQoL among in-hospital cardiac arrest (IHCA) survivors.

    Methods: This study has a cross-sectional design. In collaboration with the Swedish national register for cardiopulmonary resuscitation, data was collected 3-6 months after resuscitation by using a questionnaire including EuroQol-5 dimension (EQ-5D), the Hospital Anxiety and Depression Scale (HADS) and single questions on activities in daily life and mental/intellectual recovery. In addition, the Cerebral Performance Category (CPC) was scored.

    Results: In total, 286 IHCA survivors with a mean age of 67±12 were included. A majority of the survivors were men (65%), had a cerebral function of CPC 1 (88%) and had no need of assistance from other people in daily life (70%). A large proportion of the survivors had not made a complete mental and/or intellectual recovery (34%), causing problems in daily life for 65% of them. Pain was the dimension in EQ-5D where most survivors reported problems of some degree (64%). Problems within the dimensions anxiety/depression and mobility were reported by more than half of the survivors (53% vs. 51%). In the dimensions personal care and activities in daily life problems were reported by less than half of the survivors (24% vs. 49%). The individual variations of present health measured by the EQ-VAS were substantial (range 0-100), with a mean value of 67±22. Symptoms of anxiety and depression (measured by HADS) were reported by 15% and 16% respectively.

    Conclusions: Although the majority of the IHCA survivors reported satisfactory HRQoL, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of assessing HRQoL among IHCA survivors and the need of follow-up and structured post cardiac arrest care.

  • 50.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital ; Linköping University.
    Lilja, Gisela
    Lund University ; Skåne University Hospital.
    Bremer, Anders
    University of Borås ; Kalmar County Hospital.
    Stevenson-Ågren, Jean
    Linnaeus University, Faculty of Arts and Humanities, Department of Languages. University of Sheffield.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Post cardiac arrest care and follow-up in Sweden: a national web-survey2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.

    Methods: An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.

    Results: Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.

    Conclusions: Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.

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