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  • 51.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, P. O.
    Borell, Lena
    Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience2014In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 26, no 7, p. 1171-1179Article in journal (Refereed)
    Abstract [en]

    Background: Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear -targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. Methods: The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). Results: The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. Conclusions: The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.

  • 52.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Sandman, P O
    Umeå University, Faculty of Medicine, Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Nursing.
    Caring or uncaring - meanings of being in an oncology environment.2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 55, no 2, p. 188-197Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. BACKGROUND: The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. METHODS: A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. FINDINGS: The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. CONCLUSION: To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

  • 53.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Australian Centre for Evidence-Based Aged Care, La Trobe University, Australia.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nay, Rhonda
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care2008In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 20, no 4, p. 764-776Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical experience suggests that the work characteristics of staff in residential care may influence the well-being of residents with dementia. However, few studies have explored those anecdotal experiences. The aim of this study was to investigate associations between work characteristics of nursing staff and prevalence of behavioral symptoms among people with dementia in residential care settings.

    METHODS: The self-report job strain assessment scale was used to measure staff perceptions of their working environment, and the Multi Dimensional Dementia Assessment Scale to measure the occurrence of behavioral symptoms among residents in 40 residential care units for people with dementia.

    RESULTS: The findings show that in settings where staff reported high job strain, the prevalence of behavioral symptoms was significantly higher compared to settings where staff reported low job strain. Furthermore, settings characterized by staff having a more positive caring climate had significantly less prevalence of escape, restless and wandering behaviors compared to settings having a less positive caring climate. There was no statistically significant association between staff members' self-reported knowledge in caring for people with dementia and prevalence of behavioral symptoms.

    CONCLUSIONS: This study provides evidence for the oft-cited clinical experience that the well-being of nursing staff is associated with the well-being of people with dementia in residential care settings.

  • 54.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nay, Rhonda
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Predictors of job strain in residential dementia care nursing staff2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    AIM: To identify predictors of job strain in residential nursing care staff working with people with dementia. BACKGROUND: It is well known that nursing staff experience high levels of stress, but less is known about how to predict job strain. METHODS: The job strain of nursing care staff (n = 344) within residential dementia care settings was assessed. Standard linear regression analysis was used to explore predictors of job strain. RESULT: Data from the study shows that nursing staff in residential dementia care have a demanding job and experience high levels of strain. The linear regression model with four predictor variables explained 19% of the variability in job strain scores. Perceived caring climate of the unit, staff education level, possibilities to have discussions of difficulties and ethics at work and staff age, had a statistically significant association with job strain. CONCLUSIONS: The caring climate, staff education, reflective practice and staff age can be used as screening variables when predicting job strain. IMPLICATIONS FOR NURSING MANAGEMENT: These predictors can assist managers and directors to identify targeted strategies for supervision and support of nursing staff to secure their well-being, and by that securing the quality of care provided to residents.

  • 55.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Construction and psychometric evaluation of the Swedish language person-centred climate questionnaire: staff version2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 7, p. 790-795Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to construct and evaluate psychometric properties of the Swedish language Person-centred Climate Questionnaire - staff version. BACKGROUND: Person-centred care is often quoted but ill defined, and the literature warrants the development of valid and reliable measurement tools. METHODS: During 2006, a questionnaire was constructed and distributed to a sample of Swedish hospital staff (n = 600). Questionnaire data was subjected to item analysis and reduction. Psychometrical properties of the questionnaire were evaluated. RESULTS: The 14-item Person-centred Climate Questionnaire showed satisfactory psychometric properties. Measures of validity were good, internal consistency was high, Cronbach's alpha was satisfactory for the total scale (0.88) and test-retest reliability was adequate. CONCLUSION: The results indicate that the staff Person-centred Climate Questionnaire is a valid and reliable tool for assessing staff perceptions of the person centredness of hospital environments. IMPLICATIONS FOR NURSING MANAGEMENT: This instrument makes it possible to study the degree of person-centredness in relation to different organizational systems, environments, staff groups and managerial styles. In addition, staff variables such as turnover rates, health outcomes and efficacy can be related to staff perceived person centredness of the organization.

  • 56.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Forecasting the ward climate: a study from a dementia care unit2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 7-8, p. 1136-1144Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. This article present findings from a study aiming to explore the psychosocial climate and its influence on the well-being of people with dementia in a psycho-geriatric hospital unit.

    Background. Environmental influence in dementia is well explored in relation to the physical environment; however, few studies have explored the psychosocial environment and its influence on well-being.

    Design. The study had a grounded theory design.

    Methods. Participant observations were conducted in a psycho-geriatric ward for assessment and treatment of people with dementia in Sweden (n = 36 hours). Data were collected and analysed in a dialectical fashion using the principles of grounded theory methodology.

    Results. The basic social process that best accounted for the variation in the psychosocial climate and well-being of patients at the unit was 'staff presence or absence', conceptualised as the core category. Three categories emerged in relation to the core category; 'sharing place and moment', 'sharing place but not moment' and 'sharing neither place nor moment'.

    Conclusions. Staff were catalysts for the psychosocial climate and when being present and engaged they could create a climate interpreted as at-homeness which supported patient well-being. When being absent, the climate quickly became anxious and this facilitated patient ill-being. To provide quality care for people with dementia staff need to be aware of their role in setting the emotional tone of the psychosocial climate and also that this emotional tone significantly influences patient well-being.

    Relevance to clinical practice. The findings are clinically relevant and can be operationalised and applied in clinical practice. Awareness of the intimate connection between staff presence and absence, the psychosocial climate and patient well-being highlights an ethical responsibility to question: routines that promote staff absence; a culture of merely 'doing for'; and nursing tasks which involve a minimum of staff-patient interaction. The findings have implications for managers as well as for clinical staff.

  • 57.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Australian Centre for Evidence-Based Aged Care (ACEBAC), La Trobe University, Bundoora, Victoria, Australia.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Swedish language Person-centred Climate Questionnaire - patient version: construction and psychometric evaluation2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 63, no 3, p. 302-309Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study to construct and evaluate psychometric properties of the Swedish language patient version Person-centred Climate Questionnaire.

    BACKGROUND: Person-centred care is widely described as a preferred model of care as it uses the individual person's perspective as point of departure. However, the concept is elusive and lacks definition and a means of measurement.

    METHOD: A preliminary item pool generated from qualitative studies was distributed to a sample of hospital patients (n = 544) and subjected to item analysis and reduction using exploratory and confirmatory factor analysis. The psychometrical properties of the final questionnaire were evaluated using statistical estimates of validity and reliability.

    RESULTS: The final 17-item questionnaire consists of three factors explaining 65.1% of the total variance in data, and shows satisfactory goodness-of-fit in confirmative factor analyses. The factors were labelled safety, everydayness and hospitality. Content and construct validity was estimated as satisfactory by Delphi assessment, factor and item analysis. Cronbach's alpha was satisfactory for the total scale (0.93), and also for the three subscales: safety 0.94, everydayness 0.82 and generosity 0.64.

    CONCLUSION: The Person-centred Climate Questionnaire is a valid and reliable contribution for assessing to what extent the climate of hospital environments is person-centred. The instrument enables descriptions and comparisons of environments, exploration of correlates between person-centredness and patient outcomes and/or measure results of various interventions.

  • 58.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Melbourne, Australia.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Taylor, Michael
    Melbourne, Australia.
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, P. O.
    Stockholm, Sweden.
    Person-centred climate questionnaire (PCQ-S): establishing reliability and cut-off scores in residential aged care2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 3, p. 315-323Article in journal (Refereed)
    Abstract [en]

    AimThis study aimed to establish reliability and cut-off scores for the person-centred climate questionnaire - staff version (PCQ-S) in residential aged care. BackgroundA number of tools have emerged recently to measure person-centredness, and these need psychometric evaluation and cut-off scores to enhance utilisation and interpretation. MethodA cross-sectional survey design was employed in a Swedish sample of residential aged care staff (n=1237). Psychometric evaluation using Cronbach's alpha and item-total correlation was used, together with establishing cut-off scores based on quartile scores. ResultThe PCQ-S had satisfactory psychometric properties and the following total scale cut-off scores for unit person-centredness were suggested: 49 (well below average'), 50-56 (below average'), 57-62 (above average') and 63 (well above average'). These cut-off scores were clinically meaningful as they separated the sample into four groups in which staff in more person-centred units reported significantly higher work satisfaction, social support and less stress of conscience. ConclusionThe PCQ-S has reliability in residential aged care samples, and cut-off scores are provided that provide important fundaments for comparative studies and aggregation of data to explore person-centredness care further. Implications for nursing managementThe study enables managers with ways to measure, interpret and compare levels of person-centredness between units and facilities for research, practice development and/or benchmarking purposes.

  • 59.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Level 4 Austin Tower, PO Box 5555, Heidelberg 3084, VIC, Australia..
    Sjögren, Karin
    College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Level 4 Austin Tower, PO Box 5555, Heidelberg 3084, VIC, Australia..
    Lood, Qarin
    College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Level 4 Austin Tower, PO Box 5555, Heidelberg 3084, VIC, Australia..
    Bergland, Adel
    Kirkevold, Marit
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Caring Sciences, Depart Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, University of Technology, Luleå, Sweden.
    A person-centred and thriving-promoting intervention in nursing homes - study protocol for the U-Age nursing home multi-centre, non-equivalent controlled group before-after trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 22Article in journal (Refereed)
    Abstract [en]

    Background: The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this.

    Methods: The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents’ thriving, relatives’ satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives’ experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention.

    Discussion: The study is expected to provide evidence that can inform further research, policy and practice development on if and how person-centred care may improve wellbeing, thriving and satisfaction for people who reside in, visit or work in nursing homes. The combination of quantitative and qualitative data will illuminate the operationalisation, effects and meaning of person-centred and thriving-promoting care.

  • 60.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Street, Annette
    Sense or no-sense: the nurse as embodied ethnographer2007In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 13, no 1, p. 24-32Article in journal (Refereed)
    Abstract [en]

    Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

  • 61.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Varrailhon, Pia
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Promoting Person-Centeredness in Long-Term Care An Exploratory Study2014In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 40, no 4, p. 46-53Article in journal (Refereed)
    Abstract [en]

    This study explored how nursing staff promote person-centeredness in long-term care settings. The study used an anthropological free-listing approach to data collection and qualitative content analysis to analyze written self-report descriptions from a convenience sample of Swedish long-term care staff (N = 436). The analyses resulted in four themes that illuminate how nursing staff promote person-centeredness: Promoting Decision Making, Promoting a Meaningful Living, Promoting a Pleasurable Living, and Promoting Personhood. The study contributes to the literature by providing concrete descriptions of how person-centeredness was facilitated by staff in their everyday practice and contributes to move person-centeredness from the philosophical, policy, and conceptual domains toward clinical implementation. The study also suggests that promoting pleasure for residents is a dimension central to person-centeredness and to health-promoting gerontological nursing, and that "small talk" is an emerging nursing phenomenon that deserves more research attention.

  • 62.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University/Austin Health Clinical School of Nursing, Melbourne, Victoria, Australia.
    Watt, Elizabeth
    Pearce, Frances
    Patient experiences of caring and person-centredness are associated with perceived nursing care quality2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 1, p. 217-227Article in journal (Refereed)
    Abstract [en]

    Aims: To explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Background: Self-reported patient experiences have had limited attention in conceptualizations of healthcare quality as described in policy and national standards, as well as in health and nursing care practice. The impact of central nursing concepts such as caring and person-centredness on patient ratings of nursing care quality is largely unknown. DesignA descriptive non-experimental correlational design was used to collect and analyse data from a sample of Australian acute hospital inpatients (n=210) in December 2012. Methods: The study collected self-report patient data through a study survey including demographic data and the Caring Behaviours Inventory, the Person-centred Climate Questionnaire, the SF-36 and the Distress thermometer. Descriptive statistics together with Pearson correlation and hierarchical linear regression were used. Findings: Perceived caring behaviours of staff and the person-centredness of wards were significantly associated with nursing care quality as evidenced by Pearson correlations being significant and exceeding the pre-set cut-off of r>05. Staff caring behaviours and ward person-centredness also accounted for more than half of the total variance in perceived nursing care quality as evidenced by the final regression model. Knowledgeable and communicable staff, timeliness of assistance and environmental support stood out as most significantly related to patient perceived nursing care quality. Conclusions: Patient experiences of caring and person-centredness seem to have an influential role in the extent to which patients experience the quality of nursing care. Knowledgeable and communicable staff, timeliness of assistance and environmental support stand out as most significantly related to patient-perceived nursing care quality.

  • 63.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wijk, Helle
    Omgivningens betydelse för hälsa och vård2009In: Omvårdnadens grunder: hälsa och ohälsa / [ed] Edberg Anna-Karin & Wijk Helle, Lund: Studentlitteratur , 2009Chapter in book (Other academic)
  • 64.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winblad, Bengt
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Good dementia care: goals, strategies and perspectives2011In: Versorgungsforschung für demenziell erkrankte Menschen: Health Services Research for People with Dementia / [ed] Olivia Dibelius & Wolfgang Maier, Stuttgart: W. Kohlhammer GmbH, 2011, p. 56-61Chapter in book (Other academic)
  • 65.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Australian Centre for Evidence-Based Aged Care (ACEBAC), La Trobe University, Australia.
    Winblad, Bengt
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Person-centred care of people with severe Alzheimer's disease: current status and ways forward2008In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 7, no 4, p. 362-367Article in journal (Refereed)
    Abstract [en]

    When caring for people with severe Alzheimer's disease (AD), the concept of the person being central is increasingly advocated in clinical practice and academia as an approach to deliver high-quality care. The aim of person-centred care, which emanates from phenomological perspectives on AD, is to acknowledge the personhood of people with AD in all aspects of their care. It generally includes the recognition that the personality of the person with AD is increasingly concealed rather than lost; personalisation of the person's care and their environment; offering shared decision-making; interpretation of behaviour from the viewpoint of the person; and prioritising the relationship as much as the care tasks. However, questions remain about how to provide, measure, and explore clinical outcomes of person-centred care. In this Review, we summarise the current knowledge about person-centred care for people with severe AD and highlight the areas in need of further research.

  • 66.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Raising issues about children's overweight: maternal and child health nurses' experiences2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 12, p. 2542-2551Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study carried out to describe maternal and child health nurses' experiences of communicating and raising issues with parents about children's overweight. BACKGROUND: Children's overweight and obesity are rapidly increasing in many countries around the world. Maternal and child health nurses are in a unique position to influence parents, but studies of their experiences in communicating with parents about overweight are lacking. METHOD: Ten maternal and child health nurses in culturally diverse rural and urban areas in Melbourne, Australia, were interviewed in 2007. Data were analysed using qualitative content analysis to identify key categories. FINDINGS: During the analysis, eight categories were identified. In summary, nurses described it as difficult to raise weight issues, especially if parents were overweight themselves. The growth chart was felt to be an essential tool in discussions about weight and nurses often described themselves as holding 'expert' roles in conversations. Denial, defensiveness and excuses about children being overweight were common reactions among parents and were described as difficult to deal with. However, a strong nurse-parent relationship was experienced as facilitating conversations about weight. CONCLUSION: Raising issues about weight can be difficult, especially if parents are overweight themselves. Further research in communications is needed to understand and approach parents better--especially overweight parents--about their children's weight. Interventions involving patient-centred approaches in this context have potential, but the area is still relatively unexplored. Maternal and child health centres could be important contributors in such future interventions.

  • 67. Feigin, Valery L.
    et al.
    Nichols, Emma
    Alam, Tahiya
    Bannick, Marlena S.
    Beghi, Ettore
    Blake, Natacha
    Culpepper, William J.
    Dorsey, E. Ray
    Elbaz, Alexis
    Ellenbogen, Richard G.
    Fisher, James L.
    Fitzmaurice, Christina
    Giussani, Giorgia
    Glennie, Linda
    James, Spencer L.
    Johnson, Catherine Owens
    Kassebaum, Nicholas J.
    Logroscino, Giancarlo
    Marin, Benoit
    Mountjoy-Venning, W. Cliff
    Nguyen, Minh
    Ofori-Asenso, Richard
    Patel, Anoop P.
    Piccininni, Marco
    Roth, Gregory A.
    Steiner, Timothy J.
    Stovner, Lars Jacob
    Szoeke, Cassandra E. I.
    Theadom, Alice
    Vollset, Stein Emil
    Wallin, Mitchell Taylor
    Wright, Claire
    Zunt, Joseph Raymond
    Abbasi, Nooshin
    Abd-Allah, Foad
    Abdelalim, Ahmed
    Abdollahpour, Ibrahim
    Aboyans, Victor
    Abraha, Haftom Niguse
    Acharya, Dilaram
    Adamu, Abdu A.
    Adebayo, Oladimeji M.
    Adeoye, Abiodun Moshood
    Adsuar, Jose C.
    Afarideh, Mohsen
    Agrawal, Sutapa
    Ahmadi, Alireza
    Ahmed, Muktar Beshir
    Aichour, Amani Nidhal
    Aichour, Ibtihel
    Aichour, Miloud Taki Eddine
    Akinyemi, Rufus Olusola
    Akseer, Nadia
    Al-Eyadhy, Ayman
    Salman, Rustam Al-Shahi
    Alahdab, Fares
    Alene, Kefyalew Addis
    Aljunid, Syed Mohamed
    Altirkawi, Khalid
    Alvis-Guzman, Nelson
    Anber, Nahla Hamed
    Antonio, Carl Abelardo T.
    Arabloo, Jalal
    Aremu, Olatunde
    Arnlov, Johan
    Asayesh, Hamid
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    Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 20162019In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 18, no 5, p. 459-480Article in journal (Refereed)
    Abstract [en]

    Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.

    Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.

    Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).

    Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.

    Funding: Bill & Melinda Gates Foundation.

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    Falavarjani, Khalil Ghasemi
    Ghasemi-Kasman, Maryam
    Gill, Paramjit Singh
    Giref, Ababi Zergaw
    Giroud, Maurice
    Gishu, Melkamu Dedefo
    Giussani, Giorgia
    Godwin, William W.
    Goli, Srinivas
    Gomez-Dantes, Hector
    Gona, Philimon N.
    Goodridge, Amador
    Gopalani, Sameer Vali
    Goryakin, Yevgeniy
    Goulart, Alessandra Carvalho
    Grada, Ayman
    Griswold, Max
    Grosso, Giuseppe
    Gugnani, Harish Chander
    Guo, Yuming
    Gupta, Rahul
    Gupta, Rajeev
    Gupta, Tanush
    Gupta, Tarun
    Gupta, Vipin
    Haagsma, Juanita A.
    Hachinski, Vladimir
    Hafezi-Nejad, Nima
    Hailu, Gessessew Bugssa
    Hamadeh, Randah Ribhi
    Hamidi, Samer
    Hankey, Graeme J.
    Harb, Hilda L.
    Harewood, Heather C.
    Harikrishnan, Sivadasanpillai
    Haro, Josep Maria
    Hassen, Hamid Yimam
    Havmoeller, Rasmus
    Hawley, Caitlin
    Hay, Simon I.
    He, Jiawei
    Hearps, Stephen J. C.
    Hegazy, Mohamed I.
    Heibati, Behzad
    Heidari, Mohsen
    Hendrie, Delia
    Henry, Nathaniel J.
    Herrera Ballesteros, Victor Hugo
    Herteliu, Claudiu
    Hibstu, Desalegn Tsegaw
    Hiluf, Molla Kahssay
    Hoek, Hans W.
    Rad, Enayatollah Homaie
    Horita, Nobuyuki
    Hosgood, H. Dean
    Hosseini, Mostafa
    Hosseini, Seyed Reza
    Hostiuc, Mihaela
    Hostiuc, Sorin
    Hoy, Damian G.
    Hsairi, Mohamed
    Htet, Aung Soe
    Hu, Guoqing
    Huang, John J.
    Iburg, Kim Moesgaard
    Idris, Fachmi
    Igumbor, Ehimario Uche
    Ikeda, Chad
    Ileanu, Bogdan Vasile
    Ilesanmi, Olayinka S.
    Innos, Kaire
    Irvani, Seyed Sina Naghibi
    Irvine, Caleb M. S.
    Islami, Farhad
    Jacobs, Troy A.
    Jacobsen, Kathryn H.
    Jahanmehr, Nader
    Jain, Rajesh
    Jain, Sudhir Kumar
    Jakovljevic, Mihajlo M.
    Jalu, Moti Tolera
    Jamal, Amr A.
    Javanbakht, Mehdi
    Jayatilleke, Achala Upendra
    Jeemon, Panniyammakal
    Jha, Ravi Prakash
    Jha, Vivekanand
    Jozwiak, Jacek
    John, Oommen
    Johnson, Sarah Charlotte
    Jonas, Jost B.
    Joshua, Vasna
    Juerisson, Mikk
    Kabir, Zubair
    Kadel, Rajendra
    Kahsay, Amaha
    Kalani, Rizwan
    Kar, Chittaranjan
    Karanikolos, Marina
    Karch, Andre
    Karema, Corine Kakizi
    Karimi, Seyed M.
    Kasaeian, Amir
    Kassa, Dessalegn Haile
    Kassa, Getachew Mullu
    Kassa, Tesfaye Dessale
    Kassebaum, Nicholas J.
    Katikireddi, Srinivasa Vittal
    Kaul, Anil
    Kawakami, Norito
    Kazanjan, Konstantin
    Kebede, Seifu
    Keiyoro, Peter Njenga
    Kemp, Grant Rodgers
    Kengne, Andre Pascal
    Kereselidze, Maia
    Ketema, Ezra Belay
    Khader, Yousef Saleh
    Khafaie, Morteza Abdullatif
    Khajavi, Alireza
    Khalil, Ibrahim A.
    Khan, Ejaz Ahmad
    Khan, Gulfaraz
    Khan, Md Nuruzzaman
    Khan, Muhammad Ali
    Khanal, Mukti Nath
    Khang, Young-Ho
    Khater, Mona M.
    Khoja, Abdullah Tawfih Abdullah
    Khosravi, Ardeshir
    Khubchandani, Jagdish
    Kibret, Getiye Dejenu
    Kiirithio, Daniel Ngari
    Kim, Daniel
    Kim, Yun Jin
    Kimokoti, Ruth W.
    Kinfu, Yohannes
    Kinra, Sanjay
    Kisa, Adnan
    Kissoon, Niranjan
    Kochhar, Sonali
    Kokubo, Yoshihiro
    Kopec, Jacek A.
    Kosen, Soewarta
    Koul, Parvaiz A.
    Koyanagi, Ai
    Kravchenko, Michael
    Krishan, Kewal
    Krohn, Kristopher J.
    Defo, Barthelemy Kuate
    Kumar, G. Anil
    Kumar, Pushpendra
    Kutz, Michael
    Kuzin, Igor
    Kyu, Hmwe H.
    Lad, Deepesh Pravinkumar
    Lafranconi, Alessandra
    Lal, Dharmesh Kumar
    Lalloo, Ratilal
    Lam, Hilton
    Lan, Qing
    Lang, Justin J.
    Lansingh, Van C.
    Lansky, Sonia
    Larsson, Anders
    Latifi, Arman
    Lazarus, Jeffrey Victor
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    Leigh, James
    Leshargie, Cheru Tesema
    Leta, Samson
    Leung, Janni
    Leung, Ricky
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    Li, Yongmei
    Liang, Juan
    Liben, Misgan Legesse
    Lim, Lee-Ling
    Lim, Stephen S.
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    Linn, Shai
    Listl, Stefan
    Liu, Patrick Y.
    Liu, Shiwei
    Lodha, Rakesh
    Lopez, Alan D.
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    Lorkowski, Stefan
    Lotufo, Paulo A.
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    Lurton, Gregoire
    Lyons, Ronan A.
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    Macarayan, Erlyn Rachelle King
    Mackay, Mark T.
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    Madotto, Fabiana
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    Abd El Razek, Mohammed Magdy
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    Majeed, Azeem
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    Mansournia, Mohammad Ali
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    Martopullo, Ira
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    Massenburg, Benjamin Ballard
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    Melku, Mulugeta
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    Moazen, Babak
    Mohammad, Karzan Abdulmuhsin
    Mohammadibakhsh, Roghayeh
    Mohammed, Ebrahim
    Mohammed, Mohammed A.
    Mohammed, Shafiu
    Mokdad, Ali H.
    Mola, Glen Liddell D.
    Molokhia, Mariam
    Momeniha, Fatemeh
    Monasta, Lorenzo
    Montanez Hernandez, Julio Cesar
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    Moradi-Lakeh, Maziar
    Moraga, Paula
    Morawska, Lidia
    Velasquez, Ilais Moreno
    Mori, Rintaro
    Morrison, Shane D.
    Moses, Mark
    Mousavi, Seyyed Meysam
    Mueller, Ulrich O.
    Murhekar, Manoj
    Murthy, Gudlavalleti Venkata Satyanarayana
    Murthy, Srinivas
    Musa, Jonah
    Musa, Kamarul Imran
    Mustafa, Ghulam
    Muthupandian, Saravanan
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    Nagel, Gabriele
    Naghavi, Mohsen
    Naheed, Aliya
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    Naik, Nitish
    Najafi, Farid
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    Nangia, Vinay
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    Narayan, K. M. Venkat
    Nascimento, Bruno Ramos
    Negoi, Ionut
    Negoi, Ruxandra Irina
    Newton, Charles R.
    Ngunjiri, Josephine Wanjiku
    Nguyen, Grant
    Nguyen, Long
    Nguyen, Trang Huyen
    Nichols, Emma
    Ningrum, Dina Nur Anggraini
    Nolte, Ellen
    Nong, Vuong Minh
    Norheim, Ole F.
    Norrving, Bo
    Noubiap, Jean Jacques N.
    Nyandwi, Alypio
    Obermeyer, Carla Makhlouf
    Ofori-Asenso, Richard
    Ogbo, Felix Akpojene
    Oh, In-Hwan
    Oladimeji, Olanrewaju
    Olagunju, Andrew Toyin
    Olagunju, Tinuke Oluwasefunmi
    Olivares, Pedro R.
    Vasconcelos de Oliveira, Patricia Pereira
    Olsen, Helen E.
    Olusanya, Bolajoko Olubukunola
    Olusanya, Jacob Olusegun
    Ong, Kanyin
    Opio, John Nelson
    Oren, Eyal
    Ortega-Altamirano, Doris V.
    Ortiz, Alberto
    Ozdemir, Raziye
    Mahesh, P. A.
    Pain, Amanda W.
    Palone, Marcos Roberto Tovani
    Pana, Adrian
    Panda-Jonas, Songhomitra
    Pandian, Jeyaraj D.
    Park, Eun-Kee
    Parsian, Hadi
    Patel, Tejas
    Pati, Sanghamitra
    Patil, Snehal T.
    Patle, Ajay
    Patton, George C.
    Paturi, Vishnupriya Rao
    Paudel, Deepak
    Pedroso, Marcel de Moares
    Pedroza, Sandra P.
    Pereira, David M.
    Perico, Norberto
    Peterson, Hannah
    Petzold, Max
    Peykari, Niloofar
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    Piel, Frederic B.
    Pigott, David M.
    Pillay, Julian David
    Piradov, Michael A.
    Polinder, Suzanne
    Pond, Constance D.
    Postma, Maarten J.
    Pourmalek, Farshad
    Prakash, Swayam
    Prakash, V.
    Prasad, Narayan
    Prasad, Noela Marie
    Purcell, Caroline
    Qorbani, Mostafa
    Quintana, Hedley Knewjen
    Radfar, Amir
    Rafay, Anwar
    Rafiei, Alireza
    Rahimi, Kazem
    Rahimi-Movaghar, Afarin
    Rahimi-Movaghar, Vafa
    Rahman, Mahfuzar
    Rahman, Muhammad Aziz
    Rahman, Sajjad Ur
    Rai, Rajesh Kumar
    Raju, Bhushan
    Ram, Usha
    Rana, Saleem M.
    Rankin, Zane
    Rasella, Davide
    Rawaf, David Laith
    Rawaf, Salman
    Ray, Sarah E.
    Aspacia Razo-Garcia, Christian
    Reddy, Priscilla
    Reiner, Robert C.
    Reis, Cesar
    Reitsma, Marissa B.
    Remuzzi, Giuseppe
    Renzaho, Andre M. N.
    Resnikoff, Serge
    Rezaei, Satar
    Rezai, Mohammad Sadegh
    Ribeiro, Antonio L.
    Rios Blancas, Maria Jesus
    Rivera, Juan A.
    Roever, Leonardo
    Ronfani, Luca
    Roshandel, Gholamreza
    Rostami, Ali
    Roth, Gregory A.
    Rothenbacher, Dietrich
    Roy, Ambuj
    Roy, Nobhojit
    Ruhago, George Mugambage
    Sabde, Yogesh Damodar
    Sachdev, Perminder S.
    Sadat, Nafis
    Safdarian, Mahdi
    Safiri, Saeid
    Sagar, Rajesh
    Sahebkar, Amirhossein
    Sahraian, Mohammad Ali
    Sajadi, Haniye Sadat
    Salama, Joseph
    Salamati, Payman
    Saldanha, Raphael de Freitas
    Salimzadeh, Hamideh
    Salomon, Joshua A.
    Samy, Abdallah M.
    Sanabria, Juan Ramon
    Sancheti, Parag K.
    Sanchez-Nino, Maria Dolores
    Santomauro, Damian
    Santos, Itamar S.
    Milicevic, Milena M. Santric
    Sarker, Abdur Razzaque
    Sarrafzadegan, Nizal
    Sartorius, Benn
    Satpathy, Maheswar
    Savic, Miloje
    Sawhney, Monika
    Saxena, Sonia
    Saylan, Mete I.
    Schaeffner, Elke
    Schmidhuber, Josef
    Schmidt, Maria Ines
    Schneider, Ione J. C.
    Schumacher, Austin E.
    Schutte, Aletta E.
    Schwebel, David C.
    Schwendicke, Falk
    Sekerija, Mario
    Sepanlou, Sadaf G.
    Servan-Mori, Edson E.
    Shafieesabet, Azadeh
    Shaikh, Masood Ali
    Shakh-Nazarova, Marina
    Shams-Beyranvand, Mehran
    Sharafi, Heidar
    Sharif-Alhoseini, Mahdi
    Islam, Sheikh Mohammed Shariful
    Sharma, Meenakshi
    Sharma, Rajesh
    She, Jun
    Sheikh, Aziz
    Shfare, Mebrahtu Teweldemedhin
    Shi, Peilin
    Shields, Chloe
    Shigematsu, Mika
    Shinohara, Yukito
    Shiri, Rahman
    Shirkoohi, Reza
    Shiue, Ivy
    Shrime, Mark G.
    Shukla, Sharvari Rahul
    Siabani, Soraya
    Sigfusdottir, Inga Dora
    Silberberg, Donald H.
    Santos Silva, Diego Augusto
    Silva, Joao Pedro
    Alves Silveira, Dayane Gabriele
    Singh, Jasvinder A.
    Singh, Lavanya
    Singh, Narinder Pal
    Singh, Virendra
    Sinha, Dhirendra Narain
    Sinke, Abiy Hiruye
    Sisay, Mekonnen
    Skirbekk, Vegard
    Sliwa, Karen
    Smith, Alison
    Soares Filho, Adauto Martins
    Sobaih, Badr H. A.
    Somai, Melek
    Soneji, Samir
    Soofi, Moslem
    Sorensen, Reed J. D.
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    Soyiri, Ireneous N.
    Sposato, Luciano A.
    Sreeramareddy, Chandrashekhar T.
    Srinivasan, Vinay
    Stanaway, Jeffrey D.
    Stathopoulou, Vasiliki
    Steel, Nicholas
    Stein, Dan J.
    Stokes, Mark Andrew
    Sturua, Lela
    Sufiyan, Muawiyyah Babale
    Suliankatchi, Rizwan Abdulkader
    Sunguya, Bruno F.
    Sur, Patrick J.
    Sykes, Bryan L.
    Sylaja, P. N.
    Szoeke, Cassandra E. I.
    Tabares-Seisdedos, Rafael
    Tadakamadla, Santosh Kumar
    Tadesse, Andualem Henok
    Taffere, Getachew Redae
    Tandon, Nikhil
    Tariku, Amare Tariku
    Taveira, Nuno
    Tehrani-Banihashemi, Arash
    Shifa, Girma Temam
    Temsah, Mohamad-Hani
    Terkawi, Abdullah Sulieman
    Tesema, Azeb Gebresilassie
    Tesfaye, Dawit Jember
    Tessema, Belay
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    Thompson, Matthew J.
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    Tobe-Gai, Ruoyan
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    Topouzis, Fotis
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    Tran, Khanh Bao
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    Tripathy, Srikanth Prasad
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    Venketasubramanian, Narayanaswamy
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    Vlassov, Vasiliy Victorovich
    Vollset, Stein Emil
    Vos, Theo
    Wagnew, Fasil
    Waheed, Yasir
    Wallin, Mitchell T.
    Walson, Judd L.
    Wang, Yafeng
    Wang, Yuan-Pang
    Wassie, Molla Mesele
    Weaver, Marcia R.
    Weiderpass, Elisabete
    Weintraub, Robert G.
    Weiss, Jordan
    Weldegwergs, Kidu Gidey
    Werdecker, Andrea
    West, T. Eoin
    Westerman, Ronny
    White, Richard G.
    Whiteford, Harvey A.
    Widecka, Justyna
    Winkler, Andrea Sylvia
    Wiysonge, Charles Shey
    Wolfe, Charles D. A.
    Wondimkun, Yohanes Ayele
    Workicho, Abdulhalik
    Wyper, Grant M. A.
    Xavier, Denis
    Xu, Gelin
    Yan, Lijing L.
    Yano, Yuichiro
    Yaseri, Mehdi
    Yimer, Nigus Bililign
    Yin, Peng
    Yip, Paul
    Yirsaw, Biruck Desalegn
    Yonemoto, Naohiro
    Yonga, Gerald
    Yoon, Seok-Jun
    Yotebieng, Marcel
    Younis, Mustafa Z.
    Yu, Chuanhua
    Zadnik, Vesna
    Zaidi, Zoubida
    Zaki, Maysaa El Sayed
    Bin Zaman, Sojib
    Zamani, Mohammad
    Zenebe, Zerihun Menlkalew
    Zhou, Maigeng
    Zhu, Jun
    Zimsen, Stephanie R. M.
    Zipkin, Ben
    Zodpey, Sanjay
    Zuhlke, Liesl Joanna
    Murray, Christopher J. L.
    Lozano, Rafael
    Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 20162018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10136, p. 2236-2271Article in journal (Refereed)
    Abstract [en]

    Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.

    Methods: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.

    Findings: In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

    Interpretation: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

  • 69. Greaish, Laurie
    et al.
    Chaboyer, Wendy
    Harbeck, Emma
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University/Austin Health/Northern Health Clinical Schools of Nursing, Melbourne, Victoria, Australia.
    The person-centred care of older people with cognitive impairment in acute care (POPAC) scale: psychometric evaluation2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 2, p. 139-147Article in journal (Refereed)
    Abstract [en]

    Aim: To test the reliability and validity of the Person-centred care of Older People with cognitive impairment in Acute Care scale to determine nurses’ perceptions of person-centred care.

    Background: One-third of older adults admitted to hospital are at risk of serious hospital-acquired complications such as falls, infections and pressure injuries because of cognitive impairment. These risks can be reduced through person-centred practices. The Person-centred care of Older People with cognitiveimpairment in Acute Care scale is a self-report staff instrument to explore the extent to which person-centred practices are undertaken; however psychometric testing is limited.

    Methods: A cross-sectional sample of acute care nurses (n = 240) in Queensland, Australia completing self-report questionnaires. Psychometric analyses of item performance, reliability and validity were conducted.

    Results: Item analysis revealed independent items. One item was removed due to negatively associating with the scale, improving total Cronbach’s alpha from 0.76to 0.84. The three original factors were maintained with regrouping of items. Confirmatory factor analysis confirmed the revised model.

    Conclusions: The revised Person-centred care of Older People with cognitive impairment in Acute Care scale had satisfactory psychometric properties when used as a total scale.

    Implications for nursing management Scale brevity and simplicity together with rigorous development and testing indicates that the revised Person-centred care of Older People with cognitive impairment in Acute Care may be useful for quality improvement programmes into the care of older people in hospitals.

  • 70. Grealish, Laurie
    et al.
    Simpson, Toni
    Soltau, Dawn
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Assessing and providing person-centred care of older people with cognitive impairment in acute settings: threats, variability, and challenges2019In: Collegian, ISSN 1322-7696, E-ISSN 1876-7575, Vol. 26, no 1, p. 75-79Article in journal (Refereed)
    Abstract [en]

    Background: Person-centred care is widely accepted in health policy as a central focus for health services. However, research studies indicate that, for nurses, the person-centred care of older people with cognitive impairment is challenging. Aim: This study aimed to compare levels of person-centred care between wards and professional groups (ENs and RNs) providing tertiary hospital care of older people with cognitive impairment. Methods: A descriptive cross-sectional survey design, using the 15-item Person-centredness of Older People with cognitive impairment in Acute Care (POPAC) survey instrument, was undertaken. Results: Nurses working in hospital wards of a tertiary-level health service (n = 240; RR = 54.3%) responded. Person-centred care was rated lower in wards with higher patient turnover compared to wards with lower patient turnover. Person-centred care was rated higher by enrolled nurses compared to registered nurses. Discussion: Hospital context, specifically high turnover wards, present a threat to person-centred care, possibly related to the limited time available to undertake the personal care and associated conversations that can enhance nurses' knowledge of the person. ENs carry more responsibility for these tasks, possibly explaining the variability in person-centred scores between RNs and ENs. In comparison to other studies, nurses in this study had higher average scores for person-centred care, raising measurement as an important challenge in monitoring the implementation of person-centred care policy. Conclusion: The focus on health service efficiency appears to pose a threat to nurses' delivery of person-centred care. Further research into the variability between person-centred care of RNs and ENs, and investigation into the practices of other health disciplines would be valuable. Given the importance of person-centred care to the safety and quality of health services, the POPAC addresses the challenge of monitoring person-centred policy initiatives. However, self-report instruments should be balanced with other sources of information about practice. (C) 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.

  • 71.
    Lehuluante, Abraraw
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Anita
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    The influence of a person-centred psychosocial unit climate on satisfaction with care and work2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 3, p. 319-325Article in journal (Refereed)
    Abstract [en]

    The influence of a person-centred psychosocial unit climate on satisfaction with care and work Aim To describe nurses satisfaction with care and work and to explore the extent to which a person-centred unit climate influenced this satisfaction. Background Although the concept of person-centred care is used to describe high-quality care, there is a shortage of studies exploring the relationship between person-centredness and nurses satisfaction with care and work in acute care settings. Methods Registered nurses within a university hospital in Sweden (n = 206) completed the Satisfaction with Nursing Care and Work Assessment Scale and the Person-centred Climate Questionnaire. The data collected was analysed using descriptive and analytical statistics. Design Cross-sectional explorative study. Results The majority of respondents were satisfied with the care and work situation. Nurses with more than 9 years of work experience were more satisfied with care and work, and there were a significant association between a person-centred psychosocial climate of units and nurses satisfaction with care and work. Conclusions This study provided evidence for a significant association between person-centredness and the satisfaction with care and work of nurses in acute care environments. Implications for nursing management Promoting and implementing a person-centred philosophy of care can be one way to improve nurses satisfaction with care and work.

  • 72. Lindahl, Jeanette
    et al.
    Elmqvist, Carina
    Thulesius, Hans
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia .
    Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire - family version2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 859-864Article in journal (Refereed)
    Abstract [en]

    Background: In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

    Setting: Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

    Method: The Person-centred Climate Questionnaire – Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality – three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

    Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

    Results: The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item–total correlations were >0.3 and <0.7.

    Conclusion: In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

  • 73.
    Lood, Qarin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Backman, Annica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    The relative impact of symptoms, resident characteristics and features of nursing homes on residents’ participation in social occupations: cross-sectional findings from U-Age Swenis2017In: Journal of Occupational Science, ISSN 1442-7591, E-ISSN 2158-1576, Vol. 24, no 3, p. 327-337Article in journal (Refereed)
    Abstract [en]

    Social occupations have been described as meaningful occupations, and a determinant of health in old age. With ageing populations, and increased need for nursing home care, it is therefore important to support participation in social occupations in nursing homes. However, the limited evidence on factors that may have an impact on nursing home residents’ participation in social occupations makes it difficult to know how and when to support their participation and who to target. Therefore, the aim of this study was to explore the impact of symptoms, resident characteristics and features of nursing homes on residents’ participation in social occupations. In a sample of 4,451 nursing home residents, the average number of social occupations participated in during the week preceding data collection was 5.8. Additionally, participation in social occupations was positively influenced by fewer symptoms of cognitive impairment, female sex, shorter length of stay, and living in a dementia specific care unit. The study thereby contributes with knowledge on populations at risk for occupational deprivation, and implications for understanding who to target with interventions to promote social occupations and when. However, very little is known about how to design interventions to support nursing home residents’ occupational opportunities, and what occupations they desire and need. Further research is therefore needed to identify nursing home residents’ occupational opportunities, wishes and needs in relation to environmental barriers, individual characteristics, and individual choice.

  • 74.
    Lood, Qarin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health – AgeCap, University of Gothenburg, Gothenburg, Sweden; College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Heidelberg, Vic., Australia.
    Kirkevold, Marit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bergland, Ådel
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Heidelberg, Vic., Australia.
    Associations between person-centred climate and perceived quality of care in nursing homes: a cross-sectional study of relatives' experiences2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 11, p. 2526-2534Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore the extent to which a more person-centred climate could explain the variation in quality of care, as rated by relatives to nursing home residents in three countries.

    DESIGN: A cross-sectional, correlational, anonymous questionnaire study.

    METHODS: Questionnaires were administered to 346 relatives to residents in six nursing homes in Australia, Norway and Sweden between April-June 2016. Relatives (N = 178) agreed to participate. Data were analysed using descriptive statistics and hierarchical multiple regression.

    RESULTS: The results showed that the relatives' experiences of a more person-centred climate were associated with higher ratings of the quality of care. A person-centred climate of safety had the strongest unique association with the quality of care, explaining 14% of the variance in quality of care. In addition, the results indicated that the relatives in general were satisfied with the quality of care and that children to the residents rated the quality of care higher than partners or other relatives.

    CONCLUSION: This study advances the understanding of the relationship between person-centredness in nursing homes and quality of care, showing that person-centred climate aspects of safety and hospitality have a significant role in the quality of care as perceived by relatives.

    IMPACT: Person-centredness in nursing homes is often mentioned as a quality of care indicator, but the empirical evidence for this suggestion is limited. This study expanded the evidence-base for person-centredness as a significant aspect of relatives' experiences of the quality of care in nursing homes.

  • 75. Lozano, Rafael
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Murray, Christopher J. L.
    Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 20172018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10159, p. 2091-2138Article in journal (Refereed)
    Abstract [en]

    Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.

    Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.

    Findings The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

    Interpretation The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.

  • 76.
    Lämås, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Bergland, Ådel
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
    Thriving among older people living at home with home care services-A cross-sectional study2020In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, no 4, p. 999-1008Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the level of thriving and associated factors among older adults living at home with support from home care services.

    DESIGN: An exploratory, cross-sectional survey design.

    METHOD: A sample of 136 participants (mean 82 years) responded to a survey about thriving, health, psychosocial and care-related factors in 2016. Descriptive analysis and multiple logistic regression analysis with a stepwise backwards elimination procedure were performed.

    RESULT: The results showed that the level of thriving was relatively high among adults living at home with support from home care services, with dimensions concerning engaging in activities and peer relations and keeping in touch with people and places being rated the lowest. Regression analysis showed that participating in social relations and experiencing self-determination in activities in and around the house were associated with thriving.

    CONCLUSION: Facilitating social relations and creating opportunities for self-determination seem necessary to support thriving among older adults living at home with support from home care services.

    IMPACT: The findings in this study add important knowledge about place-related well-being when living at home with home care services.

  • 77.
    Mullaney, Tara
    et al.
    Umeå University, Faculty of Science and Technology, Umeå Institute of Design.
    Nyholm, Tufve
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wellbeing in healthcare environments: a human-centered design research approach to improving the cancer patient experience during radiation therapy2011In: Proceedings of the 1st European Conference on Design 4 Health 2011 / [ed] Dr Alaster Yoxall, Sheffield Hallam University, Art & Design Research Centre, 2011, p. 255-265Conference paper (Refereed)
    Abstract [en]

    Healthcare and medical products are often designed with the singular focus of providing the best treatment available to patients. However, research has shown that this treatment-based approach does not result in quality care. There are many factors that play into making a healthcare experience patient-centered, and this paper explores the use of human-centered design research to understand this experience. This paper presents a case-study of a Radiotherapy Department at a University Hospital, where we used patient survey, observational, and narrative data to gain awareness into the patient experience during radiation therapy. Our research shows how the current radiotherapy environment is anxiety provoking to the patient, and how insights gained from the written and visual stories of the patients’ experiences were used to develop a design solution that improves the patient view in the treatment room with the intent to make this space more patient-centered and inviting. In conclusion, this paper argues that designing for the patient experience and their emotional wellbeing is a crucial aspect of any healthcare service.

  • 78.
    Mullaney, Tara
    et al.
    Umeå University, Faculty of Science and Technology, Umeå Institute of Design.
    Olausson, Kristina
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Sharp, Lena
    Karolinska Institute, Department of Learning, Informatics, Management and Ethics.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyholm, Tufve
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    The influence of a department's psychosocial climate and treatment environment on cancer patients' anxiety during radiotherapy2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 20, p. 113-118Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The objective of this study is to determine whether there is a relationship between cancer patients' perceptions of the person-centeredness of their treatment experience and their anxiety levels during treatment.

    METHOD: A questionnaire was distributed to adult cancer patients going through external beam radiotherapy (RT) with curative intent at a university hospital in Sweden (n = 892), which included two surveys, the State Trait Anxiety Inventory-state specific questions (STAI-S), and the Patient-centered Climate Questionnaire (PCQ) and additional treatment-specific questions. Eligible patients were provided with the questionnaire on their seventh day of RT by an RT-nurse.

    RESULTS: Statistical analysis showed a significant negative relationship between STAI-S scores and PCQ scores, and a significant positive relationship between the Treatment Environment questions and the STAI-S scores. Multivariate regression modeling found the PCQ subscale of safety to have the strongest negative association with STAI-S scores, showing that a climate of safety can significantly decrease patient situational anxiety levels. On the other hand, difficulty tolerating the overall treatment experience, worry about the treatment equipment, or feelings of isolation or claustrophobia within the treatment room all significantly factor into increases in patient-reported situational anxiety levels.

    CONCLUSION: Both the treatment environment and the psychosocial climate of the RT clinic significantly impact cancer patient state anxiety levels. These findings suggest that actively employing a person-centered approach during RT, and designing the treatment environment to be more attentive to the patient experience can both play a significant role in decreasing patient situational anxiety during treatment.

  • 79. Murray, Christopher J. L.
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lim, Stephen S.
    Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 20172018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10159, p. 1995-2051Article in journal (Refereed)
    Abstract [en]

    Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.

    Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories.

    Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger.

    Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress.

  • 80. Nay, Rhonda
    et al.
    Bird, M
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Flemming, Richard
    Hill, K
    Person-centred care2009In: Older people: issues and innovations in care / [ed] Rhonda Nay, Sally Garratt, Elsevier, 2009, 3, p. 169-Chapter in book (Other (popular science, discussion, etc.))
  • 81. Nichols, Emma
    et al.
    Szoeke, Cassandra E. I.
    Vollset, Stein Emil
    Abbasi, Nooshin
    Abd-Allah, Foad
    Abdela, Jemal
    Aichour, Miloud Taki Eddine
    Akinyemi, Rufus O.
    Alahdab, Fares
    Asgedom, Solomon W.
    Awasthi, Ashish
    Barker-Collo, Suzanne L.
    Baune, Bernhard T.
    Bejot, Yannick
    Belachew, Abate B.
    Bennett, Derrick A.
    Bijani, Belete Biadgo Ali
    Bin Sayeed, Muhammad Shahdaat
    Brayne, Carol
    Carpenter, David O.
    Carvalho, Felix
    Catala-Lopez, Ferran
    Cerin, Ester
    Choi, Jee-Young J.
    Dang, Ahn K.
    Degefa, Meaza G.
    Djalalinia, Shirin
    Dubey, Manisha
    Duken, Eyasu Ejeta
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
    Endres, Matthias
    Eskandarieh, Sharareh
    Faro, Andre
    Farzadfar, Farshad
    Fereshtehnejad, Seyed-Mohammad
    Fernandes, Eduarda
    Filip, Irina
    Fischer, Florian
    Gebre, Abadi K.
    Geremew, Demeke
    Ghasemi-Kasman, Maryam
    Gnedovskaya, Elena V.
    Gupta, Rajeev
    Hachinski, Vladimir
    Hagos, Tekleberhan B.
    Hamidi, Samer
    Hankey, Graeme J.
    Haro, Josep M.
    Hay, Simon I.
    Irvani, Seyed Sina N.
    Jha, Ravi P.
    Jonas, Jost B.
    Kalani, Rizwan
    Karch, Andre
    Kasaeian, Amir
    Khader, Yousef Saleh
    Khalil, Ibrahim A.
    Khan, Ejaz Ahmad
    Khanna, Tripti
    Khoja, Tawfik A. M.
    Khubchandani, Jagdish
    Kisa, Adnan
    Kissimova-Skarbek, Katarzyna
    Kivimaki, Mika
    Koyanagi, Ai
    Krohn, Kristopher J.
    Logroscino, Giancarlo
    Lorkowski, Stefan
    Majdan, Marek
    Malekzadeh, Reza
    Marz, Winfried
    Massano, Joao
    Mengistu, Getnet
    Meretoja, Atte
    Mohammadi, Moslem
    Mohammadi-Khanaposhtani, Maryam
    Mokdad, Ali H.
    Mondello, Stefania
    Moradi, Ghobad
    Nagel, Gabriele
    Naghavi, Mohsen
    Naik, Gurudatta
    Nguyen, Long H.
    Nguyen, Trang H.
    Nirayo, Yirga L.
    Nixon, Molly R.
    Ofori-Asenso, Richard
    Ogbo, Felix A.
    Olagunju, Andrew T.
    Owolabi, Mayowa O.
    Panda-Jonas, Songhomitra
    Passos, Valeria M. de Azeredo
    Pereira, David M.
    Pinilla-Monsalve, Gabriel D.
    Piradov, Michael A.
    Pond, Constance D.
    Poustchi, Hossein
    Qorbani, Mostafa
    Radfar, Amir
    Reiner, Robert C.
    Robinson, Stephen R.
    Roshandel, Gholamreza
    Rostami, Ali
    Russ, Tom C.
    Sachdev, Perminder S.
    Safari, Hosein
    Safiri, Saeid
    Sahathevan, Ramesh
    Salimi, Yahya
    Satpathy, Maheswar
    Sawhney, Monika
    Saylan, Mete
    Sepanlou, Sadaf G.
    Shafieesabet, Azadeh
    Shaikh, Masood A.
    Sahraian, Mohammad A.
    Shigematsu, Mika
    Shiri, Rahman
    Shiue, Ivy
    Silva, Joao P.
    Smith, Mari
    Sobhani, Soheila
    Stein, Dan J.
    Tabares-Seisdedos, Rafael
    Tovani-Palone, Marcos R.
    Tran, Bach X.
    Tran, Tung T.
    Tsegay, Amanuel T.
    Ullah, Irfan
    Venketasubramanian, Narayanaswamy
    Vlassov, Vasily
    Wang, Yuan-Pang
    Weiss, Jordan
    Westerman, Ronny
    Wijeratne, Tissa
    Wyper, Grant M. A.
    Yano, Yuichiro
    Yimer, Ebrahim M.
    Yonemoto, Naohiro
    Yousefifard, Mahmoud
    Zaidi, Zoubida
    Zare, Zohreh
    Feigin, Valery L.
    Vos, Theo
    Murray, Christopher J. L.
    Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 20162019In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 18, no 1, p. 88-106Article in journal (Refereed)
    Abstract [en]

    Background: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists.

    Methods: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugarsweetened beverages).

    Findings: In 2016, the global number of individuals who lived with dementia was 43.8 million (95% uncertainty interval [UI] 3 7. 8-51.0), increased from 20.2 million (17. 4-23 5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1.7% (1.0-2.4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27.0 million, 95% UI 23 .3-31. 4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2.4 million (95% UI 2.1-2.8) deaths. Overall, 28.8 million (95% UI 24. 5-34. 0) DALYs were attributed to dementia; 6.4 million (95% UI 3 .4-10. 5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages.

    Interpretation: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide.

  • 82.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
    Rushton, Carole
    Nurses’ descriptions of person‐centred care for older people in an acute medical ward—On the individual, team and organisational levels’2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1251-1259Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: To describe nurses' experiences of providing person-centred care for older people on an acute medical ward.

    BACKGROUND: There is evidence that person-centred care for older people contributes to a higher quality care and increased satisfaction with care. However, there is a shortness of studies providing concrete examples of what facilitates nurses providing person-centred care for older people in acute care.

    DESIGN: An interview study with qualitative content analysis. COREQ guidelines have been applied.

    METHOD: Fourteen registered nurses and enrolled nurses from an acute care ward participated in semi structured research interviews. The interviews were conducted during 2016 and interpreted using qualitative content analyses.

    RESULTS: Person-centred care was described at different levels in care; at the individual nurse level, person-centred care was described as involving person-centred assessing, relating and spacing which involved personalising assessments, relationships as well as the physical environment. At the team level, person-centred care was described in terms of person-centred goal setting, team responsibilities and team support, and involved having shared and personalised goals, different team responsibilities and a climate of support and collaboration. At the organisational level, person-centred care was described in terms of having person-centred routines, workloads and staff roles that all contributed to put the person at the core of the organisation and build routines to support this.

    CONCLUSIONS: The current study emphasises that, rather than confining person-centred care to specific moments or relationships, a systematic, multilevel organisational approach seems needed to enable nurses as individuals and teams to provide person-centred care consistently and continuously to older people in acute care settings.

    RELEVANCE TO CLINICAL PRACTICE: The results of this study should inspire nurses and managers to expedite implementation of person-centred care for older care recipients hospitalised in acute care wards. Examples of person-centred care are presented herein at clearly identified sites, namely, the "individual," "team" and "organisational levels."

  • 83.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Measuring levels of person-centeredness in acute care of older people with cognitive impairment: evaluation of the POPAC scale2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, p. 327-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Person-centeredness is increasingly advocated in the literature as a gold-standard, best practice concept in health services for older people. This concept describes care that incorporates individual and multidimensional needs, personal biography, subjectivity and interpersonal relationships. However, acute in-patient hospital services have a long-standing biomedical tradition that may contrast with person-centred care. Since few tools exist that enable measurements of the extent to which acute in-patient hospital services are perceived as being person-centred, this study aimed to translate the English version of the Person-centred care of older people with cognitive impairment in acute care scale (POPAC) to Swedish, and evaluate its psychometric properties in a sample of acute hospital staff.

    METHODS: The 15-item POPAC was translated, back-translated and culturally adjusted, and distributed to a cross-sectional sample of Swedish acute care staff (n = 293). Item performance was evaluated through assessment of item means, internal consistency by Cronbach's alpha on total and on subscale levels; temporal stability was assessed through Pearson's product correlation and intra-class correlation between test and retest scores. Confirmatory factor analysis was used to explore model fit.

    RESULTS: The results indicate that the Swedish version POPAC provides a tentatively construct-valid and reliable contribution to measuring the extent to which acute in-patient hospital services have processes and procedures that can facilitate person-centred care of older patients with cognitive impairment. However, some questions remain regarding the dimensionality of POPAC.

    CONCLUSIONS: POPAC provides a valuable contribution to the quest of improving acute care for older patients with cognitive impairment by enabling measures and subsequent accumulation of internationally comparable data for research and practice development purposes. POPAC can be used to highlight strengths and areas for improvements in care practice for older patients, and to illuminate aspects that risk being overlooked in busy acute hospital settings.

  • 84.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 5, p. 640-647Article in journal (Refereed)
    Abstract [en]

    Aim To explore the attitudes held by staff working in acute care units towards patients aged 70 years or older with cognitive impairment, and to explore factors associated with negative attitudes.

    Background Hospital staff attitudes towards older patients with cognitive impairment are of concern as older people are the main hospital users, and because staff attitudes influence care quality and uptake of evidence-based care.

    Method A cross-sectional survey design was used to collect data from staff (n = 391). Results  Staff attitudes were not explicitly negative. However, higher perceived strain in caring for older patients with cognitive impairment, higher perceived prevalence of these patients in the ward, being younger and working as an assistant nurse were associated with negative attitudes. A majority of staff reported that these patients received the best possible care, but few reported formally assessing cognitive status or working with evidence-based care protocols.

    Conclusion Staff characteristics associated with negative attitudes were described and staff perception that patients received best hospital care, despite limited cognitive assessments and care guidelines, indicate areas for improvement. Implications for nursing management Supporting young staff and assistant nurses, and implementing cognitive assessments and evidence-based guidelines can promote positive attitudes and best practice.

  • 85.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery La Trobe University Melbourne Vic. Australia.
    Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 11-12, p. 1682-1691Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To develop a theoretical understanding of the processes hindering person-centred care of older people with cognitive impairment in acute care settings.

    BACKGROUND: Although person-centred care with its holistic focus on the biopsychosocial needs of patients is commonly considered the gold standard care for older people with cognitive impairment, the extent to which care is person-centred can increase in acute care settings generally.

    DESIGN: Grounded theory inspired by Strauss and Corbin.

    METHOD: The study used a grounded theory approach to generate and analyse data from a Swedish sample of acute care staff, patients and family members.

    RESULTS: The substantive theory postulates that staff risks 'falling behind' in meeting the needs of older patients with cognitive impairment if working without consensus about the care of these patients, if the organisation is disease-oriented and efficiency-driven, and if the environment is busy and inflexible. This facilitated 'falling behind' in relation to meeting the multifaceted needs of older patients with cognitive impairment and contributed to patient suffering, family exclusion and staff frustration.

    CONCLUSIONS: The theory highlights aspects of importance in the provision of person-centred care of older people with cognitive impairment in acute settings and suggests areas to consider in the development of caring environments in which the place, pace and space can meet the needs of the older person.

    RELEVANCE TO CLINICAL PRACTICE: The proposed substantive theory can be used to critically examine current ward practices and routines, and the extent to which these support or inhibit high-quality person-centred care for older patients with known or unknown cognitive impairments.

  • 86.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of nurses’ lived experiences of providing care for older patients with cognitive impairment in acute care settingsManuscript (preprint) (Other academic)
    Abstract [en]

    Aim. This study aimed to illuminate meanings of caring for older patients with cognitive impairment in acute care settings as experienced by nursing staff.

    Background. Older people with cognitive impairment represent a large group of patients in acute care settings. Research demonstrates that these acute care environments can be unsafe and even unfriendly for frail older patients. Also research and clinical experience reveals that being a nurse in acute/specialized medical facilities means to work in a high-speed, technologically complex and demanding environment. And when providing care for older patients with cognitive impairment, nurses’ workload and responsibilities increases. This being largely dependent on how easily it is to connect with and help patients understand what to do, and what is best for them.

    Method. A purposeful sample of thirteen nurses experienced in caring for older people with cognitive impairment in acute care settings participated in the study. Narrative interviews were conducted during autumn 2012 and interpreted using a phenomenological-hermeneutic method.

    Findings. Caring for older, acutely ill patients with cognitive impairment was found to be very complex Meanings of caring for older patients with cognitive impairment seemed to shift depending on perception of the patients and the gap between what nurses can do (real) and want to do (ideal) in providing care for these patients. The greater this gap was experienced and the care perceived as meaningless, the more serious the treat to nurses’ personal-professional integrity which could be risked, compromised or harmed.

    Comprehensive understanding- Indicates that, being a nurse and having to care for older patients in acute care settings is to provide nursing care in an environment that does not support the nurses’ possibilities to protect and develop their personal–professional integrity.

  • 87.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit H.
    Department of Health Sciences, Lund University.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
    A threat to our integrity: meanings of providing nursing care for older patients with cognitive impairment in acute care settings2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, p. 48-56Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Older people with cognitive impairment represent a large group of patients in acute care settings. Research show that these acute care environments can be unsafe and even unfriendly for frail older patients. Research and clinical experience show that being a nurse in acute/specialised medical facilities means to work in a high-speed, technologically complex and demanding environment. When caring for older patients with cognitive impairment, nurses' workload and responsibilities have been shown to increase. This is largely dependent on how easily it is to connect with and help patients understand what to do, and what is best for them.

    AIM: This study aimed to illuminate meanings of caring for older patients with cognitive impairment in acute care settings as experienced by nursing staff.

    METHOD: A purposeful sample of thirteen nurses experienced in caring for older people with cognitive impairment in acute care settings participated in the study. Narrative interviews were conducted during autumn 2012 and interpreted using a phenomenological hermeneutic method.

    FINDINGS: Caring for older, acutely ill cognitively impaired patients was found to be very complex. The meanings of caring for these older patients seemed to change depending on the nurses' perceptions of the patients and the gap between what they could do (real) and wanted to do (ideal) in providing care for them. The greater this gap was felt to be and the more care was perceived as meaningless, the more serious was the threat to nurses' personal-professional integrity which could be at risk, compromised or harmed.

    CONCLUSION: The comprehensive understanding indicates that being a nurse and having to care for older patients in acute care settings means providing nursing care in an environment that does not support possibilities to protect and develop nurses' personal-professional integrity.

  • 88.
    Nilsson, Anita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit Holritz
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Becoming a step behind: acute care of older patients with cognitive impairment2012In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 52, no S1, p. 282-282Article in journal (Other academic)
  • 89.
    Nolan, Mike
    et al.
    University of Sheffield, Sheffield, United Kingdom.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Choowattanapakorn, Tassana
    Chiang Mai University, Chiang Mai, Thailand.
    Oo, Cho
    Care and support for older people: some international reflections2009In: Older people: Issues and innovations in care / [ed] Rhonda Nay, Sally Garratt, Elsevier, 2009, 3, p. 3-8Chapter in book (Other (popular science, discussion, etc.))
  • 90.
    Nystedt, Astrid
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Willman, Ania
    To Mander R (2004) commentary on Nystedt et al. (2004)2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 7, p. 911-911Article in journal (Refereed)
  • 91.
    Olausson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Holst Hansson, Annette
    Department of Care Sciences, Faculty of Health and Society, Malmö, Sweden.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University/Austin Health Clinical School of Nursing, Melbourne, Australia.
    Östlund, Ulrika
    Centre for Research & Development, Uppsala University/Region Gävleborg, Sweden.
    Nyholm, Tufve
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Development and psychometric testing of an instrument to measure the patient’s experience of external radiotherapy: The Radiotherapy Experience Questionnaire (RTEQ)2017In: Technical Innovations & Patient Support in Radiation Oncology, ISSN 2405-6324, Vol. 3-4, p. 7-12Article in journal (Refereed)
    Abstract [en]

    Background

    The patient’s perception of external radiotherapy (RT) procedures and equipment is important to evaluate as a complement to endpoints such as treatment outcome and reproducibility. There is a lack of a proper, psychometrically robust instrument to evaluate the patient’s comfort and experience of the external RT procedure. Hence, this study aimed to develop and test an instrument to measure the patient’s experience during external RT.

    Material and Methods

    A preliminary 34-item questionnaire was generated from research literature, expert consultations and patient interviews, and it was distributed to patients (n = 825) at 8 RT units in Sweden. The answers were subjected to item analysis and reduction by using exploratory factor analysis. The reliability of the final questionnaire was evaluated using Cronbach’s alpha. Mean scale scores were compared across gender, length of RT and treatment area.

    Results

    Most items were highly skewed towards positive responses. Scree plot analyses of the 34-item correlation matrix identified six underlying themes explaining 68% of the total variance. After item reduction, the 6 themes explained 73% of the variance in a 23-item questionnaire. Cronbach’s alpha was satisfactory for all themes (between 0.79 and 0.9). Significant differences between treatment areas were found for two scales: situational unease and situational repose.

    Conclusion

    The RT Experience Questionnaire is a tentatively valid and reliable instrument to measure how patients experience the external RT session process and the environment in the treatment room.

  • 92. Pascoe, Elizabeth C.
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Psychological Characteristics and Traits for Finding Benefit From Prostate Cancer Correlates and Predictors2016In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 39, no 6, p. 446-454Article in journal (Refereed)
    Abstract [en]

    Background: Although beginning evidence suggests that the capacity to derive benefit from cancer-associated experiences may be influenced by some individual psychological characteristics and traits, little is known about predictors for finding benefit from prostate cancer.

    Objective: The aim of this study was to explore the correlates and predictors for finding benefit from prostate cancer among a sample of men undergoing androgen deprivation.

    Methods: Pearson correlation and multiple linear regression modeling were performed on data collected in an acute tertiary hospital outpatient setting (N = 209) between July 2011 and December 2013 to determine correlates and predictors for finding benefit from prostate cancer.

    Results: Multiple linear regression modeling showed that while the 6 predictors of self-reported coping, depression, anxiety, distress, resilience, and hope explained 38% of the variance in finding benefit, coping provided the strongest and statistically significant predictive contribution.

    Conclusions: Self-reported coping was strongly predictive of finding benefit from prostate cancer, but questions remain about if subtypes of coping strategies can be more or less predictive of finding benefit. Self-reported levels of depression, anxiety, distress, resilience, and hope had a less predictive and nonsignificant role in finding benefit from prostate cancer and raise questions about their function in this subpopulation.

    Implications for Practice: The findings suggest that coping strategies can maximize finding benefit from prostate cancer. Knowledge of influential coping strategies for finding benefit from prostate cancer can be immensely valuable to support men in rebuilding positive meaning amid a changed illness reality. Developing practice initiatives that foster positive meaning-making coping strategies seems valuable.

  • 93. Pascoe, Elizabeth C.
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
    Which coping strategies can predict beneficial feelings associated with prostate cancer?2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, p. 2569-2578Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: This study aimed to identify the extent to which different coping strategies can predict benefit finding in prostate cancer experiences. Background. Although beginning evidence suggests that the capacity to find positives in adversity and find some benefit from cancer-associated experiences may be influenced by coping, little is known about which coping strategies can predict benefit finding in prostate cancer. Design: Cross-sectional. Method: Data from men (n = 209) diagnosed with prostate cancer receiving hormone suppression therapy were analysed using descriptive statistics, bivariate correlations and backward stepwise multiple linear regression. Sociodemographic and clinical data, and self-report scales (17-item Benefit Finding Scale and Brief COPE) were used. Results: Bivariate analyses showed significant correlations between 14 coping strategies and benefit finding in prostate cancer. Multiple linear regression modelling showed that the predictor variables 'acceptance', 'positive reframing' and 'turning to religion' explained 35% of the variance in dependant variable benefit finding when the other variables were controlled for. Of the three predictor variables, acceptance and positive reinterpretation were most strongly related to benefit finding. Conclusion: The self-reported coping strategies 'acceptance' and 'positive reframing' emerged as being most significantly predictive of benefit finding in this sample. 'Turning to religion' was also significant, but to a somewhat lesser extent in predicting benefit finding in the disruptive experience of prostate cancer. Relevance to clinical practice: The use of positively oriented emotional coping strategies of 'acceptance', 'positive reframing' and 'turning to religion' are influential to benefit finding in prostate cancer. An understanding of the coping strategies that are predictive to benefit finding can assist clinicians to discern and target men who are more or less likely to find benefit, and to develop person-centred support strategies and interventions with an aim to optimising positive emotional states throughout the cancer journey.

  • 94. Pascoe, Liz
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Benefit finding in adult cancer populations: Psychometric properties and performance of existing instruments2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 5, p. 484-491Article in journal (Refereed)
    Abstract [en]

    Purpose:

    To analyse the psychometric properties and performance of existing instruments that aim to measure benefit finding in adult cancer populations.

    Methods:

    Four electronic databases were searched. The focus was to identify English language, peer-reviewed journal articles where benefit finding is assessed with adult cancer populations. The terms 'benefit finding', 'cancer', 'instruments', 'scales', and 'adult' were used in various combinations. The instruments were rated against established criteria for instrument construction, reliability, validity, and interpretability.

    Results:

    Seventeen benefit finding instruments were reviewed. The instruments present a multifarious conceptualisation of the construct. Instrument structure is diverse. Several instruments (n = 4) reported on all the psychometric properties, but not interpretability. One instrument, the Stress-Related Growth Scale - Revised, additionally reported correlation statistics with another benefit finding instrument. Based on the information provided, the psychometric rigour of a number of instruments is yet to be established.

    Conclusions:

    One instrument reported validation statistics for all the identified criteria. While existing instruments provide a range of operationalisations of the benefit finding concept and have been more or less used in previous research, a majority are in the early stages of development and require further validation work in adult cancer populations. Given the increasing interest in the role benefit finding in clinical practice, researchers are urged to use these instruments further and to report relevant validation statistics when using them. (C) 2014 Elsevier Ltd. All rights reserved.

  • 95.
    Pascoe, Liz
    et al.
    La Trobe/Austin Clinical School of Nursing, La Trobe University, Australia.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe/Austin Clinical School of Nursing, La Trobe University, Australia.
    Benefit finding in cancer: A review of influencing factors and health outcomes2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 6, p. 760-766Article, review/survey (Refereed)
    Abstract [en]

    Purpose: Emerging research is revealing that the use of positively-oriented coping efforts may be beneficial to people living with and beyond cancer treatments. Benefit finding is such a positively-oriented coping strategy suggested to influence psychological and physical health outcomes, but the empirical evidence for these suggestions is unclear. This study aimed to review the existing evidence on factors that influence the use of benefit finding, and the associated health outcomes in cancer. Methods: Searches were undertaken in established databases. Studies were reviewed if published between January 1980 and June 2012. The search terms 'benefit finding', 'coping', 'positive emotions', and 'neoplasms' were used in various combinations. Ten studies were included in the Review. Results: Optimism was the only influencing factor that was consistently supported by evidence in the literature (n = 5/10). For health outcomes, physiological stress-response biomarkers of enhanced immune function were associated with benefit finding (n = 2/10). Inconsistent evidence were found between benefit finding and social support, and between benefit finding and psychological outcomes. Conclusions: There is inconclusive evidence to date to conclude that certain factors influence the use of benefit finding in cancer populations, or that benefit finding is clearly associated with any particular health outcomes. There is beginning evidence to conclude that optimism is related to benefit finding, and that benefit finding is associated with reduced physiological stress-response biomarkers. Further research is needed to explore predictors, co-variates, associations and clinical outcomes of benefit finding in cancer populations.

  • 96. Pascoe, Liz
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychometric properties and performance of the 17-item Benefit Finding Scale (BFS) in an outpatient population of men with prostate cancer2015In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, no 2, p. 169-173Article in journal (Refereed)
    Abstract [en]

    Purpose: To analyse the psychometric properties and performance of the 17-item Benefit Finding Scale (BFS) in an Australian outpatient sample of men with prostate cancer.

    Methods: The instrument's psychometric properties and performance were rated against established criteria for reliability (internal consistency), construct validity (instrument dimensionality) and variability (floor and ceiling effects).

    Results: Internal consistency reliability was satisfactory as evidenced by a Cronbach's alpha of 0.95 Dimensionality analysis confirmed a unidimensional structure indicating construct validity. A greater than 15% floor effect suggested limited data variability.

    Conclusion: The 17-item BFS seems to have satisfactory psychometric properties for use in an outpatient sample of men with prostate cancer, with some questions regarding detection of variability. The high internal consistency reliability points to the instruments ability to reliably capture the benefit finding construct in this population. The evidence for instrument dimensionality indicates a unidimensional scale, and thus a calculation of a single total score can be recommended. The >15% floor effect suggests that there may be issues with the instrument's ability to detect variance, and thus some questions remain regarding the instrument's ability to discern change in health status over time. Nevertheless, the findings of this study together with previous evidence indicate that the 17-item BFS can be recommended as the tool of choice when exploring benefit finding in adult cancer populations.

  • 97. Pascoe, Liz
    et al.
    Rahman, Muhammad Aziz
    Edvardsson, Kristina
    Jokwiro, Yangama
    McDonald, Ewan
    Lood, Qarin
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing & Midwifery, La Trobe University, Melbourne, Australia; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health – AgeCap, University of Gothenburg, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing & Midwifery, La Trobe University, Melbourne, Australia.
    Li, Xia
    Psychometric evaluation of the English version 14-item resilience scale (RS) in an Australian outpatient population of men with prostate cancer2018In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 35, p. 73-78Article in journal (Refereed)
    Abstract [en]

    Purpose: Human resilience refers to the processes of positive adaptation and development in the context of perceived significant threats to an individual's life or function. This paper analyses the psychometric properties and performance of the English version 14-item Resilience Scale (RS) in an Australian outpatient sample of men (n = 209) with advanced prostate cancer receiving androgen deprivation therapy.

    Methods: A cross-sectional design was used to collect data from a purposive sample of men. The instrument's psychometric properties were rated against established criteria for reliability (internal consistency), construct validity (instrument dimensionality) and variability (floor and ceiling effect). Exploratory and confirmatory factor-analyses were performed.

    Results: The English version 14-item RS demonstrated satisfactory internal consistency reliability (Cronbach's alpha = 0.91). A greater than 15% ceiling effect suggested limited data variability. Confirmatory factor analysis showed that items in the instrument measured primarily as a single factor with a good model of fit (RMSEA = 0.059; TLI = 0. 950, CFI = 0.962).

    Conclusion: The English version 14-item RS had satisfactory psychometric properties to capture the concept of resilience in an Australian outpatient sample of men with advanced prostate cancer, with some questions regarding detection of variability for ceiling effect. Further psychometric evaluation of the instrument in other adult clinical settings is recommended.

  • 98. Patomella, Ann-Helen
    et al.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Health Sciences and Society, Karolinska Institutet,Stockholm, Sweden; Department of Health Sciences, University of Technology, Luleå, Sweden.
    Bergland, Ådel
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.
    Characteristics of residents who thrive in nursing home environments: a cross-sectional study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 9, p. 2153-2161Article in journal (Refereed)
    Abstract [en]

    Aim. To describe what characterizes residents with higher levels compared with those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale. Background. Thriving is conceptualized as people's experiences of well-being in relation to the environment where they live. Thriving has the potential to emphasize health-promotion and positive experiences in nursing home residents in addition to current focus on illness and symptoms. Design. Cross-sectional design. Methods. Data from a total sample of 191 residents in a large Swedish nursing home facility were separated into two groups; rated as having high and low thriving based on a median split of thriving total score for each participating resident. The characteristics of residents with higher and lower levels of thriving were compared using bivariate analyses to investigate differences. Data were collected in 2013. Results. Residents with higher levels of thriving had shorter length of stay at the facility, higher functioning in Activities of Daily Living and less cognitive impairment, lower frequency of behavioural and psychological symptoms and higher assessed quality of life. The ability to walk and possibilities to spend time outdoors were higher among those with higher levels of thriving. Conclusion. Nursing home residents who experience thriving have a higher level of functioning in activities of daily living, a higher quality of life and are less physically and cognitively impaired.

  • 99. Rahman, Muhammad Aziz
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Austin and Northern Clinical School of Nursing, Australia.
    McDonald, Christine
    Castle, David
    E-cigarettes or vaping: examining perceptions of use and associated harm among current users in Australia and Bangladesh2018In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, no 1, p. 92-92, article id A244Article in journal (Other academic)
    Abstract [en]

    Background: E-cigarettes or vaping are currently increasing in popularity among smokers globally. This study aims to examine the perceptions of e-cigarette users regarding use and associated harm.

    Methods: A cross sectional survey was conducted during July 2017 among members of different popular online forums in Australia and Bangladesh, who were current or ex-users of e-cigarettes. A structured questionnaire was used to collect data anonymously using Qualtrics.

    Results: There were 452 study participants, mean age was 39(±13.2) years and 80%(n=356) were men. Half of them (n=223) resided in Australia and 32%(n=143) in Bangladesh. Three in four participants (77%) lived in metropolitan areas, 47% were married, 33% had undergraduate level of education, a fifth of them were either professionals or employed. More than three quarters (76%) of respondents were not current smokers and 40% of them quit smoking 1-5 years ago. Three quarters of the current smokers (76%) tried to quit smoking cigarettes in the last 12 months. Almost all of the participants (96%) were using e-cigarettes daily and 94% of them had nicotine in the e-liquid used. The average amount of e-liquid used, nicotine strengths and duration of use were 8.2(±6.9) ml/day, 6.7(±5.8) mg/ml, and 25.2(±23.3) months respectively. Reasons for using e-cigarettes were to reduce/quit cigarette smoking (91%), good taste/flavor (50%), low cost (41%), safe to use (39%) and can be used indoor/smoke free areas (33%). The majority of respondents (81%) perceived e-cigarettes as less harmful than cigarettes and 65% perceived them as less addictive. The majority of respondents (88%) did not try to stop using e-cigarettes, however, 75% of them had an intention to discontinue in the next five years.

    Conclusions: E-cigarettes were primarily used for reducing/quitting cigarettes, which supports prior evidence regarding the effectiveness of e-cigarettes for smoking cessation.

  • 100. Rahman, Muhammad Aziz
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Austin and Northern Clinical School of Nursing, Australia.
    McDonald, Christine
    Castle, David
    E-cigarettes or vaping: is there any difference in perceptions of use and associated harm among the current users between a developed and a developing country?2018In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, no 1, p. 92-93, article id A245Article in journal (Other academic)
    Abstract [en]

    Background: E-cigarettes or vaping are currently increasing in popularity among smokers globally. This study aims to compare e-cigarette users between a developed country and a developing country to identify similarities/differences regarding perceptions of use and associated harm.

    Methods: A cross sectional survey was conducted during July 2017 among members of different popular online forums in Australia and Bangladesh, who were current or ex-users of e-cigarettes. Data were collected anonymously using Qualtrics.

    Results: There were 452 study participants, mean age was 39(±13.2) years and 80%(n=356) were men. Daily or occasional smoking in the last 30 days was more frequent among the Bangladeshi participants than their Australian counterparts (38% vs. 18%, p< 0.001, ORs 2.85, 95%CIs 1.76-4.62). Endeavour to quit smoking was also more common among the current smokers in Bangladesh (90% vs. 72%, p=0.013, ORs 3.69, 95%CIs 1.16-11.7). Almost all of the participants in both countries were using e-cigarettes daily and had nicotine in the e-liquid. The average amount of e-liquid used, nicotine strengths and duration of use in Australia and Bangladesh were 9(±7.9) vs. 5.9(±3.5) ml/day, 6.8(±6.4) vs. 4.6(±1.8) mg/ml, and 22.9(±22.3) vs. 15.9(±12.8) months respectively. The most commonly cited reason for using e-cigarettes in both countries was to reduce/quit cigarette smoking, although there was a significant difference between Australia and Bangladesh (95% vs. 83%, p< 0.001, ORs 3.89, 95%CIs 1.84-8.21). More than three quarters of respondents in both countries perceived e-cigarettes as less harmful and more than two thirds perceived them as less addictive. The majority of respondents did not try to stop using e-cigarettes, however, intention to discontinue in the next five years was more in Bangladesh than Australia (85% vs. 74%, p=0.006, ORs 1.99, 95%CIs 1.15-3.46).

    Conclusions: E-cigarettes were primarily used for reducing/quitting cigarettes in both countries, which supports prior evidence regarding the effectiveness of e-cigarettes for smoking cessation.

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