bluuebunny/crossref_metadata_2025 huggingface dataset:
Nuclear GSK‐3β segregation in desmoid‐type fibromatosis
Authors: Meneghello Cristiana , Ousghir Bouchra , Rastrelli Marco , Anesi Laura , Sommariva Antonio , Montesco Maria Cristina , Rossi Carlo Riccardo , Hladnik Uros , Segat Daniela
Published: March 2013

Aims

Desmoid‐type fibromatosis (DF) is a rare benign myofibroblastic neoplasm of the connective tissue that is unable to metastasize but is associated with a high local recurrence rate. Nuclear β‐catenin is the most commonly used histological marker of DF; however, clinical and biological predictive markers guiding the treatment and follow‐up of DF are still lacking. Normally, β‐catenin is regulated by the cytoplasmic multiprotein complex of adenomatous polyposis coli (APC), axin, casein kinase 1α (CK1α), and glycogen synthase kinase 3β (GSK‐3β); this phosphorylates and degrades β‐catenin, which would otherwise translocate to the nucleus. The aim of this study was to analyse the expression and localization of the β‐catenin–protein complex of the Wnt pathway in cells isolated from DF patients.

Methods and results

We isolated cells from biopsies of DF patients, and demonstrated, by immunofluorescence and immunoblot analyses, that it is almost exclusively nuclear GSK‐3β that colocalizes and interacts with β‐catenin. The nuclear translocation of β‐catenin and GSK‐3β is not correlated with CTNNB1 mutations. In DF samples, the multiprotein complex is disrupted, as the cytoplasmic localization of APC and axin makes interaction with the nuclear β‐catenin and GSK‐3β impossible.

Conclusions

Our data suggest that GSK‐3β is an additional DF marker with an important role in the aetiopathogenesis of this entity.
Pharmacokinetics of the combination raltegravir/atazanavir in HIV‐1‐infected patients
Authors: Jansen A , Colbers EPH , van der Ven AJAM , Richter C , Rockstroh JK , Wasmuth JC , van Luin M , Burger DM
Published: March 2013

Objectives

To evaluate the use of raltegravir with unboosted atazanavir in combination with one nucleoside reverse transcriptase inhibitor (NRTI) (lamivudine or emtricitabine) as a potentially well‐tolerated once‐daily (qd) maintenance regimen.

Methods

We compared the pharmacokinetics of raltegravir 400 mg twice daily (bid) with raltegravir 800 mg qd in HIV‐infected patients (n = 17) on unboosted atazanavir (600 mg qd) in combination with lamivudine or emtricitabine.

Results

The area under the plasma concentration vs. time curve for a dose interval t (AUC0–t) of 800 mg qd divided by 2 was not significantly different from the AUC0–t of 400 mg bid (P = 0.664) but the minimum concentration (Cmin) was 72% lower with the qd regimen (P = 0.002). The regimen was well tolerated and the viral load remained undetectable in all patients during the 6 weeks of the study follow‐up.

Conclusions

A qd regimen of raltegravir 800 mg, atazanavir 600 mg and lamivudine or emtricitabine resulted in favourable pharmacokinetic profiles and good short‐term safety and efficacy data. Larger phase IIb studies are needed to explore this novel regimen.
What is Stroke Symptom Knowledge?
Authors: Mosley Ian , Nicol Marcus , Donnan Geoffrey , Thrift Amanda G. , Dewey Helen M.
Published: March 2013

Background

No commonly agreed definition exists for ‘stroke symptom knowledge’ among members of the general public. Recalling at least one correct stroke symptom has been used in the past. However, this criterion was not associated with rapid presentation to hospital. Rapid presentation is vital in order to provide effective acute stroke treatment.

Aims and/or hypothesis

We sought to identify a base level of community stroke symptom knowledge associated with stroke recognition when symptoms occur, an immediate ambulance call, and ‘stroke recognition and immediately calling an ambulance’ as a single sequence of events.

Methods

For six-months in 2004–2005, we identified all patients with stroke living in a defined region of Melbourne and who were transported by ambulance to one of the three hospitals. The person who called the ambulance (caller) was interviewed.

Results

One hundred ninety-eight patients were identified and 150 callers interviewed. Symptoms reported most frequently were limb weakness (67%), speech problems (57%), and facial weakness (24%). Reporting at least two of the symptoms – facial weakness, limb weakness, or speech problems (62% of callers) – was associated with stroke recognition ( P = 0.004), immediately calling an ambulance ( P = 0.065), and both ‘stroke recognition and immediately calling an ambulance’ ( P = 0.053).

Conclusions

Knowing at least two of the symptoms – facial weakness, limb weakness, and speech problems – appears to be an appropriate indicator of stroke symptom knowledge as it is associated with stroke recognition and appropriate action. Recognizing stroke symptoms and immediately calling an ambulance increase the potential to reduce prehospital time delays and improve eligibility of acute stroke patients for rapid treatment.
Door-to-Door Survey of Cardiovascular Health, Stroke, and Ischemic Heart Disease in Rural Coastal Ecuador – the Atahualpa Project: Methodology and Operational Definitions
Authors: Del Brutto Oscar H. , Peñaherrera Ernesto , Ochoa Elio , Santamaría Milton , Zambrano Mauricio , Del Brutto Victor J. ,   for the Atahualpa Project Investigators
Published: March 2013

Rationale

Stroke and cardiovascular diseases will be the next health epidemics in Latin America due to increased life expectancy and changes in the lifestyle and dietary habits of the population. Knowledge of the cardiovascular health status of the inhabitants will allow the implementation of policies directed to reduce the burden of stroke and cardiovascular diseases in the region.

Aims

To evaluate the cardiovascular health status of the inhabitants of Atahualpa (a rural village in coastal Ecuador) and to determine the prevalence and incidence of stroke and ischemic heart disease in the region.

Design

Three-phase epidemiologic survey. During phase I, Atahualpa residents aged ⩾40 years will be screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In phase II, neurologists and cardiologists will examine suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess the prevalence and incidence of these conditions. In phase III, patients with a diagnosis of stroke and ischemic heart disease will undergo complementary tests for achieving a more specific diagnosis.

Discussion

Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective in improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.
Evaluation of Plasma d-Dimer Plus Fibrinogen in Predicting Acute CVST
Authors: Meng Ran , Wang Xiaoying , Hussain Mohammed , Dornbos David , Meng Lu , Liu Yu , Wu Yan , Ning Mingming , Ferdinando S Buonanno , Lo Eng H. , Ding Yuchuan , Ji Xunming
Published: March 2013

Background

Prompt diagnosis of cerebral venous sinus thrombosis is a challenge owing in part to its complex and non-specific early clinical symptoms.

Objective

This study aims to evaluate the value of clinically useful biomarkers (d-dimer and fibrinogen) for cerebral venous sinus thrombosis prediction.

Methods

Two-hundred and thirty-three suspected cerebral venous sinus thrombosis patients were enrolled in this prospective study. Thirty-four cases confirmed as cerebral venous sinus thrombosis using imaging modalities, whereas the other 199 cases served as mimic controls. Plasma samples of 34 healthy controls were further collected from age- and gender-matched volunteers. d-dimer and fibrinogen levels of all patients and controls were measured before imaging and treatment. The dynamic d-dimer and fibrinogen levels in cerebral venous sinus thrombosis cases after anticoagulation were monitored for up to 180 consecutive days.

Results

At admission before treatment the average d-dimer and fibrinogen levels in cerebral venous sinus thrombosis group were 968·9 ± 160·1 μg/l and 6·9 ± 1·3 g/l, both of which were significantly elevated when compared with that of the controls. In cerebral venous sinus thrombosis patients, 94·1% had d-dimer elevation, 73·5% had fibrinogen elevation, and 67·6% had both elevated d-dimer and fibrinogen. During acute phase, the sensitivity and specificity of predicting cerebral venous sinus thrombosis using only d-dimer were 94·1% and 97·5%, whereas that of d-dimer in combination with fibrinogen were 67·6% and 98·9%. After administering anticoagulation, d-dimer levels gradually recovered; however, fibrinogen levels fluctuated with 33·3% of the patients still exhibiting elevated values up until 180 days.

Conclusion

d-dimer may serve as an important screening tool to determine the urgency of obtaining magnetic resonance imaging/magnetic resonance venography or digital subtraction angiography in patients presenting with clinical symptoms that are suspected of cerebral venous sinus thrombosis. Furthermore, d-dimer in combination with fibrinogen may increase the predictive value of acute cerebral venous sinus thrombosis.
Representation of People with Aphasia in Randomized Controlled Trials of Acute Stroke Interventions
Authors: Ali Myzoon , Bath Philip M. , Lyden Patrick D. , Bernhardt J. , Brady Marian
Published: March 2013

Background

Aphasia affects up to a third of the stroke population and is associated with poor social participation and quality of life. Yet people with aphasia may be excluded from some types of stroke research due to challenges in informing, consenting, and conducting follow-up in this population.

Aims and/or hypothesis

We described the representation of those with aphasia in acute stroke clinical research, the level of inclusion across international trial sites, and whether there have been improvements in the inclusion of this population in recent clinical trials.

Methods

We conducted a retrospective analysis of clinical trial data from the Virtual International Stroke Trials Archive (VISTA), defining aphasia using the Best Language (item 9) domain of the National Institutes of Health Stroke Scale. We used proportional odds modeling, adjusting for age, gender, ethnicity, stroke severity, medical history, hemisphere affected by stroke, and trial eligibility criteria, to examine the associations between year, location of enrollment, inclusion, and attrition of those with aphasia.

Results

Data were available for 8904 patients from 10 trials; no trials listed aphasia as an exclusion criterion. At baseline, aphasia was present in 4039 (45·4%); severe/global aphasia was present in 2688 (30·2%). We observed no geographic or longitudinal disparity in the attrition of these patients at three-months. Centers in the Philippines recruited fewer people [ P = 0·05, odds ratio = 0·5, 95% confidence interval (0·2, 1·0)], while centers in Central and South America included more people with severe/global aphasia [ P = 0·0004, odds ratio = 2·4, 95% confidence interval (1·3, 4·3)], when compared with centers in the USA and Canada.

Conclusion

Acute stroke trials have demonstrated the feasibility of including people with aphasia in stroke research; we observed geographic variations that were not entirely explained by case mix or trial eligibility criteria. Similar levels of inclusion should be sought in nonemergency stroke trials to improve the applicability of research findings to this population.
CHIMES-I: Sub-Group Analyzes of the Effects of NeuroAiD According to Baseline Brain Imaging Characteristics among Patients Randomized in the CHIMES Study
Authors: Navarro Jose C. , Chen Christopher Li Hsian , Lagamayo Pedro Danilo J. , Geslani Melodia B. , Eow Gaik Bee , Poungvarin Niphon , de Silva Asita , Wong Lawrence K. S. , Venketasubramanian N.
Published: March 2013

Rationale

The clinical effects of neuroprotective and/or neurorestorative therapies may vary according to location and size of the ischemic injury. Imaging techniques can be useful in stratifying patients for trials that may be beneficial against particular ischemic lesion characteristics.

Aim

To test the hypothesis that the efficacy of NeuroAiD compared with placebo in improving functional outcome and reducing neurological deficit in patients with cerebral infarction of intermediate severity varies between sub-groups of patients randomized in the main Chinese Medicine Neuroaid Efficacy on Stroke study when categorized according to baseline imaging characteristics.

Design

This is a retrospective cohort sub-group analysis of patients who participated in the main Chinese Medicine Neuroaid Efficacy on Stroke study, a multicenter, double-blind, placebo-controlled trial that recruited 1100 patients within 72 h of ischemic stroke onset with National Institutes of Health Stroke Scale 6–14 and were randomized to either NeuroAiD or placebo taken four capsules three times daily for three months. Review of the baseline images to classify the acute stroke lesions in terms of size, location, and extent of involvement will be performed retrospectively by two readers who will remain blinded as to treatment allocation and outcomes of the subjects.

Study outcomes

The primary efficacy end-point in the main Chinese Medicine Neuroaid Efficacy on Stroke study is the modified Rankin Scale grades at three-months. Secondary efficacy end-points are the National Institutes of Health Stroke Scale score at three-months; difference of National Institutes of Health Stroke Scale scores between baseline and 10 days and between baseline and three-months; difference of National Institutes of Health Stroke Scale sub-scores between baseline and 10 days and between baseline and three-months; modified Rankin Scale at 10 days, one-month, and three-months; Barthel index at three-months; and Mini Mental State Examination at 10 days and three-months. Analysis of these primary and secondary end-points will be performed for sub-groups defined in this study after review of the baseline brain imaging: nonlacunar and lacunar, cortical and sub-cortical, hemispheric vs. brainstem, Alberta Stroke Program Early CT score <7 and 7–10, and score <8 and 8–10.
The Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial Protocol: A Randomized, Blinded, Efficacy Trial of Standard vs. Intensive Hyperglycemia Management in Acute Stroke
Authors: Bruno Askiel , Durkalski Valerie L. , Hall Christiana E. , Juneja Rattan , Barsan William G. , Janis Scott , Meurer William J. , Fansler Amy , Johnston Karen C.
Published: March 2013

Rationale

Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during acute stroke is feasible and can be accomplished safely but has not been fully assessed for efficacy.

Aims

The Stroke Hyperglycemia Insulin Network Effort trial aims to determine the safety and efficacy of standard vs. intensive glucose control with insulin in hyperglycemic acute ischemic stroke patients.

Design

This is a randomized, blinded, multicenter, phase III trial of approximately 1400 hyperglycemic patients who receive either standard sliding scale subcutaneous insulin (blood glucose range 80–179 mg/dL, 4·44–9·93 mmol/L) or continuous intravenous insulin (target blood glucose 80–130 mg/dL, 4·44–7·21 mmol/L) for up to 72 h, starting within 12 h of stroke symptom onset. The acute treatment phase is single blind (for the patients), but the final outcome assessment is double blind. The study is powered to detect a 7% absolute difference in favorable outcome at 90 days.

Study outcomes

The primary outcome is a baseline severity adjusted 90-day modified Rankin Scale score, defined as 0, 0–1, or 0–2, if the baseline National Institutes of Health Stroke Scale score is 3–7, 8–14, or 15–22, respectively. The primary safety outcome is the rate of severe hypoglycemia (<40 mg/dL, <2·22 mmol/L).

Discussion

This trial will provide important novel information about preferred management of acute ischemic stroke patients with hyperglycemia. It will determine the potential benefits and risks of intensive glucose control during acute stroke.
Financial Determinants of International Remittance Flows to the Sub‐Saharan African Region
Authors: Ezeoha Abel Ebeh
Published: March 2013

There is a general belief that Sub‐Saharan Africa has the poorest record of international remittances because, due to deficiencies in the region's financial systems, a greater proportion of remittances passes through informal channels. This article examines the interactive impact of financial development on remittances to the region. Using a panel data covering 32 countries in the region from 1995 to 2009, it finds evidence of weak financial infrastructure constraining the flow of remittances. It also shows that the higher the level of a country's infrastructural development, the greater the impact on remittances. The article establishes that the impact of financial development and institutional quality is greater in emerging markets than in developing economies, implying that improving the financial system and institutional structures in Africa should be at the centre of the current policy efforts to optimize the benefits of remittances.
Immigration Policy and Entrepreneurship
Authors: Mahuteau Stéphane , Piracha Matloob , Tani Massimilano , Lucero Matias Vaira
Published: March 2013

This article analyses the impact of a change in Australia's immigration policy, introduced in the mid‐1990s, on migrants' probability of becoming entrepreneurs. The policy change consists of stricter entry requirements and restrictions to welfare entitlements. The results indicate that those who entered under more stringent conditions – the second cohort – have a higher probability of becoming self‐employed, than those in the first cohort. We also find significant time and region effects. Contrary to some existing evidence, time spent in Australia positively affects the probability to become self‐employed. We discuss the intuitions for the results and their policy implications.
The Impact of EU Migration Policies on African Countries: the Case of Mali
Authors: Trauner Florian , Deimel Stephanie
Published: March 2013

This article elaborates on the impact of EU migration policies on African countries, taking Mali as a case study. Building upon fieldwork in the country, it argues that enhanced European involvement (EU and individual member states) has caused Mali to develop a more control‐oriented dimension to its migration policy and to strengthen its links with European development actors and the Malian diaspora. While these reverberations of EU policies can be likened to what scholars have established for other African countries, Mali is unusual because of its large exposure to altered regional patterns of migration cooperation. Many of the regional refoulements and deportations end in Mali despite the fact (or, perhaps, because of the fact) that the official Malian state does little to regulate these operations. In the absence of official policy responses, civil society organizations have stepped in to provide returned migrants with basic care and reception.
Migrant Indebtedness: Bangladeshis in the GCC Countries
Authors: Rahman Md Mizanur
Published: March 2013

Labour migration affects family economics in at least two ways: one is the outflow of indispensable family resources to meet the expenses incurred in the migration process and the other is the transfer in cash or kind from migrants to their non‐migrating families. This study primarily addresses the former flow, that is sources of funds for migration and resulting migrant indebtedness. Drawing on the experiences of Bangladeshi migrants in the GCC countries, this study explores the economic cost of migration, the extent of migrant indebtedness, and the implications of remittances on migrant families. This research exposes the complexity and multiplicity of the economic costs of migration to the GCC countries and reports that Bangladeshi migration to the Gulf states runs on debt, with migrants and their families indebting themselves in the migration process.
Bridges and Barriers: Religion and Immigrant Occupational Attainment across Integration Contexts
Authors: Connor Phillip , Koenig Matthias
Published: March 2013

This article advances knowledge about context-dependent impacts of religion on immigrant structural integration. Drawing on theories of inter-generational immigrant integration, it identifies and spells out two context-dependent mechanisms through which religion impinges upon structural integration — as ethnic marker prompting exclusion and discrimination, or as social organization providing access to tangible resources. The propositions are empirically tested with nationally representative data on occupational attainment in three different integration contexts which vary in religious boundary configurations and religious field characteristics — the United States, Canada, and Western Europe. Using data from the US General Social Survey, the Canadian Ethnic Diversity Survey, and the European Social Survey, the article analyzes indirect and direct effects of religious affiliation and participation on occupational attainment among first and second generation immigrants. The analyses find only limited evidence for the assumption that in contexts with strong religious boundaries (such as Western Europe and, to a lesser extent, Canada), immigrants face religious penalties in structural integration. By contrast, the analyses support the assumption that in contexts with a thriving religious field (such as the United States and, to a lesser extent, Canada), religious attendance tends to be positively related to occupational attainment, especially for the second generation. For the first time, the article empirically tests arguments about transatlantic differences in the role of religion for immigrant structural integration, and it suggests ways of better integrating micro-oriented survey research with macro-oriented institutional analysis.
Implicit Nativist Attitudes, Social Desirability, and Immigration Policy Preferences
Authors: Knoll Benjamin R.
Published: March 2013

While previous research on immigration attitudes among the American public has focused on factors such as economic threat, social context, and racial prejudice, fewer studies have examined the psychological determinants of immigration policy preferences. This study analyzes the results of an implicit association test (IAT) procedure that measures automatic nativist preferences for a traditional American culture versus a Latino-American culture {i.e., implicit nativist attitudes). In brief, this study demonstrates that implicit nativist attitudes are fairly common, that they are an independent predictor of immigration policy attitudes, and that they affect those who are not explicitly nativist but who still hold restrictionist policy views.
Rooted Cosmopolitans: Israelis with a European Passport – History, Property, Identity
Authors: Harpaz Yossi
Published: March 2013

Over the past decade, a new and intriguing phenomenon developed in Israel: close to 60,000 Israelis applied for citizenship in the Central and Eastern European countries from which their families immigrated. Typically, these new dual citizens have no plans to “return” to Germany or Poland, nor do they feel any identification with their countries of origin. Instead, they are mainly interested in obtaining a “European Union passport” and in gaining potential access to the European common market. The paper presents statistics on this unconventional case of dual citizenship, surveys the historical and legal circumstances that produced it and uses material from interviews to explore the meanings and uses that European-Israeli dual citizens attribute to their European passports. Dual citizenship, the findings show, is used by Israelis in various and sometimes unexpected ways: as enhancer of economic opportunities, “insurance policy,” intergenerational gift, and even as an elitist status symbol. This modality of state belonging can be termed “passport citizenship”: Non-resident citizenship here is stripped of its national meaning and treated as an individual piece of property, which is embodied by the passport and obtained for pragmatic reasons.
Does Unemployment Lead to Greater Alcohol Consumption?
Authors: Popovici Ioana , French Michael T.
Published: March 2013

Using panel data from Waves 1 and 2 of the NESARC, we estimate gender‐specific effects of changes in employment status on overall alcohol consumption, binge‐drinking episodes, and a diagnosis of alcohol abuse and/or dependence. We employ various fixed‐effects models to address potential bias from unobserved and time‐invariant individual heterogeneity. All results show a positive and significant effect of unemployment on drinking behaviors, and the findings are robust to numerous sensitivity tests. Perhaps, macroeconomic policy decisions intended to stimulate the economy during economic downturns should also consider the avoided personal costs and externalities associated with alcohol misuse.
Methodological Problems of Clinical Trials in Nursing Illustrated by a Study of Post‐partum Care
Authors: Waldenström Ulla , Lindmark Gunilla , Sundelin Claes
Published: March 2013

ABSTRACT This paper is concerned with some of the methodological problems encountered when evaluating a medical health care programme. The example of a post‐partum care programme with early discharge is used to illustrate the difficulty of weighing the theoretical against the practical demands of science in the complex social context of real life. Considerations regarding choice of design, number of subjects and methods of data collection are dealt with, but not problems concerning outcome variables and how they are measured.
Solving Patients' Information Problems by the Nursing Process and Collaboration between the Medical and Nursing Staff
Authors: Engström Birgitta
Published: March 2013

ABSTRACT A system for assessment and solution of patients' information problems was studied. The system is a modified nursing process with built‐in collaboration and communication between medical and nursing staff, including individual nursing care plans for information. The effects on patients' satisfaction with received information were evaluated together with the staff's functioning in the system. Data were collected by a questionnaire sent to patients, estimations by physicians and from the nursing records. An improvement of patients' satisfaction with information occurred for medications, examinations, and their results a year after the study started. The interviews on admission were not entirely satisfactory. A planned problem‐solving process did not occur. New norms for patients' need for information were established and a process of change was initiated.
Autonomy and Paternalistic Behaviour in Care
Authors: Elander Gunnel , Hermerén Göran
Published: March 2013

ABSTRACT. The aim of the present study is to identify ethical dilemmas as experienced by hospital personnel. The dilemmas reported often focused on problems of hospitalised patients' autonomy. Tape‐recorded interviews were performed with different categories of personnel, from different care areas. One of the problems was found to be a diminishing autonomy for hospitalised patients, especially in the areas of long‐term and psychiatric care. According to the interviews the reasons for the obstacles for autonomy were due to the hospital organisation, the staff, the patients themselves and to relatives.
Instrumental Activities of Daily Living in Two Patient Populations, Three Months and One Year After a Stroke
Authors: Lindmark Birgitta , Hamrin Elisabeth
Published: March 2013

ABSTRACT. The pattern of instrumental activities of daily living (I‐ADL) such as household work, locomotion, psychosocial functions and intellectual activity was investigated in two groups of patients, three months and one year after a stroke. Group A (n=78 at three months, n=63 at one year) had received conventional care during the hospital period, while Group B (n=129 at three months, n=120 at one year) had taken part in a more individualised care programme. There was no difference in I‐ADL performance between the two groups on the follow‐up occasions according to interviews. The individualised care programme in the present study did not result in any significant differences in long‐term functional improvements, although the mortality rate was somewhat lower in Group B. The patients of both groups were dependent to a large extent on somebody else in all activities except locomotion. Three‐fourths of the patients, however, declared that they were satisfied with their health and life situation, in spite of their handicap.
Caring Paradigms
Authors: Eriksson Katie
Published: March 2013

ABSTRACT. The international discussion about caring has been reflected by two central themes in the twentieth century: (1) How can caring be developed into a holistic paradigm focused on caring and man as a human being? (2) How can a scientific basis be formed for the education, research, and practice of caring? The purpose of this study is to describe how the paradigm should be formed, developed, and integrated among nursing students during the training period. To what extent the paradigm will remain after the training period will be presented in a later article. The data collection was done by means of a questionnaire. The paradigm‐measuring instrument was developed in accordance with Törnebohm's paradigm factors. The research group comprised 63 graduate students. In summary we can state that the students have a paradigm already at the beginning which can be characterised as a caring paradigm. Distinct changes have taken place during the training period. The changes are highly significant (p<0.001) as to all factors except the capability of developing caring activities (p<0.05) and getting people interested in caring (p<0.10).
The Risk to Nurses of Developing Burnout Syndrome
Authors: Beierhol Margareta , Tiselius Ingrid , Ek Anna‐Christina
Published: March 2013

aCollege of Higher Education for Health Professions in östergötland

ABSTRACT In order to get information on the risk to nurses of developing burnout syndrome an interview was carried out with 69 nurses from a large hospital and 28 nurses from a small hospital. Particular attention was paid to the following questions in the questionnaire: Does burnout occur among nurses on a short‐stay hospital ward? Is the risk of burnout associated with any particular field of medicine? Does the service as a nurse, hours on duty or rank have any significance? Does the size of the hospital have any influence? Are there any ways of preventing burnout? The questions were asked to establish the presence of a psychical, physical, social and emotional type in addition to factors from the MBI scale. The results showed that nurses risk developing burnout regardless of age, period of service, hours on duty, rank, or field of medicine. The nurse's personality is apparently of relevance but the determinant for burnout development is how different stressors affect the individual. Some methods are proposed whereby the nurses can better cope with the stressors. However, these methods are certainly insufficient and further research is important to define more clearly the principles by which the development of burnout syndrome can be prevented.
Factors Affecting Work‐time Allocation Among Physiotherapists
Authors: Bergman Birgitta , Marklund Staffan
Published: March 2013

ABSTRACT As part of a time budget study among 149 physiotherapists in Västerbotten County, northern Sweden, a Multiple Classification Analysis was completed. The aims were to evaluate the relative importance of some factors for the allocation of working hours, and to devise comparable measures of the ability of the particular set of variables to account for the variations in time utilisation. Occupational area was the most important factor in explaining the distribution of working hours, when the other factors were kept constant. Time utilisation was slightly affected by professional post and sex, but not by working hours. The explained variance, R2, was 0.37 for patient treatment and 0.30 for transport, indicating a fair degree of explained variance in these models. The R2 coefficients for the other tasks were low, indicating that factors, not included in thestudy, were more important in explaining the allocation of working hours for those tasks.
Feeding Problems in Severely Demented Patients Seen from Task and Relationship Aspects
Authors: Athlin Elsy , Norberg Astrid , Asplund Kenneth , Jansson Lilian
Published: March 2013

ABSTRACT This study aimed at increasing the understanding of feeding problems in severely demented patients cared for in a task assignment system. Twenty‐three video‐recordings made during the feeding of 15 severely demented patients and 55 focused interviews with 45 caregivers, who fed the 15 patients during that period were analysed regarding the feeding problems seen from a task aspect and from a relationship aspect. The result indicated that the problems were partly of a more constant nature and partly fluctuated from meal to meal. Feeding problems regarding the task aspect were mentioned first by the caregivers in the interviews in spite of the fact that the patients had severe communication problems which could be expected to cause great problems in the relationship between the patient and his caregiver. Reasons for these findings are suggested.
The Teaching of Decision‐making Process to Nurses Working in Hospital
Authors: Lauri Sirkka H.
Published: March 2013

ABSTRACT. The study examines how systematic teaching of nursing decision‐making process can develop nurses' decision‐making in practice. The study was carried out as action research. Teaching lasted five months. The subjects were measured by many methods at the beginning and at the end of the study. The results showed that by systematic teaching nurses can learn the identifying and understanding of decision‐making process as separate from the organisational factors in the work environment. The utilisation of this knowledge in nursing practice presupposes the support of the work environment.
Moral Sensing and Ideological Conflict
Authors: Lützén Kim
Published: March 2013

ABSTRACT. A qualitative research study was conducted for the purpose of gaining knowledge of the therapeutic relationship as experienced by the psychiatric nurse. Deinstitutionalisation of the mentally ill, one of the goals of the mental health policy in Sweden, has broadened the field for psychiatric nurses. Nursing education on an academic level has prepared the nurse theoretically for increased responsibility in a variety of psychiatric settings. A general psychiatric ward in a large mental institution was chosen for the field work in this study. A phenomenological perspective and aspects of Grounded Theory were combined in the research strategy of participant observation. Data were collected and analysed simultaneously. The emerging conceptual categories were abstracted to two core concepts, moral sensing and ideological conflict. These were seen as central themes of the nurse‐patient relationship as experienced by the psychiatric nurse. The nurse experienced that the dominant psychiatric ideology contradicted her own ideology. In order to reduce tension caused by this conflict, the nurse sought emotional support and encouragement from her co‐workers. Alliance with the group could be seen as one strategy to reduce tensions but not necessarily to solve moral issues. The implication of this study is that although there may be a change in attitudes and approaches to mental illness and health, there are areas in psychiatric nursing which have not been fully explored. The nurse experiences many conflicts which can be described as ideological. This indicates the need to examine further the value and belief system upon which ethical decision‐making is based and its effect on the nurse‐patient relationship in psychiatric nursing.
Homecare at the End of Life
Authors: Sørbye Liv Wergeland
Published: March 2013

ABSTRACT. The study is a part of a research project on death in a sector of a large city, involved cooperation with the Franciscan Aid “home care team”. The purpose was to study death in the home setting. Fifteen deaths were registered. Participant observation in the care of 14 patients were made—a total of 83 visits to homes, 2–15 visits per patient. In one case the author had contact with the relatives, after the death had occurred. Most of the patients had cancer. Their age varied from 28 to 80 years. The observations were recorded immediately after each visit. After the death of a patient a structured interview with the closest relatives and the nurse responsible were made. Their statements were used as a basis for formulating problems for the further study and the clarification of quantitative data. Results showed that the patients who chose to leave the hospital and remain at home often had negative experiences in hospital. All the patients in this study received good palliative treatment at home. All patients were also informed about their condition. One‐third of the patients were readmitted to hospital during the final days.
Caregivers' Perceptions and Interpretations of Severely Demented Patients during Feeding in a Task Assignment System
Authors: Athlin Elsy , Norberg Astrid , Asplund Kenneth
Published: March 2013

ABSTRACT. Ninety‐one focused interviews concerning the feeding of 23 severely demented patients were performed with 62 caregivers who fed the patients in a task assignment system. The aim was to increase the understanding about how caregivers perceive and interpret severely demented patients' behaviour and experiences during feeding. Content analysis showed that the caregivers' commitment or lack of commitment constituted a superior level that determined whether the patient was seen as a subject or as an object. Subcategories that were found were knowledge of the patient's disease and personal history, intuition, identification, empathy, generalisation and routinisation.
Sexuality and the Satisfaction of Sexual Needs
Authors: Paunonen Marita , Häggman‐Laitila Arja
Published: March 2013

ABSTRACT. This article discusses conceptions of sexuality and the satisfaction of sexual needs in a sample of aged home nursing patients (N= 50) in a small rural town in Finland. The purpose of the study, which was carried out as part of a nursing development project in the form of action research, was to gain a deeper understanding of the satisfaction of basic human needs and problems of need‐satisfaction in aged people, particularly in the domain of sexual needs. The data were collected using a semi‐structured questionnaire, which was designed primarily on the basis of the need theories of Yura & Walsh and Orem.

Negative attitudes towards sexual needs were found in more than half of the aged respondents; they did not consider it proper for aged people to have an active sex life. One‐quarter felt that sexual needs and desires were shameful and sinful. Only less than one‐quarter had positive attitudes towards sex. The majority of the respondents felt that they could freely and confidently talk about sex with the nursing staff, but only less than one‐quarter were willing to do so. Almost all had some need to show affection to another person. The majority accepted their own self‐image, but half were not satisfied with their physical appearance.
Urinary Incontinence after Perineal Trauma at Childbirth
Authors: Röckner Gunny
Published: March 2013

ABSTRACT. Stress urinary incontinence is the most common form of female incontinence. The purpose with this study was to describe consequences of episiotomy and spontaneous tears on urinary incontinence after the delivery. A postal questionnaire was sent to 205 women who had participated in an earlier study concerning episiotomy and spontaneous tears during delivery. They were contacted four years post‐partum. One hundred and eighty‐five women (90%) responded and there was no difference in the response rate between the group with episiotomy and in the group with spontaneous tears. Urinary incontinence symptoms were found in 65 women (36%). This frequency was similar in both groups. The study does not confirm the protective value of episiotomy on urinary incontinence.
Learning to Cope and Living with Cancer
Authors: Grahn Gertrud , Johnson Judi
Published: March 2013

ABSTRACT. Giving of information to cancer patients and their family members regarding the disease, the treatment procedures and the adaptation process for living with the uncertainty inherent in a diagnosis of cancer, is as reported often not effective due to peoples' failure to understand. The impact of emotional stress creates communication difficulties. Information not based on assessed learning needs and considered individual differences as to learning militates against proper understanding. In developing an educational programme a study has been carried out aiming to assess learning needs. Cancer patients (n= 50), their family members (n= 20) and staff members within cancer care (n= 30) were asked to answer a need assessment questionnaire. The patients/family members indicated an extensive desire to learn about cancer and its ramifications, whereas staff members indicated that they seldom were approached regarding some questions in the area. The findings support the appropriateness for providing a structured patient education programme based on assessed needs and planned to meet individual differences in learning readiness and learning capabilities, that would complement the information currently given by staff members.
A Comparison between Experienced and Objectively Demonstrated Urinary Leakage in 85‐year Old Men and Women
Authors: Hellström Lisbeth , Ekelund Peter , Larsson Mayethel , Milsom Ian
Published: March 2013

ABSTRACT.The ability of 37 urinary incontinent 85‐year old men and women to perform the 48‐h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48‐h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty‐eight of the 37 men and women successfully performed the 48‐h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 ± 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 ± 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of >30 g. Six men considered their incontinence to be moderate (25.0 ± 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.
Recovery after Myocardial Infarction
Authors: Fridlund Bengt , Högstedt Benkt , Lidell Evy , Larsson Pår A
Published: March 2013

ABSTRACT. The aim of the study was to evaluate a multifactorial rehabilitation programme based on interdisciplinary caring efforts for myocardial infarction (MI) patients. Randomly chosen MI‐patients participated, either in a six‐month rehabilitation programme (intervention group=53) or in routine cardiac followups (control group=63). Subjective and objective instruments were used for measuring their health recovery. Biophysical improvements were showed as an increased physical capacity (p<0.001) using a submaximal exercise test six months after MI, and less reinfarctions (p<0.024) twelve months after MI, to the intervention patients' advantage. Psychological improvements were demonstrated in a higher life satisfaction (p<0.001) six months and (0.1>p>0.05) twelve months after MI to the intervention patients' advantage. Social improvements were indicated as a better leisure situation (p<0.004) six months after MI, and as a better partner situation (p<0.010), including a less influenced sex life (p<0.017), twelve months after MI to the intervention patients' advantage. As to the overall view, the caring rehabilitation programme appeared to be required for the MI‐patients' health recovery. In order to be able to reach an optimal state of human health, an even more individualised programme seems to be necessary.
Patients' Experience of Uncertainty in Illness in Two Intensive Coronary Care Units
Authors: Andersson‐Segesten Kerstin
Published: March 2013

ABSTRACT. The Swedish concept “trygghet” is multidimensional and includes notions such as security, safety, confidence, certainty and trust. Patients in coronary pain are in special need of “trygghet”. In order to study the certainty dimension of the concept the Mishel Uncertainty in Illness Scale, MUIS, was used. This 34 item Likert scale is based on four factors: multidimensional ambiguity, complexity, deficit information and unpredictability. A special Cardiovascular Population Scale is formed by utilising 16 of the items included in MUIS. Patients' experiences of uncertainty were studied in two Intensive Coronary Care Units, in different locations, and with different staffing and nursing routines.

There were almost no significant differences in scores on MUIS between the two ICCU wards. In the background data, the only discriminating factor was the time between previous and current hospital stays. The shorter the time, the more the uncertainty.
Abilities and Activities of Patients with Dementia in Day Hospitals
Authors: Borell Lena , Sandman Per‐Olof , Winblad Bengt
Published: March 2013

ABSTRACT. The proportion of individuals with dementia is increasing in all kinds of institutions. Specialised day hospitals are now being developed as an alternative to long term care for the demented. Twelve day hospital wards, with 312 individuals suffering from dementia, were included in a study aiming to assess functional abilities and frequencies of participation in different activities. Eighty‐nine per cent of the day hospital patients could be classified as having a dementia disease. Seventy‐eight per cent of the population were dependent on some kind of help from a caregiver in the performance of ADL activities. The most common occupations that could be seen in the programmes were physical activities, entertainment, and personal care activities. The activities were often undertaken as large group activities, often including more than ten patients. The functional abilities that characterise the population are comparable with those of the population living in pensioners' service blocks with full board.
The Norwegian, Danish and Dutch Version of the Appraisal of Self‐care Agency Scale; Comparing Reliability Aspects
Authors: van Achterberg Theo , Lorensen Margarethe , Isenberg Marjorie A. , Evers George C. M. , Levin Erna , Philipsen Hans
Published: March 2013

ABSTRACT. This study was designed to test reliability aspects of a scale that was developed to measure the theoretical concept of self‐care agency (Orem 1985). Equivalence and internal consistency of the scale were studied with populations of elderly patients and their nurses in The Netherlands, Norway and Denmark. Data was provided by 120 patients and 233 nurses. Not all criteria for reliability could be met for the Danish and the Norwegian versions of the scale. Nevertheless it is concluded that the results are indications for the reliability of the Dutch, as well as the Danish and Norwegian versions of the scale.