Abstraktsamling muntliga föredrag och postervisning. Utmaningar, möjligheter och horisonter i hälsans globala århundrade

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1 Abstraktsamling muntliga föredrag och postervisning Utmaningar, möjligheter och horisonter i hälsans globala århundrade Den 15 oktober 2014

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3 1 När kriget är allt jag minns hur hjälper vi traumatiserade äldre? Föreläsningssal Henry Dunant, klockan Föreläsare: Frida Johnsson Metso, leg. psykolog Institution/affiliering: Röda Korsets Center för torterade flyktingar Syfte Hur hjälper vi dem som utan försvar återupplever sina krigstrauman om och om igen? Hur förstår vi minnesförsämringar hos en äldre traumatiserad flykting - kan vi upptäcka tidig demens eller tar vi för givet att det är traumatiseringen som påverkar minnet? Misstar vi förvirring för demens, när det rör sig om posttraumatiskt stressyndrom? Vi behöver utveckla vår förståelse för skillnaden mellan de minnessvårigheter som uppstår på grund av posttraumatiskt stressyndrom (PTSD) och de som uppstår på grund av demens för att kunna erbjuda patienten en så god behandling och ett så gott bemötande som möjligt. Vi behöver också förstå samspelet dem emellan, hur de kan maskera och förändra varandras uttryck och symptom, vilket kan göra differentialdiagnosticering svårt och lämna många traumatiserade flyktingar utan den vård de behöver. Föreläsningen redogör för en kunskapsöversikt av relevanta delar av den tillgängliga psykologiska forskningen på området, som bland annat visar att skadade minnesfunktioner, demensutveckling och åldrande påverkar utvecklingen av vissa PTSD-symptom samt att PTSD-patienter har förhöjd risk att utveckla demens. Bakgrund När en traumatiserad person åldras och drabbas av demens är motståndskraften mot traumaminnen mycket svag. PTSD betraktas vanligtvis som en ångestdiagnos men är i hög utsträckning också en minnessjukdom och anses också accelerera det naturliga åldrandet. Hittills består den svenska erfarenheten av att upptäcka och hantera dessa patienter framför allt av arbetet vid judiska äldreboenden och forskningen är begränsad. När nu många av de flyktingar som kom till Sverige på och 80-talet blir äldre behöver vi förbereda oss på att kunna ge dem bästa möjliga omsorg - och vi behöver blir skickligare på att ställa tidiga och riktiga diagnoser och förstå hur PTSD och demens påverkar varandras sjukdomsförlopp.

4 2 Att möte och rehabilitera traumatiserade flyktingar Föreläsningssal L3, klockan Föreläsare: Tuire Toivanen, leg. läkare Medförfattare: Susanna Toivanen, fil. doktor Institution/affiliering: Stiftelsen Röda Korsets Center för torterade flyktingar Bakgrund Tortyr förekommer i alla delar av världen och används som förhörsmetod och bestraffning i syfte att bryta ned en människas kropp och psyke. Nästan alla flyktingar som idag kommer till Sverige bär på svåra upplevelser av tortyr eller andra trauman. Syfte Det finns ett stort behov i samhället och arbetsmarknaden av kunskap om tortyrens konsekvenser. Studien vill svara på följande frågor: Hur möter man en traumatiserad person? Hur hjälper och bemöter man traumatiserade personer som vill ha stöd att klara sin vardag i ett nytt land? Hur stödjer man bäst deras integration i det nya samhället? Metod Författaren har arbetat på Stiftelsen Röda Korsets Center för torterade flyktingar sedan 1992 med både social, medicinsk och arbetslivsinriktad rehabilitering. Kunskap av möten med drygt tre tusen torterade människor har samlats. De erfarenhetsmässigt och samhällsekonomiskt bästa rehabiliteringsinsatser har valts. Resultat Studien pekar på fördelarna med rehabilitering ur ett psykofysiskt och socioekonomiskt helhetsperspektiv. Den poängterar också vikten av att öka samordningen mellan olaika myndigheter och vårdinsatser. Slutsats Studien har resulterat i en bok Utsatt för tortyr - att möta och rehabilitera traumatiserade flyktingar (Gothiafortbildning 2014).

5 3 A study of the life world of the spouses to persons with Alzheimer s disease Föreläsningssal HD, klockan Föreläsare: Mette Bergman 1,2, doktorand Medförfattare: Caroline Graff 1,2, Maria Eriksdotter 1,2, Marja Schuster 3 Institution/affiliering: 1 Karolinska Institutet, 2 Karolinska University Hospital, 3 Swedish Red Cross University College. Background Few studies focus on the life world of a spouse to a person who is affected by early-onset Alzheimer s disease (AD). There is no evidence for how healthcare professionals can ease their situation. The aim of the study was to explore the meaning of being a spouse to a person with AD. The lived experiences of spouses were focused. Methods The study had an existential phenomenological hermeneutic perspective. The theoretical underpinnings consist of life world experiences explored by means of four life existentials: lived space, lived body, lived time and lived relation. Ten narrative interviews were performed with five women and five men at age between 40 and 64. The interviews were recorded and transcribed and the analysis of the texts evolved through phenomenological hermeneutical reflection, following the four life existentials. Results The results showed that the spouses being-in- the world changed with the diagnosis. The weakness of the person affected by AD was compensated by the spouse and their life became tightly interlaced. The spouses feeling of responsibility and dependence, on one hand, and the longing for freedom and independence on the other hand, was apparent in the texts. The future made the spouses feel deprived of their dreams, their beloved, and all their plans and they remained fixed in the moment to ease their existential anxiety. The role of a secure home became central while it was perceived as limiting at the same time. Conclusions The results of the study indicate an ambivalent and complex picture of the existential conditions of the spouses. It therefore appears to be important for healthcare professionals to get a deeper understanding of these conditions in order to be able to support spouses in their struggle for new meaning in their lives.

6 4 Flyktingar med krigs- och tortyrskador datainsamling för beskrivning av patientgrupper på Röda Korsets Behandlingscenter (RKC) Malmö Föreläsningssal L3, klockan Föreläsare: Henrik Nilsson, leg. sjukgymnast Medförfattare: Andreas Malm, leg. psykolog Institution/affiliering: Röda Korsets Behandlingscenter Malmö Bakgrund RKC Malmö bedriver sedan 1988 multimodal behandling (psykologisk, sjukgymnastisk, kurativ, medicinsk) för flyktingar som traumatiserats genom upplevelser av krig och/eller tortyr. Följderna av den typen av upplevelser är alltid komplexa, och påverkar inte bara individen, utan också hennes familj och det samhälle hon lever i. Sedan 2010 gör RKC systematiskt skattningar av patienters självupplevda hälsa och hur den påverkas under behandlingens gång. Syfte Att fånga komplexiteten i den problematik som finns bland flyktingar i Sverige som traumatiserats genom upplevelser av krig och tortyr och som får behandling på RKC Malmö. Att bättre förstå hur individens hälsa påverkas av såväl behandlingsspecifika faktorer som pre- och postmigratoriska faktorer. Att insamlad data ska kunna ligga till grund för fortsatta studier av både kvantitativ och kvalitativ art, metodutveckling inom RKC, ökad samverkan med andra delar inom SRK samt samhällelig informationsspridning - för att totalt sett öka förutsättningarna för en mer gynnsam anpassnings- och återhämtningsprocess för målgruppen. Metod Självskattningsformulär med avsikt att mäta ett flertal av de vanligast förekommande besvären för målgruppen har administrerats till nya patienter innan behandlingsstart och därefter med 6 månaders intervall så länge behandling pågått. Aktuella formulär gäller PCL-C (Posttraumatic Checklist, civilian version), HSCL-25 (Hopkins Symptom Checklist), SCL-90 somatiseringslista (Symptom Checklist Somatization Items), WHO-5 (WHO-5 Well-Being Index) samt SDQ-5 (Somatoform Dissociation Questionnaire). Formulären har administrerats på arabiska, bosniska/kroatiska/serbiska, svenska och engelska, beroende på patientens modersmål och språkkunskaper. Mindre språkgrupper samt funktionell analfabetism har i vissa fall försvårat administreringen och frågorna har i dessa fall lästs upp för patienten med hjälp av tolk. Språklig och kulturell validering har gjorts för vissa formulär, andra under pågående arbete. Kompletterande data gällande personuppgifter, trauma- anamnes, ankomst till Sverige, familjeförhållande etc., har samlats in under bedömningsfas med behandlare på RKC. En strukturerad mall för denna bedömning är under pågående arbete. Resultat Från januari 2010 till juni 2014 har data från 530 unika individer samlats in, totalt har 925 självskattningar utförts med en variation på 1-7 upprepade tillfällen. Heterogeniteten i gruppen har varit stor, varierande demografi, traumabakgrund, tid i Sverige, familjesituation etc. Dominerande ursprungsland och språk har varit Irak respektive arabiska, ca 1/3 kvinnor och 2/3 män, ålder Slutsats Data som samlats in på RKC sedan 2010 har varit av stort kliniskt värde på individnivå, det har dock saknats verktyg och kunskap för att kunna använda materialet i ett större perspektiv. För detta behöver i första hand en databas upprättas, statistiska analyser genomföras och fortsatta studier/forskningsansatser formuleras.

7 5 Intersektionella perspektiv på äldreboende anhörigas sociala position som mellanförskap Föreläsningssal HD, klockan Föreläsare: Jessica Holmgren 1, doktorand Medförfattare: 1 Azita Emami, Lars E Eriksson 1, Henrik Eriksson 2 Institution/affiliering: 1 Karolinska Institutet, 2 Röda Korsets Högskola Bakgrund Att vara anhörig till någon som bor på äldreboende har tidigare beskrivits som ibland både komplext och utmanande. Trots att anhöriga vill vara delaktiga i vården kring sina äldre familjemedlemmar och närstående stöter de på bekymmer i mötet med vårdpersonalen och äldreboendena som institutioner. Detta har visat sig beror bland annat på bristande kommunikation och information, brist på kunskap och resurser. Trots omfattande forskning har man i liten utsträckning beskrivit anhörigas sociala position på äldreboende utifrån olika intersektionella maktordningar. Syfte Syftet var att beskriva anhörigas delaktighet och sociala position utifrån föreställningar om genus, etnicitet, ålder och klass vid tre äldreboenden. Metod Femton anhöriga intervjuades kvalitativt om sitt resonemang kring sin delaktighet på äldreboende. Materialet analyserades temaanalytiskt med hänsyn till de intersektionella perspektiven. Resultat Det första temat av tre; Inklämd mellan generationella genusfierade familjeansvar och ombytta vårdarroller, beskriver att de anhöriga upplever att de socialt sett befinner sig i ett mellanförskap. Mellanförskapet representerar känslan av att vara inklämd mellan olika konkurrerande sociala måsten från de äldre familjemedlemmarna, vårdpersonalen och äldreboendena som institutioner. Nästa tema; Att vara en förfrämligad talesperson en komplex position i egenskap av den Andre mellan familjemedlemmar och institutioner, belyser hur anhöriga fungerar som språkrör mellan sina familjemedlemmar och äldreboendena. Detta blev extra tydligt när de boende inte kunde tala svenska och hade en annan etnisk bakgrund än den svenska. Det sista temat; Att uppnå hegemonisk ömsesidighet mellan vårdpersonal och anhöriga, illustrerar en mer priviligierad position för somliga anhöriga som kunde kopplas till socialt kapital. De anhöriga som hade utbildning och ett nätverk såg till att de hade inflytande och kunde vara delaktiga i det som rörde deras äldre familjemedlemmar på äldreboendena. Slutsats Anhörigas delaktighet villkoras av att de upplever att de befinner sig i ett mellanförskap där de är inklämda mellan olika sociala förväntningar från sina äldre familjemedlemmar, vårdpersonalen och äldreboendena som institutioner. Anhöriga tillskrivs olika sociala identiteter som är kopplade till maktordningar rörande genus, etnicitet, ålder och klass vilka skapar förväntningar på anhöriga som ibland får dem att känna sig förfrämligade och maktlösa. Dessa intersektionella maktordningar bidrar till en känsla av annanhet.

8 6 Possibilities to understand men s health in forensic psychiatric care a challenge for the new millennium Föreläsningssal L3, klockan Föreläsare: Per Ekstrand 1, docent Medförfattare: Esa Kumpula 2 Institution/affiliering: 1 Swedish Red Cross University College, 2 Mälardalen University Background Forensic psychiatric care in Sweden constitutes a specific institutional environment in health care in terms of gender and power relationships. The project focuses on challenges and possibilities to understand men s health in forensic psychiatric care. Health is a welfare issue with implications for gender equality, age, ethnicity and other dimensions of power. From the standpoint of equality it is possible to interpret that constructions of gender could influence caregivers view on health and activities of health promotion for the patients. Aim Is to explore and discover the interplay between gender and men s health in forensic psychiatric care (fpc). Method: the research project has an ethnographic approach and in this paper the main focus is to problematize men s health in fpc from some theoretical standpoints. Result When men together constitute a majority of staff and patients, there are complex relationships between men s health and constructions of masculinities. When contextualizing gender it help us to describe what constitutes the core of patient s experiences of health and factors that influence caregiver s views on health and activities that promote health. When patients lack freedom and their social life is limited and controlled by rules and regulation, it indicates that caregiver s definitions of health and health promotion activities are of practical importance for their caring work. We also find that questions of men s health in fpc not are a single issue that can be separated from patterns and structures in the environment. Conclusion If the overall objective in forensic psychiatric care is to prevent criminal recidivism, it is relevant to argue that this could be related to differences in men s health and the constructions of masculinities in caregiver s everyday work.

9 7 Extension of labels within the EQ-5D-Y Föreläsningssal HD, klockan Föreläsare: Mimmi Åström 1, MSc. Medförfattare: Ann-Charlotte Egmar 2, Kristina Burström 1 Institution/affiliering: 1 Karolinska Institutet, 2 Swedish Red Cross University College Background Patients health-related quality of life (HRQoL) has over the last century gained more value as an outcome measure in healthcare than traditional measures such as mortality and other clinical parameters. EQ-5D is a well-known generic measure, which makes it possible to compare HRQoL among different disease groups. In 2010, EQ-5D was adapted to be suitable for children and adolescents, known as the EQ-5D-Y. The EQ-5D-Y consist likewise the EQ- 5D of a descriptive system with five dimensions; mobility, looking after myself, doing usual activities, having pain or discomfort and feeling worried sad or unhappy, where each dimension is defined with three level of severity; no problems some problems and a lot of problems. Additionally to the dimensions the EQ-5D-Y consist of a visual analogue scale (VAS). In 2011, a five level of the EQ-5D adult version was introduced, as a more sensitive measure of HRQoL. The purpose with increasing the number of severity levels was to avoid ceiling effects. Since the development of the adult 5-level version the interest in also developing a version with more than three levels of severity for children and adolescents has increased. Aim The aim of the study is to extent the labels within the EQ-5D-Y and to develop and test a four- and five level version of the instrument. Methods The study is conducted parallel in four different countries; Sweden, United Kingdom, Germany and Spain, from March 2014 until June A literature review of existing HRQoL instrument for children and adolescents was conducted to generate a pool of possible labels of severity. For the first phase of the study, children and adolescents will be recruited from the general population of school children. Interviews will be held with each participant to assess the labels. The younger children, 8-10 years, will sort the labels according to the severity for each dimension along a scale with smileys and for the older children, years, the participants will be asked to rate the severity levels along a VAS scale. For the second phase one sample of children and adolescents will be recruited from general population of school children and one sample from Karolinska Hospital. Focus groups interviews will be held to assess the comprehensibility and interpretation of the potential labels. All participants will self-complete one of the potential alternatives of new EQ-5D-Y versions, and afterwards there will be a discussion regarding the participant s preferences. Preliminary results Preliminary results will be presented at the conference in 15th of October 2014.

10 8 Virtual invisible men: privacy and invisibility as forms of privilege in online venues for fathers during early parenthood Föreläsningssal HD, klockan Föreläsare: Henrik Eriksson 1, professor Medförfattare: Martin Salzmann-Erikson 2, Keith Pringle 3 Institution/affiliering: 1 Swedish Red Cross University College, 2 Dalarna University, 3 Uppsala University Given the proliferation of support technology for men entering parenthood in virtual forums this project s aim was to explore a virtual forum exclusively for fathers and elaborate on gendered questions for men s parenthood within that milieu. An archival forum study was undertaken using principles for nethnography. The categories presented in the results overall indicate that the online venue creates a privileged invisibility from experiences in real life gender relations. This suggests that both horizontal and vertical homo-social dimensions are present in the forum support/negotiations which occur among the forum posters, whereby issues of invisibility and entitlement in some cases take a central position. The result suggest that being virtual invisible men entails participation in both a marketplace of opinions and a homo-social competition. Key words Parental practice, internet forum, nethnography, invisible masculinity, parenthood.

11 9 Coping effectiveness training in patients with chronic heart failure a randomized controlled study Föreläsningssal HD, klockan Föreläsare: Catarina Nahlén Bose 1,2, doktorand Medförfattare: G Björling 1, ML Elfström 2, H Persson 2, F Saboonchi 1 Institution/affiliering: 1 Swedish Red Cross University College, 2 Karolinska Institutet (KI DS) Background Chronic heart failure (CHF) is an illness that affects 2-3 percent of the population and the prevalence increases sharply with age, above 70 years old 10 percent have CHF. It is one of the major healthcare costs and it is a challenge for healthcare to take care of all the patients. Individuals with CHF do not only suffer from the physical limitations caused by the illness, but anxiety and depression are more prevalent in this group compared to other conditions. They also experience worse quality of life. Depression has been shown to be an independent predictor of mortality in patients with CHF. Psychosocial intervention could be a possible approach to help people with CHF to cope with their illness better. Purpose To develop, implement and evaluate a stress management program to improve emotional well-being, health-related quality of life and to reduce readmission to hospital. Method A randomized controlled study design was employed in which the intervention consisted of Coping Effectiveness Training (CET), a manual-based group intervention based on a cognitive transactional theory of stress and coping. The purpose of CET is to improve skills to appraise stress, teach a number of techniques to cope with stress, and to give an opportunity to interact with other people with similar experiences of living with CHF. The CET program was, in this study, modified for patients with CHF. The intervention consisted of seven, 90- minute weekly sessions. The control group (n= 50) received standard health care. The intervention group (n= 50) received CET intervention led by a nurse with a Master s degree in nursing science and extensive experience in heart failure care in collaboration with a professional psychologist. Each group consisted of 8 to 12 patients. Assessments of the outcome variables were performed before the intervention, directly after the intervention, six weeks, six months and one year after the intervention period. The following outcome variables were included: emotional well-being, depression and anxiety, illness perception, health-related quality of life, coping strategies and social support. The participants in the intervention group also filled in a written evaluation directly after the intervention. The clinical variable that will be included is readmission to hospital. Results Preliminary results from the written evaluation forms indicate that most of the participants considered they benefited from the intervention, and that they would recommend it to a friend. The majority were pleased with the logistics and organisation of the CET intervention. Conclusion Stress management intervention for patients with CHF is feasible and appears to provide important support to this patient group.

12 10 Women s voices in a shifting global health landscape a journalistic analytical approach: A step behind a leap forward Föreläsningssal L3, klockan Föreläsare: Stéphanie Paillard-Borg, med. dr. Institution/affiliering: Swedish Red Cross University College Background Japan is facing a super-aged society, a steady birth decline resulting in a major population decline and very-low female employment rate compared to other industrialized countries. The most important structural reforms proposed by the Japanese Prime Minister Shinzo Abe, include increase in international labor mobility and Japanese women s participation in the labor force. The first reform implies the immigration to Japan of female foreign domestic help and the second one an increase in Japan s GDP through Japanese women employment. These two matters are highly correlated and their economic and socio-cultural impact massive for the country. Currently without enough feasible options to manage child and elderly care and work responsibilities, many Japanese women will continue to bail out of the employment force. In order to find this equilibrium between a better work-life balance in general, the use of foreign domestic helpers is an obvious case option. However, this alternative is source of major dilemma such as multiculturalism, challenged traditional role of wives and mothers, exploitation etc. Aim To describe one Japanese woman s reflections about immigration, foreign "domestic help" and women's employment in the midst of a country facing a super-aged society, demographic shrinkage and major social changes. Method A single case study with one open-ended interview was performed and analyzed by content analysis with a methodological departure in journalistic interviewing. Preliminary results Motherhood, privacy, pride, criminality, morality and stereotype were identified as the main elements maintaining the Japanese society with one foot in the past and propelling the other one in a global future.

13 11 Approaching adjustment through a proxy: The example of a latent analysis of change in anxiety in breast cancer Föreläsningssal HD, klockan Föreläsare: Fredrik Saboonchi, docent. Institution/affiliering: Swedish Red Cross University College, Karolinska Institutet Conceptualisations of health, wellbeing, quality of life, and adjustment display substantive overlaps. These overlaps have important implications for research, assessment, clinical work, and health promotion. Furthermore, there are inherent difficulties in approaching these constructs as directly observable. Latent variable modelling and latent modelling of change provide efficient methods to address these issues. These topics will be illustrated by the results of an investigation about the trajectories of anxiety in breast cancer.

14 12 Clinical use and material wear of silver tracheostomy tubes six-month study Föreläsningssal L3, klockan Föreläsare: Gunilla Björling 1,2, med. dr. Medförfattare: Minoodohkt Arzpeima 3, Claes Frostell 2, Aune Ragnhild 3,4 Institution/affiliering: 1 Swedish Red Cross University College; 2 Karolinska Institutet; 3 The Royal Institute of Technology, 4 The Norwegian University of Sciences and Technology. Background Studies have shown severe degradation of polymeric tracheostomy tubes in long-term use. Silver tracheostomy tubes are often used in long-term care, as they are believed to be less prone to material degradation and less associated to complications. Aim The aim was to study material degradation of silver tracheostomy tubes. Methods A six-month clinical study was conducted including six patients using silver tracheostomy tubes. The tube material was characterised by Scanning Electron Microscopy (SEM) before and after exposures. The release of metals from the tube material was studied in-vitro after exposure to synthetic body fluids using Flame Atomic Absorption Spectroscopy (FAAS). Results/Conclusion The in-vitro study showed high release of silver, far above the recommended exposure limits. New tubes revealed irregularities and defects on the surface origin from the manufacturing processes. Severe degradation was observed in case of the clinically exposed tube. The tip of the tubes was the area with the most attachment of secretion and showed the highest degree of degradation in all cases (Figure 1). The surface defects on the new tubes can host microorganisms and have an important role in initiation and acceleration of material degradation. Toxicity measurements in patients using silver tubes are recommended. Figure 1. SEM micrographs of samples from silver tubes used for six months. (a) biofilm attached around holes in the material (b) organic substances found inside the grooves around the fenestration site (c) biofilm covers the surface (d) a bacterial colony covered in biofilm attached to a rough and porous surface (e) condition as in (b) (f) the surface is very porous and organic substances is attached to the surface. (the bars show 10 µm)

15 13 In-vitro study of surface alterations of subcutaneous venous access ports exposed to antineoplastic drugs and whole blood Posterpresentation kl (L4) Författare: Gunilla Björling 3,4, med. dr. Medförfattare: Maren K. Fossum 1, Emma Strömberg 2, Javier Sanchez 3, Charlotta Tegnestedt 3,4, Samuel Rotstein 3, Ragnhild E. Aune 1 Institution/affiliering: 1 Norwegian University of Science and Technology, Trondheim, Norway, 2 The Royal Institute of Technology, 3 Karolinska Institutet, 4 Swedish Red Cross University College Subcutaneous Venous Access Ports (SVAPs) are commonly used during long-term placement for administration of antineoplastic drugs used in chemotherapy. A significant number of complications that can lead to implantation failure have over the years been reported, i.e. thrombosis and infections. These complications subsequently also increases patient suffering and health care costs. The main aim of the present in-vitro study was to monitor the inner surface alterations of polyurethane SVAPs exposed to antineoplastic drugs over a prolonged period of time (6 cycles during 18 weeks). The chemical stability and mechanical properties of the material were analysed both before and after each exposure to the drugs, and the changes in surface structure and topography recorded. Moreover, the thrombogenicity of the catheters was evaluated by exposing the outer surface of the drug-exposed catheters to whole blood. The results clearly indicate an association between the observed surface alterations and an increased thrombogenicity. Figure 1. The picture clearly shows fibrin on the surface of the SVAP after exposure for 60 min ex vivo in native human blood, in a Chandler loop. (After 6 treatments with FE 100C in-vitro.) Blood clot in detail Figure 2. The outer surface of a SVAP Reference Figure 3. The outer surface of 6 sessions of Catherer (SEM. Magnification: 4000X) 6 treatments with cytostatica, FE 100C, (SEM. Magnification: 4000X). Keywords: Subcutaneous Venous Access Port (SVAP), polyurethane, antineoplastic drugs, blood, alterations, thrombogenicity.

16 14 An international university college in the era of globalization of health Posterpresentation kl (L4) Författare: Sofia Larsson, MSc. Medförfattare: Jenny Cadstedt Institution/affiliering: Swedish Red Cross University College Background The Swedish Red Cross University College has belonged to the international humanitarian Red Cross organisation for over a century. This association means that students who want to work with global health issues and to reduce human suffering internationally choose to study at the Swedish Red Cross University College. Internationalisation has always been a prioritised area for the university college, this includes not only student- and teacher exchange and international collaborations in research and education, but also global perspectives in the curriculum. In an increasingly globalising world the pressure for universities and university colleges to focus on internationalisation is high. This is seen in the Swedish government's directives and legislation. In the Swedish Higher Education Act (Högskolelagen) it is stated that university education shall aim to increase students' knowledge of other countries and of international conditions (the Swedish Higher Education Act chapter 1, section 5). Aim The overall aim of the project "An international University college in the era of globalisation of health" is to educate students about global perspectives on health conditions, health systems and health challenges. An important part is to develop the students' capacity to think critically and reflect upon different health- and knowledge discourses, power relations and social positions, as well as upon politics of health in the world. Methods In order to fulfil the aim above the whole university college must be involved in various ways. There is a need to develop the curriculum, the pedagogy and teaching in a coherent and systematic way. To do this the overall aim must be translated into measurable objectives that the different staff categories can work with. In order to strengthen the relations with the Swedish Red Cross organisation this work should be conducted in close cooperation with them. Expected results This project is expected to result in nurses and other health professionals prepared to meet the health challenges in a globalising world. As graduates of the Swedish Red Cross University College our students will be able to critically reflect upon the inequalities of health and thereby be ready to work for social justice in line with the values of the Red Cross organisation. Conclusion The project "An international University college in the era of globalisation of health" will be an extensive long term project requiring resources of different kinds such as capacity building, time and commitment. These efforts will make the Swedish Red Cross University College an even more attractive higher education institution within the health sector.

17 15 Tools for subject integrated teaching and the formation of vocational knowledge in a Swedish upper-secondary health and social care program Posterpresentation kl (L4) Författare: Maria Christidis, doktorand Institution/affiliering: Swedish Red Cross University College, Stockholm University, Södertörn University The aim of the main study was to investigate subject integrated teaching in an uppersecondary Health and Social Care program and the vocational knowledge that was shaped in teaching. The aim of this presentation is to highlight a teacher-constructed case report as a tool for subject integration, the use of the tool for integration and the kind of vocational knowledge that is shaped through the use of the tool. The material was collected ethnographically and comprised of observation on teaching, with the case report as a base, during a theme unit called Professional language. The material further comprised of field-notes on teaching, interviews and informal discussions, soundrecording of teaching and material handed out during teaching. The material was analysed according to Activity-Theoretical concepts of actions, goals and tools. The results identified that the case report had a vocational origin but had been modified to an educational context. This qualified the case report as a boundary object. It was used by a teacher of core-subjects in teaching to highlight content related to Swedish and to vocational subjects, but also content that related to the theme unit. In conclusion, the use of the teacher-constructed case report in subject integrated teaching helped shape additional vocational knowledge compared to subject-specific teaching. Keywords: Activity-theory, subject integration, vocational education, vocational knowledge

18 16 Allogeneic stem cell transplantation patients and family members experiences from two different caring contexts Posterpresentation kl (L4) Författare: Karin Bergkvist 1, doktorand Medförfattare: Joacim Larsen 2 Institution/affiliering: 1 Karolinska Institutet, 2 Swedish Red Cross University College, Background Allogeneic hematopoietic stem cell transplantation (HSCT) is a well-established treatment for mainly haematological diseases and has lately been offered to elderly patients and patients with co-morbidities. During the last decade, toxicity and mortality associated with HSCT have been reduced due to several improvements such as better pre-treatment, genomic tissue typing, improved supportive care and treatment of infections. These advances have led to development of HSCT programs in outpatient and home care (HC). Since 1998 it has been possible for patients at the transplantation center at Karolinska University Hospital, to choose between hospital care and home care after HSCT. Home care has shown to be safe with medical positive outcomes. Aim The aim of this PhD-project is to investigate and compare how patient s and family members experiences care from two different caring contexts, in home or at hospital. Patient s satisfaction with care and support from the healthcare staff will be evaluated ( study 1+4) and the family members experiences during the acute post-transplant phase will be described and explored (study 3). A comparison regarding general health and symptom occurrence between patients treated in hospital or at home will be performed post HSCT (study 2). Methods Data have been collected with different instruments; the SAUC measures self-rated satisfaction with care and support, General health (SF-12), symptom occurrence (SFID-SCT), anxiety and depression (HADS) and self-efficacy (GSE). To gain a deeper understanding for patients and family members own experiences interviews have been conducted. Results In study 1, the patients were highly satisfied with the care and support. Patients in home care were found to be more satisfied with care in general than patients in hospital care. The importance of safety, empathy, and encouragement from healthcare staff were expressed regardless of where care was given. In study 3, the majority of all patients in both hospital and home care rated their health as good, despite a median of fourteen ongoing symptoms; the most common symptom was fatigue. A high self-efficacy was also identified. There were no statistically significant differences between the two study groups, hospital or home care. Analysis are ongoing regarding study 3 and 4. Conclusions The main findings are that in comparison to hospital care, home care does not appear to have a significant negative effect on patients experiences of care and support. There are no longterms difference in general health and symptom occurrence between hospital and home care. Based on these results and earlier experiences we encourage other centers to start home care for patients who prefer it.

19 17 Patients thoughts regarding their consent to HPV vaccinate their young daughter in a school-based vaccination programme Posterpresentation kl (L4) Författare: Maria Gottvall 1, PhD Medförfattare: M Grandahl, A Höglund 2, Larsson M 2, C Stenhammar 2, B Andrae 2, T Tydén 2 Institution/affiliering: 1 Swedish Red Cross University College, 2 Uppsala University Objectives The objective of this study was to explore parents thoughts regarding their consent to HPV vaccinate their year old daughter in a recently started school-based vaccination programme in Sweden. The objective was also to explore their views on HPV-related information. Methods Individual interviews with parents (n=27) who had accepted HPV vaccination for their year-old daughter were conducted in the spring of The interviews were recorded, transcribed verbatim and analysed using thematic content analysis. Conclusions The parents expressed trust in the recommendations from authorities and a wish to protect their daughter from a severe disease. A school-based vaccination programme was considered convenient by the parents. All this outweighed their concerns about vaccine safety and potential side effects. The school nurse was found to have an important role; the parents wished for a dialogue with her/him to bridge the information gaps.

20 18 Time trends in prevalence of medication use in older adults (aged 78 years and older): a comparison of three elderly cohorts living in Stockholm, Sweden Posterpresentation kl (L4) Författare: Åsa Gransjö Craftman 1,2, doktorand Medförfattare: Kristina Johnell 1, Johan Fastbom 1, Eva von Strauss 3 Institution/affiliering: 1 Karolinska Institutet, 2 Sophiahemmet University, 3 Swedish Red Cross University College Background Older adults may suffer from several diseases and disorders and therefore often take multiple medications. This could be due to problems like temporary pain, anxiety, or an infection that needs treatment. It can also involve chronic illnesses that require treatment for a longer time. Medication use in older adults may bring significant opportunities but also involves risks. During the past decades there has also been an increased development of new drugs for the elderly, i.e. against pain, depression and dementia. How has this affected the consumption of medication in the elderly population? Aim To study time trends in prevalence of medication use and polypharmacy over 20 years ( ) by comparing three cohorts of older adults living in central Stockholm, Sweden. Method This study was based on three population-based cross-sectional surveys of older adults aged 78 years or over carried out in central Stockholm: the Kungsholmen Project in (n = 1,517), and the Swedish National study on Aging and Care in Kungsholmen in (n = 1,581) and in (n=1,206). All were clinically examined by physicians and interviewed by nurses using standardized protocols. Information about drug use was collected by the physician during the clinical examination. Drug prescriptions and medical containers were inspected when available (i.e. when the interview was carried out in the participant s own home). Both prescribed and over-the-counter drugs were recorded. Polypharmacy was defined as the use of five drugs or more. Univariate analyses was implemented (chi-square tests for proportions and one-way analyses of variance for means), and multivariate logistic models presented as odds ratios (OR) to compare prevalence, controlling for major confounders. Results The gender specific use of medication (mean number of drugs) in 1987 was 2.6 (±2.2) for men and 3.4 (±2.6) for women. The corresponding figures in 2001 was 4.5 (±3.4) and 5.5 (±3.4), and in (±4.0) and 6.6 (±3.9). The prevalence figures of polypharmacy had also increased significantly from 27.0% in 1987, to 53.9% in 2001, and 65.3% in After adjusting for age, gender, education and cognition, the odds of using analgesics and psychotropic were significantly higher in the year 2007 as compared to 1987, with an OR (and 95% Confidence Interval) for all of 3.3 ( ) and 1.3 ( ) respectively. Conclusion Prevalence of medication use in older adults has increased dramatically from the late 1980s to the mid-2000s in central Stockholm, Sweden. This was also true for polypharmacy and specifically for the use of analgesics.

21 19 Experiences of living with asthma a focus group study with adolescents and parents of children with asthma Posterpresentation kl (L4) Författare: Marina Jonsson 1,2, doktorand Medförfattare: Ann-Charlotte Egmar 3, Eva Hallner 1, Inger Kull 2 Institution/affiliering: 1 Stockholm County Council, 2 Karolinska Institutet, 3 Swedish Red Cross University College Objective The goal for asthma treatment is that every individual, so far as possible, shall live without symptoms and exacerbations. Patients and health care professionals sometimes have different perceptions of what is important for achieving good quality of life. Aim To describe the experiences among adolescents as well as those of parents with young children living with asthma. Methods Four focus group interviews were performed, two with parents of young children and two with adolescents. The data were qualitatively analyzed, using Systematic Text Condensation. Results Three themes relevant to the participants' experiences of living with asthma were presented; strategies, frustrations and expectations. The adolescents wanted to be like their peers and developed their own strategies for self-management of asthma, which included not always taking medication as prescribed. The parents emphasized frustration regarding not being believed, lack of understanding feelings of loneliness, or anxiety. One identified expectation was that the participants wanted to be met with competence and understanding in asthma care from health care professionals. Another expectation expressed among parents was that teachers in nursery and primary schools should have more knowledge and understanding on how to care for children with asthma. Conclusion Living with asthma leads to developing personal strategies in self-management of asthma. Moreover both parents and adolescents had expectations of being met by competent and understanding health care professionals. Developing a partnership between patients and health care professionals could be a successful way to improve the care of patients with asthma.

22 20 Patients in the forensic psychiatric setting and their nursing care needs Posterpresentation kl (L4) Författare: Maria Åling, MSc. Institution/affiliering: The Swedish Red Cross University College Three hundred (300) persons are sentenced to forensic psychiatric care/year. Thousand (1000) hospital beds out of 4300 in total in psychiatric care, are occupied by patients sentenced to forensic psychiatric care. The median length of stay for patients in forensic psychiatry is 3.5 years. In 2002 the National Board of Health and Welfare (Socialstyrelsen) pointed out that there is a lack of knowledge of the content of nursing care in forensic psychiatry. The care in the forensic psychiatric setting is a dual and conflicting mission that involves nursing of patients with complex mental illness when at the same time civic protection aspects must be considered. The overall scientific aim with this research project is to describe different aspects of nursing care in a forensic psychiatric setting (from a patient- and nursing relationship perspective). With the long-term clinical purpose of creating a nursing care intervention program for patients in forensic psychiatric setting. The aim of study I is to describe the nursing care needs and the experiences of being a patient in the forensic psychiatric setting. In this study interviews will be performed with around 20 patients and analysed with qualitative content analyses. The aim of study II is to identify and categorize the nursing care needs of patients in the forensic psychiatric setting. The method used in study II will be semi structured individual interviews with around 60 patients. The analyses will be made by identifying and categorizing the data according to the international taxonomy of NANDA. Descriptive statistics will be used as well. The aim of study III is to describe interactions in the daily nursing care performed in the forensic psychiatric setting. The method used in this study is observations along with informal interviews. The participants will be staff and patients in the psychiatric forensic setting and the method for analysing data will be content analyses with an ethnographic approach. The aim of study IV is to outline a nursing care intervention program for patients in the forensic psychiatric setting. Data collection will be done with a Delphi technique prospect based on the results of study I, II and III, and followed by questionnaires. Participants included in this study will be nursing care researchers, Registered Nurses and patient organizations. The analysis of data will be made with descriptive statistics, and qualitative and quantitative content analyses.

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