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  • 151.
    Persson, Carina U
    et al.
    University of Gothenburg.
    Linder, Annika
    Physiotherapy Department NU-Hospital Group, Trollhättan/Uddevalla.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Measurement properties of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) using Rasch analysis2017In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 53, no 6, p. 848-855Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A previous small-sample (n=150) Rasch analysis of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) suggested problems regarding response categories and redundant items that need confirmation in larger samples with more severe strokes.

    AIM: To evaluate the measurement properties of the SwePASS in patients with acute stroke.

    DESIGN: A multicentre, cross-sectional study.

    SETTING: Two stroke units in Western Sweden.

    POPULATION: The study cohort included 250 consecutive inpatients undergoing rehabilitation after acute stroke.

    METHODS: The SwePASS assessments were performed once within the first four days after admission to the stroke units. The data were analysed according to the Rasch measurement model regarding targeting, model fit, reliability, response category function, local dependence and differential item functioning.

    RESULTS: Postural control of 250 patients (median age, 76.5 years) was assessed with the SwePASS within median of two days after admission to the stroke units. The SwePASS covered a continuum of different levels of postural control, but had suboptimal targeting with insufficient representation of lower and higher levels of postural control. The reliability was high, the item fit statistics were generally acceptable and there was no differential item functioning by sex, age and stroke localization. However, response categories did not function as expected for four of the 12 SwePASS items and five items exhibited local dependency.

    CONCLUSIONS: The SwePASS exhibited several promising measurement properties. To improve the scale, poor targeting, illogical response categories and local dependency should be addressed.

    CLINICAL REHABILITATION IMPACT: The SwePASS provides valuable clinical information regarding postural control in the acute phase after stroke.

  • 152.
    Petersson, Ulrika
    et al.
    Neonatal Intensivvårdsavdelning, SUS, Lund.
    Sobiecki, Dariusz
    AIIVA, Infektionsklinik, SUS, Malmö.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Samuelson, Karin
    Institutionen för hälsa, vård och samhälle, Medicinska fakulteten, Lunds Universitet.
    Intensivvård ur ett genusperspektiv: en registerstudie2012In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 32, no 2, p. 51-55Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe in a gender specific perspective, demographic data from adult patients that have been treated in an intensive care unit.

    Background: Many studies show that there are differences between men and women when it comes to different aspects of health care. The knowledge of these differences is limited when relating to intensive care in Sweden.

    Method: Demographic data registered in the Swedish intensive care register including all intensive care cases during the year of 2009 (n=695) in an intensive care unit in a hospital in southern Sweden was analyzed. A group comparison between the sexes was made with the following variables: number of patients admitted, length of stay in the ICU, SAPS 3 (Simplified Acute Physiology Score) points, the five most common diagnosis, mortality and mortality per diagnosis.

    Results: The study showed an over-representation of men (62,2 %, p<0.001) in number of intensive care patients. The mortality was 9,9 % overall and significantly higher amongst men (11,8 %), compared with women (6,8 %, p=0.034). There were no differences between the sexes in length of stay, diagnosis, SAPS 3 points and mortality per diagnosis.

    Conclusions: This study has shown that more men than women are treated in the intensive care unit and that more men die during their time in the intensive care unit.

  • 153.
    Piccini, P
    et al.
    England.
    Brooks, D J
    England.
    Björklund, A
    Lund University Hospital.
    Gunn, R N
    England.
    Grasby, P M
    England.
    Rimoldi, O
    England.
    Brundin, P
    Lund University.
    Hagell, Peter
    Lund University Hospital.
    Rehncrona, S
    Lund University Hospital.
    Widner, H
    Lund University Hospital.
    Lindvall, O
    Lund University Hospital.
    Dopamine release from nigral transplants visualized in vivo in a Parkinson's patient1999In: Nature Neuroscience, ISSN 1097-6256, E-ISSN 1546-1726, Vol. 2, no 12, p. 1137-1140Article in journal (Refereed)
    Abstract [en]

    Synaptic dopamine release from embryonic nigral transplants has been monitored in the striatum of a patient with Parkinson's disease using [11C]-raclopride positron emission tomography to measure dopamine D2 receptor occupancy by the endogenous transmitter. In this patient, who had received a transplant in the right putamen 10 years earlier, grafts had restored both basal and drug-induced dopamine release to normal levels. This was associated with sustained, marked clinical benefit and normalized levels of dopamine storage in the grafted putamen. Despite an ongoing disease process, grafted neurons can thus continue for a decade to store and release dopamine and give rise to substantial symptomatic relief.

  • 154.
    Piccini, P
    et al.
    England.
    Lindvall, O
    Lund University.
    Björklund, A
    Brundin, P
    Lund University.
    Hagell, Peter
    Lund University.
    Ceravolo, R
    England.
    Oertel, W
    Tyskland.
    Quinn, N
    England.
    Samuel, M
    England.
    Rehncrona, S
    Lund University.
    Widner, H
    Lund University.
    Brooks, D J
    England.
    Delayed recovery of movement-related cortical function in Parkinson's disease after striatal dopaminergic grafts2000In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 48, no 5, p. 689-695Article in journal (Refereed)
    Abstract [en]

    Intrastriatal transplantation of dopaminergic neurones aims to repair the selective loss of nigrostriatal projections and the consequent dysfunction of striatocortical circuitries in Parkinson's disease (PD). Here, we have studied the effects of bilateral human embryonic dopaminergic grafts on the movement-related activation of frontal cortical areas in 4 PD patients using H2 15O positron emission tomography and a joystick movement task. At 6.5 months after transplantation, mean striatal dopamine storage capacity as measured by 18F-dopa positron emission tomography was already significantly elevated in these patients. This was associated with a modest clinical improvement on the Unified Parkinson's Disease Rating Scale, whereas the impaired cortical activation was unchanged. At 18 months after surgery, there was further significant clinical improvement in the absence of any additional increase in striatal 18F-dopa uptake. Rostral supplementary motor and dorsal prefrontal cortical activation during performance of joystick movements had significantly improved, however. Our data suggest that the function of the graft goes beyond that of a simple dopamine delivery system and that functional integration of the grafted neurones within the host brain is necessary to produce substantial clinical recovery in PD.

  • 155.
    Piccini, Paola
    et al.
    MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital.
    Pavese, Nicola
    MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital.
    Hagell, Peter
    of Restorative Neurology, University Hospital, Lund.
    Reimer, Jan
    of Restorative Neurology, University Hospital, Lund.
    Björklund, Anders
    Division of Neurobiology, Lund University.
    Oertel, Wolfgang H
    Quinn, Niall P
    6Department of Neurology, University of Marburg.
    Brooks, David J.
    Sobell Department of Motor Neuroscience and Movement Disorders, London.
    Lindvall, Olle
    Section of Restorative Neurology, University Hospital, Lund.
    Factors affecting the clinical outcome after neural transplantation in Parkinson's disease2005In: Brain, ISSN 0006-8950, E-ISSN 1460-2156, Vol. 128, no 12, p. 2977-2986Article in journal (Refereed)
    Abstract [en]

    Intrastriatal grafts of embryonic mesencephalic tissue can survive in the brains of patients with Parkinson's disease, but the degree of symptomatic relief is highly variable and some cases develop troublesome dyskinesias. Here we explored, using clinical assessment and 18F-dopa and 11C-raclopride PET, factors which may influence the functional outcome after transplantation. We observed increased 18F-dopa uptake in the grafted putamen, signifying continued survival of the transplanted dopaminergic neurons, in parallel with a progressive reduction of 18F-dopa uptake in non-grafted regions for the whole patient group. The patients with the best functional outcome after transplantation exhibited no dopaminergic denervation in areas outside the grafted areas either preoperatively or at 1 or 2 years post-operatively. In contrast, patients with no or modest clinical benefit showed reduction of 18F-dopa in ventral striatum prior to or following transplantation, which may have limited graft-induced improvement. We obtained no evidence that dyskinesias were caused by abnormal dopamine (DA) release from the grafts. As has been observed for intrinsic dopaminergic neurons, there was a significant correlation between 18F-dopa uptake and methamphetamine-induced change of 11C-raclopride binding (as a measure of DA release) in the putamen containing the graft. Furthermore, we observed no correlation between 11C-raclopride binding in anterior, posterior or entire putamen under basal conditions or after methamphetamine, and dyskinesia severity scores in the contralateral side of the body. Withdrawal of immunosuppression at 29 months after transplantation caused no reduction of 18F-dopa uptake or worsening of UPDRS motor score, indicating continued survival and function of the graft. However, patients showed increased dyskinesia scores, which might have been caused either by growth of the graft or worsening of a low-grade inflammation around the graft. These findings indicate that poor outcome after transplantation is associated with progressive dopaminergic denervation in areas outside the grafts, a process which may have started already before surgery. Also, that the development of dyskinesias after transplantation is not associated with excessive DA release from the grafts. Finally, our data provide evidence that long-term immunosuppression can be withdrawn without interfering with graft survival or the motor recovery induced by transplantation.

  • 156.
    Pietz, K
    et al.
    Tyskland.
    Hagell, Peter
    Lund University Hospital.
    Odin, P
    Lund University Hospital.
    Subcutaneous apomorphine in late stage Parkinson's disease: a long term follow up1998In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 65, no 5, p. 709-716Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Despite the recent introduction of new peroral drugs as well as neurosurgical methods for Parkinson's disease, treatment of late stage parkinsonian patients remains difficult and many patients become severely handicapped because of fluctuations in their motor status. Injections and infusions of apomorphine has been suggested as an alternative in the treatment of these patients, but the number of studies describing the effects of such a treatment over longer time periods is still limited. The objective was to investigate the therapeutic response and range of side effects during long term treatment with apomorphine in advanced Parkinson's disease.

    METHODS: Forty nine patients (30 men, 19 women; age range 42-80 years) with Parkinson's disease were treated for 3 to 66 months with intermittent subcutaneous injections or continuous infusions of apomorphine.

    RESULTS: Most of the patients experienced a long term symptomatic improvement. The time spent in "off" was significantly reduced from 50 to 29.5% with injections and from 50 to 25% with infusions of apomorphine. The quality of the remaining "off" periods was improved with infusion treatment, but was relatively unaffected by apomorphine injections. The overall frequency and intensity of dyskinesias did not change. The therapeutic effects of apomorphine were stable over time. The most common side effect was local inflammation at the subcutaneous infusion site, whereas the most severe were psychiatric side effects occurring in 44% of the infusion and 12% of the injection treated patients.

    CONCLUSION: Subcutaneous apomorphine is a highly effective treatment which can substantially improve the symptomatology in patients with advanced stage Parkinson's disease over a prolonged period of time.

  • 157.
    Prendergast, Virginia
    et al.
    Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ.
    Hagell, Peter
    Department of Health Sciences, Lund University.
    Rahm Hallberg, Ingalill
    Department of Health Sciences, Lund University.
    Electric versus manual tooth brushing among neuroscience ICU patients: is it safe?2011In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 14, no 2, p. 281-286Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU).

    METHODS: As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission.

    RESULTS: Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial η(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001).

    CONCLUSIONS: In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.

  • 158.
    Prendergast, Virginia
    et al.
    Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, Arizona.
    Rahm Hallberg, Ingalill
    Department of Health Sciences, Lund University.
    Jahnke, Heidi
    St Joseph’s Hospital and Medical Center, Phoenix, Arizona.
    Kleiman, Cindy
    Phoenix College, Phoenix, Arizona.
    Hagell, Peter
    Department of Health Sciences, Lund University.
    Oral health, ventilator-associated pneumonia, and intracranial pressure in intubated patients in a neuroscience intensive care unit2009In: American Journal of Critical Care, ISSN 1062-3264, E-ISSN 1937-710X, Vol. 18, no 4, p. 368-376Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although oral health affects systemic health, studies of oral health during intubation among critically ill neuroscience patients are lacking. Furthermore, the effect of oral care on intracranial pressure among critically ill patients in a neuroscience intensive care unit is unknown.

    OBJECTIVES: To describe changes in oral health and development of ventilator-associated pneumonia during intubation among patients in a neuroscience intensive care unit and to assess the influence of oral care on intracranial pressure.

    METHODS: Data on 45 consecutive intubated patients admitted to a neuroscience intensive care unit during 1 year were collected by using oral cultures and the Oral Assessment Guide throughout intubation and 48 hours after extubation. Occurrence of ventilator-associated pneumonia and intracranial pressures associated with oral care were recorded.

    RESULTS: Oral health, assessed by the Oral Assessment Guide, deteriorated significantly during intubation and improved to almost baseline levels 48 hours after extubation. During intubation, occurrence of oral gram-negative bacteria and yeast increased. The incidence of ventilator-associated pneumonia was 24% among patients enrolled for 4 to 10 days. During or after 879 instances of oral care, overall intracranial pressure did not increase. Among 30 instances in which intracranial pressure was greater than 20 mm Hg before oral care, pressure decreased during and 30 minutes after the procedure (P < .001).

    CONCLUSIONS: Intubation may contribute to worsening of oral health among patients in neuroscience intensive care units. Execution of oral care does not seem to affect intracranial pressure adversely. Oral care should be explored further to promote good oral and systemic health in patients in neuroscience intensive care units and to determine its effect on ventilator-associated pneumonia.

  • 159.
    Reimer, J.
    et al.
    University Hospital, Lund.
    Grabowski, M.
    University Hospital, Lund.
    Lindvall, O.
    University Hospital, Lund.
    Hagell, Peter
    Lund University.
    Use and interpretation of on/off diaries in Parkinson's disease2004In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 75, no 3, p. 396-400Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore the use and interpretation of self reported on/off diary data for assessment of daily motor fluctuations in Parkinson's disease.

    METHODS: 26 consecutive non-demented patients with fluctuating Parkinson's disease received standardised training on how to fill out the four category CAPSIT-PD on/off diary, followed by four hours of clinical observation and four weeks of daytime on/off diaries every 30 minutes at home.

    RESULTS: Overall patient-clinician agreement in diary entries was good (kappa = 0.62; weighted kappa = 0.84). Agreement for individual diary categories was good for "off" and "on with dyskinesias" (kappa = > or =0.72), but moderate for "partial off" and "on" (kappa = 0.49). The overall validity of patient kept diaries was supported by expected symptom severity variability across diary categories, as assessed in the clinic. One day's home diary data failed to predict outcomes from the full four weeks for all diary categories, and data from three days failed to yield good prediction (predefined as R(2) = > or =approximately 0.7) for the time spent in "off" and "partial off". Data from one week yielded good prediction (R(2) = > or =0.74) in all instances except "partial off", which could not be well predicted even when two weeks' home diary data were considered (R(2) = 0.52).

    CONCLUSIONS: The data provide support for the overall accuracy and validity of the four category CAPSIT-PD on/off diary, but suggest that a three category diary format may improve accuracy and validity. Interpretation of diary data beyond the assessed time frame should be made with caution unless diaries have been kept for sufficiently long periods.

  • 160.
    Rosqvist, Kristina
    et al.
    Lund University.
    Hagell, Peter
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Iwarsson, Susanne
    Lund University.
    Nilsson, Maria H
    Lund University.
    Odin, Per
    Lund University.
    Satisfaction with care in late stage Parkinson’s disease2019In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, Vol. 2019Article in journal (Refereed)
    Abstract [en]

    In late stage Parkinson’s disease (PD) (i.e., Hoehn and Yahr (HY) stages IV-V), both motor and nonmotor symptoms (NMS) are pronounced, and the patients become increasingly dependent on help in their daily life. Consequently, there is an increasing demand on health-care and social care resources for these patients and support for their informal caregivers. The aim of this study was to assess satisfaction with care in late stage PD patients and to identify factors associated with satisfaction with care. Moreover, to assess their informal caregivers’ satisfaction with support and to identify factors associated with caregivers’ satisfaction with support. Factors potentially associated with satisfaction with care/support were assessed in 107 late stage PD patients and their informal caregivers () and entered into multivariable logistic regression analyses. Fifty-eight (59%) of the patients and 45 (59%) of the informal caregivers reported satisfaction with their overall care/support. Patients satisfied with their care reported higher independence in activities of daily living (ADL) (Katz ADL index; ), less depressive symptoms (Geriatric Depression Scale, GDS-30; ), and higher individual quality of life (QoL) (Schedule for the Evaluation of Individual Quality of Life Questionnaire, SEIQoL-Q; ). Multivariable logistic regression analyses identified depressive symptoms () and independence in ADL () as independently associated with satisfaction with care. For informal caregivers, the analyses identified patients’ HY stage () and caregivers’ QoL (Alzheimer’s Carers Quality of Life Inventory, ACQLI; ) as independently associated with satisfaction with caregiver support. The results indicate that an effective both pharmacological and nonpharmacological PD therapy is important, to adequately treat motor and NMS (e.g., depressive symptoms) in order to improve depressive symptoms and patient independence in ADL. This may benefit not only the patients, but also their informal caregivers.

  • 161.
    Rosqvist, Kristina
    et al.
    Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Odin, P.
    Lund University.
    Ekström, H.
    Lund University.
    Iwarsson, S.
    Lund University.
    Nilsson, M. H.
    Lund University.
    Factors associated with life satisfaction in Parkinson's disease2017In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 1, p. 64-71Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD.

    MATERIAL AND METHODS: The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed.

    RESULTS: In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue.

    CONCLUSIONS: This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.

  • 162.
    Rosqvist, Kristina
    et al.
    Lunds universitet.
    Hagell, Peter
    Kristianstad University, School of Health and Society. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Odin, Per
    Lunds universitet.
    Iwarsson, Susanne
    Lunds universitet.
    Ekström, Henrik
    Lunds universitet.
    Nilsson, Maria
    Lunds universitet.
    Life satisfaction in Parkinson’s disease: associated factors2016Conference paper (Other academic)
    Abstract [en]

    Objective: To identify factors associated with life satisfaction (LS) in people with Parkinson’s disease (PD), including a specific focus on those with late stage PD.

    Background: Despite that patients with PD have an increased risk of reduced LS, there is limited knowledge regarding which factors are associated with LS. Such knowledge could serve as an important base for optimizing treatment and care. Concerning patients with late stage PD, i e Hoehn and Yahr (HY) IV-V, no published study has specifically addressed LS for this group.

    Methods: Data from 251 persons with PD (median age 70 years and duration 8 years) was analyzed statistically; the total sample was assessed and a subsample with late stage PD was further evaluated separately. LS was assessed by item 1 of the Life Satisfaction Questionnaire (LiSat-11). A large number of independent variables were described in relation to HY for groups HY I-III and IV-V, differences between the groups were tested. Sample characteristics in relation to LS were tested with simple logistic regression analyses. Independent variables with a p-value < 0.3 in the simple logistic regressions were entered into a multiple logistic regression model. For the subsample with late stage PD, simple logistic regression analyses were calculated.

    Results: The simple logistic regression analyses showed that 11 out of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; pain; PD severity; freezing episodes; gender (women) and fluctuations. When controlling for age and gender in the multiple logistic regression model, two independent variables were found to be independently associated with LS; depressive symptoms (negatively associated with high LS) and general self-efficacy (positively associated with high LS). For late stage PD, when controlling for age and gender in simple logistic regression analyses, associated factors with LS were: number of NMS, general self-efficacy, walking difficulties and fatigue, all except for general self-efficacy were negatively associated with high LS.

    Conclusions: This study identified factors associated with LS in a population with PD and further factors associated with LS for those with late stage PD. The ultimate goal for PD care should be improvement in LS and therefore the identification of associated factors has direct clinical implication.

  • 163.
    Rosqvist, Kristina
    et al.
    Lund University.
    Horne, Malcolm
    Australien.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Iwarsson, Susanne
    Lund University.
    Nilsson, Maria H
    Lund University.
    Odin, Per
    Lund University.
    Levodopa effect and motor function in late stage Parkinson's disease2018In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 8, no 1, p. 59-70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is unclear to which degree Levodopa (L-dopa) remains effective also in the late stage of Parkinson's disease (PD) and to which degree motor fluctuations and dyskinesias remain a problem.

    OBJECTIVE: To assess responsiveness of motor symptomatology to L-dopa in a group of patients with late stage PD. Moreover, to investigate the extent to which motor fluctuations and dyskinesias occur.

    METHODS: Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. L-dopa responsiveness was assessed with a standardized L-dopa test in the defined "off" and defined "on" states. Motor function was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests. Motor fluctuations and dyskinesias were assessed by the UPDRS IV. The participants were further monitored for 10 days with a mobile movement-analyses-system, the Parkinson's Kinetigraph (PKG). The median (q1-q3) L-dopa equivalent daily dose (LEDD) was 799 (536-973) mg.

    RESULTS: The UPDRS III score improved with ≥15% in 15 (50%) and with ≥30% in six (20%) participants during the L-dopa test. The median (q1-q3) UPDRS III score in "off" was 46 (37-53) and in "on" 36 (28-46). Twenty-one (70%) of the participants reported either predictable or unpredictable "off" fluctuations (items 36-37). The prevalence of dyskinesias (item 32, duration of dyskinesias ≥1) was 47%. The PKG indicated that dyskinesias primarily were mild and that a majority had a pronounced "off" symptomatology, spending a large proportion of the day either asleep or very inactive.

    CONCLUSIONS: Half of a group of patients with late stage PD had an L-dopa response of ≥15% on the UPDRS III. According to the UPDRS IV, a majority of the patients had motor fluctuations and about half had dyskinesias, although the PKG results suggested that these were not very severe.

  • 164.
    Rosqvist, Kristina
    et al.
    Lund University.
    Horne, Malcolm
    Australien.
    Hagell, Peter
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Iwarsson, Susanne
    Lund University.
    Nilsson, Maria
    Lund University.
    Odin, Per
    Lund University.
    Levodopa effect and motor function in late stage Parkinson’s disease2017In: Movement Disorders, 2017, Vol. 32, p. 915-916Conference paper (Refereed)
    Abstract [en]

    Objective: To assess responsiveness to Levodopa (L-dopa) in patients with late stage Parkinson’s disease (PD). Moreover, to investigate if the L-dopa effect is stable or whether motor fluctuations and dyskinesias are present.

    Background: A majority of PD patients treated with L-dopa develop motor complications, in many cases within a few years of treatment. It is unclear to which degree L-dopa remains effective also in the last stages and whether motor fluctuations and dyskinesias remain a problem.

    Methods: The study included 30 patients with PD in Hoehn and Yahr (HY) stages IV and V in “on” and/or having a substantial need of help with ADL (<50% Schwab and England Scale) and having been diagnosed with PD for =7 years. Nineteen were men, median age 83 and median PD duration 12 years. Nineteen were in HY stage IV and 11 in V. L-dopa responsiveness was assessed with an L-dopa test and motor evaluation according to a standardized protocol in the defined “off” and defined “on” state. Motor performance was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests for gait and hand-arm. The participants were further evaluated with a mobile movement-analyses-system, the Parkinson’s Kinetigraph (PKG) for 10 days.

    Results: The number of participants with an improvement in UPDRS III during L-dopa test of =15% were 15 (50%) and of =30% were 6 (20%). The median UPDRS III score in “off” was 46 (q1-q3, 37-53) and in “on” 36 (28-46), with a median improvement of 15.5% (8-27%), p<0.001. There was a statistically significant effect in almost all variables; UPDRS III total score; speech (item 18); resting tremor (item 20); tremor (items 20, 21); rigidity (item 22); bradykinesia (items 23-26, 31); gait (item 29); axial signs (items 18, 19, 22, 27-30); dyskinesias (Clinical Dyskinesia Rating Scale); hand-arm movement; gait test and blood pressure. According to the UPDRS IV, 67% experienced predictable off-fluctuations, while 30% had unpredictable off-fluctuations. The prevalence of dyskinesias according to item 32 (duration of dyskinesias =1) of the UPDRS IV was 47%. According to the PKG registrations, some patients were experiencing significant motor fluctuations, though very few had significant dyskinesias.

    Conclusions: Half of a group of patients with late stage PD (HY IV-V in “on”) had a significant L-dopa response (=15% on the UPDRS III). According to the UPDRS IV, a majority of the patients still had motor fluctuations and about half had dyskinesias.

  • 165.
    Rosqvist, Kristina
    et al.
    Lund University.
    Odin, Per
    Lund University.
    Hagell, Peter
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Iwarsson, Susanne
    Lund university.
    Nilsson, Maria
    Lund University.
    Storch, Alexander
    Dopaminergic effect on non-motor symptoms in late stage Parkinson's disease2018In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 8, no 3, p. 409-420Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Non-motor symptoms (NMS) are common in late stage Parkinson's disease (PD), as the frequency and severity of most of these symptoms increase with advancing disease.

    OBJECTIVE: To assess effect of dopaminergic therapy on NMS in late stage PD and to investigate relationships between dopaminergic effect on NMS and on motor function.

    METHOD: Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. Dopaminergic effect on non-motor symptomatology was assessed by the modified version of the Non-Motor Symptoms Scale (NMSS) in the "off" and the "on" state during a standardized L-dopa test, in parallel also assessing motor function.

    RESULTS: NMS were common and many of the symptoms occurred in >80% of the individuals. The highest NMSS scores were seen within the NMSS domains 3: mood/apathy and 7: urinary in both the "off" and the "on" state. There was a statistically significant (p <  0.001) improvement in the modified NMSS total score (median) from 79 in "off" to 64 in "on". There were statistically significant differences between the "off" and the "on" state for domains 2: sleep/fatigue, 3: mood/apathy, 5: attention/memory, 6: gastrointestinal and 7: urinary. The differences in the NMSS score between the "off" and the "on" state were in general larger for motor responders than for motor non-responders. In motor non-responders, differences of the NMSS score between the "off" and the "on" state were found for the total score, domain 3: mood/apathy and its item 11-flat moods.

    CONCLUSION: There is an effect of dopaminergic medication on NMS in late stage PD, to some extent also for those with a non-significant response on motor function during L-dopa test. It is therefore of importance to optimize dopaminergic therapy in order to give the most effective symptomatic treatment possible.

  • 166.
    Sjödahl Hammarlund, Catharina
    et al.
    Kristianstad University, School of Health and Society. Kristianstad University, Research Environment PRO-CARE.
    Andersson, Karolina
    Lund University.
    Andersson, Margareta
    Lund University.
    Nilsson, Maria H.
    Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    The significance of walking from the perspective of people with Parkinson's disease2014In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 4, no 4, p. 657-663Article in journal (Refereed)
    Abstract [en]

    Background: Parkinson's disease (PD) is associated with progressive mobility and walking difficulties. Although these aspects have been found to be central from a patient perspective, the perceived significance of walking is less well understood. Objective: To explore the significance of walking as perceived and experienced by individuals with PD. Methods: Eleven persons with PD (seven men; median age, 71 years; median PD duration, 7 years) participated. Data were collected through semi-structured interviews, which were recorded and transcribed verbatim. Data were qualitatively analysed by systematic text condensation. Results: The ability to walk had a complex and multifaceted impact on the participants, including physical, psychological and emotional aspects as well as on the ability to be active in daily life and to participate in society. The central role of coping strategies was prominent in filtering emotional reactions to physical changes, and when managing the activities and participation in everyday situations. The sense of unpredictability, uncertainty and loss of control were underlying phenomena in all categories. Furthermore, inability to manage walking difficulties had a negative impact on the participants' self-concept. Conclusions: The central meaning of being able to walk appears to be intimately linked to an individual's social identity, emotional well-being and integrity. Consequently, being able to walk independently was a prerequisite to an autonomous life and participation in society. This implies that rehabilitation and other mobility interventions also need to consider individual emotional, psychological, and social implications, and to facilitate appropriate compensatory and coping strategies.

  • 167.
    Sjödahl Hammarlund, Catharina
    et al.
    Lund University.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Platform for Collaboration for Health.
    Nilsson, Maria H
    Lund University.
    Motor and non-motor predictors of illness-related distress in Parkinson's disease2012In: Focus on Parkinson's disease, ISSN 0924-2015, Vol. 23, no 1, p. 27-28Article in journal (Other academic)
  • 168.
    Sjödahl Hammarlund, Catharina
    et al.
    Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Nilsson, Maria H.
    Lund University.
    Motor and non-motor predictors of illness-related distress in Parkinson's disease2012In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 18, no 3, p. 299-302Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify motor and non-motor symptoms independently associated with distress in Parkinson's disease (PD).

    METHOD: Clinical and patient-reported data from 118 people with PD (mean age and PD-duration, 64 and 8 years) were analyzed regarding associations with patient-reported distress using multiple regressions (controlling for age).

    RESULTS: Non-motor symptoms independently associated with distress were pain, fatigue, sleep, depression and anxiety (R(2), 0.81). The only significant motor aspect was mobility (R(2), 0.31). When considering both motor and non-motor symptoms, fatigue, pain, depression and sleep showed independent associations with distress (R(2), 0.76).

    CONCLUSION: Distress in PD is primarily associated with non-motor features.

  • 169.
    Sjödahl Hammarlund, Catharina
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Platform for Collaboration for Health.
    Nilsson, Maria H
    Department of Health Sciences, Lund University, Lund, Sweden.
    Motoriska och icke-motoriska prediktorer för patientrapporterad distress vid Parkinsons sjukdom2012In: BestPractice Psykiatri/Neurologi, Vol. 3, no 12, p. 12-15Article, review/survey (Other academic)
  • 170.
    Sjödahl Hammarlund, Catharina
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Lund University.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Westergren, Albert
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Fall risk and its associated factors among older adults without home help services in a Swedish municipality2016In: Journal of Community Health Nursing, ISSN 0737-0016, E-ISSN 1532-7655, Vol. 33, no 4, p. 181-189Article in journal (Refereed)
    Abstract [en]

    During preventive home visits, the purpose of this study was, to identify the prevalence of fall risk and any associated factors. Participants (n=1471) were cognitively sound community-dwelling older adults (≥ 70 years) without home-help service, living in a Swedish municipality. The Downton Fall Risk Index and nine single items were used. Tiredness/fatigue, age ≥ 80, inability to walk one hour, inability to climb stairs and worrying were significantly associated with fall risk. Preventive home visits incorporating fall risk screening proved valuable, providing information for interventions aimed at preventing falls, maintaining independence and facilitating health among community dwelling participants.

  • 171.
    Sjödahl Hammarlund, Catharina
    et al.
    Kristianstad University, School of Health and Society. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, Maria H.
    Lund University.
    Idvall, Markus
    Lund University.
    Rosas, Scott R.
    Concept Systems, Inc., Ithaca, NY.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Conceptualizing and prioritizing clinical trial outcomes from the perspectives of people with Parkinson’s disease versus health care professionals: a concept mapping study2014In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 23, no 6, p. 1687-1700Article in journal (Refereed)
    Abstract [en]

    Background

    Focusing clinical investigations on outcomes that are meaningful from an end-user perspective is central in clinical research, particularly in chronic disorders such as Parkinson’s disease (PD). However, little is known about how end-users such as people with PD (PwPD) and health care professionals (HCPs) view and prioritize therapeutic outcomes.

    Purpose

    To compare the perspectives of PwPD and HCPs regarding prioritized areas for outcome measurement in clinical PD trials.

    Methods

    Concept mapping was used to identify prioritized outcomes (statements) through focus groups (n = 27; 12 PwPD, 12 HCPs, three researchers), statement sorting and importance rating (n = 38; 19 PwPD, 19 HCPs), followed by quantitative (multidimensional scaling, cluster analysis, procrustes analysis) and qualitative analysis.

    Results

    Sorting of 99 statements by PwPD and HCPs yielded 2D maps (PwPD/HCPs stress values, 0.31/0.21) with eight clusters per group. The correlation between raw sorting data of PwPD and HCPs was 0.80, and there was a significant concordance (m12 = 0.53; P < 0.001; i.e., r = 0.68) between the spatial arrangements in their respective maps. Qualitatively, the maps from the two groups represented partially different perspectives. There were no significant differences between PwPD and HCP item importance ratings.

    Conclusion

    Although similarities dominated, there were differences in how the relationships between items were perceived by the two groups, emanating from different perspectives, i.e., the clinical biomedical (“disease”) versus the lived experience (“illness”). This study illustrates the clinical importance of attention to the perspective of PwPD; taking this into account is likely to provide evidence from clinical investigations that are meaningful and interpretable for end-users.

  • 172.
    Sjödahl Hammarlund, Catharina
    et al.
    Department of Health Sciences, Lund University.
    Nilsson, Maria
    Department of Health Sciences, Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Measuring outcomes in Parkinson's disease: a multi-perspective concept mapping study2012In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 21, no 3, p. 453-463Article in journal (Refereed)
    Abstract [en]

    To identify and develop a conceptual map of prioritized areas and to determine their relative importance for outcome measurement in clinical Parkinson's disease (PD) trials, from the perspectives of health care professionals and people with PD.

    METHOD:

    We used concept mapping, a qualitative/quantitative method consisting of three steps: item generation through focus groups (n = 27; 12 people with PD, 12 health care professionals, 3 researchers), item sorting and rating (n = 38; 19 people with PD, 19 health care professionals), and data analysis (multidimensional scaling, cluster analysis).

    RESULTS:

    Ninety-nine items and eight clusters were generated. Clusters representing Participation; Mobility and motor functioning; Cognitive and executive functioning; and Emotions were the most homogenous. Statements within clusters representing Energy and abilities; Autonomic dysfunctions; Sensory, speech and swallowing problems; and Neuropsychiatric symptoms also related to statements outside their respective clusters. Clusters rated most important were Participation and Mobility and motor functioning, and the highest rated items were quality of life, walking ability, and sleeping problems.

    CONCLUSION:

    By the use of concept mapping, a multi-perspective conceptual map of prioritized aspects for the outcome measurement in PD was defined. These findings provide an initial conceptual basis toward improved outcome measurement priorities in clinical PD trials.

  • 173.
    Sjödahl Hammarlund, Catharina
    et al.
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Lund University.
    Westergren, Albert
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Åström, Ingrid
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Edberg, Anna-Karin
    Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Hagell, Peter
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    The Impact of Living with Parkinson’s Disease: Balancing within a Web of Needs and Demands2018In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, Vol. 2018, article id 4598651Article in journal (Refereed)
    Abstract [en]

    This study explores the impact of living with Parkinson’s disease (PD). Nineteen persons (11 women) aged 55–84 diagnosed with PD 3–27 years ago participated. Data were collected through semistructured interviews, which were recorded, transcribed verbatim, and analysed by qualitative content analysis. Four categories represented the impact of living with PD: “Changed prerequisites for managing day-to-day demands,” “Loss of identity and dignity,” “Compromised social participation,” and “The use of practical and psychological strategies.” There was a shift from an internal to an external locus of control in managing, control, competence, relatedness, and autonomy. According to self-determination theory, a shift towards extrinsically motivated behaviours may occur when these basic needs are thwarted, leading to compensatory strategies or needs substitutes with negative consequences on health and well-being. We suggest a needs-based approach as an important starting point to better understand the consequences of living with PD and to explore the means for people with PD to acquire an improved quality of life on their own terms. In conclusion, our findings suggest for a shift in focus, from a biomedical to a needs-based approach to understand the impact of living with PD and facilitate more person-centred care and person-centred outcome measurement.

  • 174.
    Smith, Steve
    et al.
    Storbritannien.
    Westergren, Albert
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Saunders, Julia
    Storbritannien.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Nutritional screening: a user-friendly tool adapted from Sweden2016In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 25, no 4, p. 208-211Article in journal (Refereed)
    Abstract [en]

    Screening for undernutrition is highly important and may reduce morbidity and mortality. The Minimal Eating Observation and Nutrition Form Version II (MEONF-II) is a nutritional screening tool specifically developed for use by nurses. The authors describe the translation, performance and appropriateness of MEONF-II for the UK. Following translation from Swedish to British English, the user-friendliness and appropriateness of the British MEONF-II was tested by 29 registered nurses and final-year student nurses on 266 hospital inpatients. The new British MEONF-II was perceived as highly user-friendly and appropriate. Assessors found MEONF-II to compare favourably with other similar tools in terms of preference, usefulness and helpfulness in providing good nutritional care. Dependency in activities and poorer subjective health were associated with a higher risk of undernutrition. These findings support the appropriateness of the British MEONF-II version and suggest it may act as a user-friendly facilitator for good nutritional nursing care.

  • 175.
    Steen Krawcyk, R.
    et al.
    Department of Health Sciences, Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Sjödahl Hammarlund, Catharina
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Danish translation and psychometric testing of the Rivermead Mobility Index2013In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 128, no 4, p. 20-25Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The Rivermead Mobility Index (RMI) is widely used in several neurological conditions including multiple sclerosis (MS), but its psychometric properties have not been documented in Scandinavia. Therefore, the aim of the study was to translate RMI from UK English into Danish and conduct an initial psychometric testing of the Danish RMI. MATERIALS AND METHODS: The Danish translation conducted by the forward-backward method was first field-tested regarding user-friendliness and relevance. It was then psychometrically tested among 40 outpatients with MS regarding unidimensionality (corrected item-total correlations, adherence to an assumed Guttman response pattern), reliability, and construct validity. RESULTS: Field testing found the Danish RMI relevant and user-friendly. Corrected item-total correlations were ≥0.47 and item responses fitted the Guttman pattern. There was a 47.5% ceiling effect, and reliability was 0.91. Correlations supported construct validity. CONCLUSION: The Danish RMI is user-friendly, unidimensional, reliable, and valid. The results correspond to those previously reported with the original UK RMI version. Ceiling effects are limiting but sample related. Larger samples representing a wider variety of MS severities are needed for firmer evaluation of the Danish RMI.

  • 176. Swaine-Verdier, Angelo
    et al.
    Doward, Lynda C.
    Galen Research, Manchester.
    Hagell, Peter
    Department of Nursing, Lund University.
    Thorsen, Hanne
    Department of General Practice, University of Copenhagen.
    McKenna, Stephen P.
    Galen Research, Manchester.
    Adapting quality of life instruments2004In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 7, no Suppl 1, p. S27-S30Article, review/survey (Refereed)
    Abstract [en]

    Due to the international nature of many clinical studies and trials it is often necessary to produce several language versions of specific measures. While it is generally acknowledged that it is necessary to produce versions that are conceptually equivalent, the best method of achieving this is more controversial. It is commonly stated that there is a gold-standard method, which involves forward and backward translation. However, no evidence has been presented to support this view. This paper argues that the "gold-standard" method is difficult to support and describes an alternative method involving dual translation panels that has been used in the production of all adaptations of needs-based quality of life instruments.

  • 177.
    Tennant, Alan
    et al.
    Academic Unit of Musculoskeletal & Rehabilitation Medicine, University of Leeds.
    McKenna, Stephen P.
    Galen Research, Manchester.
    Hagell, Peter
    Department of Nursing, Lund University.
    Application of Rasch analysis in the development and application of quality of life instruments2004In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 7, no Suppl. 1, p. S22-S26Article, review/survey (Refereed)
    Abstract [en]

    This paper discusses recent advances that have been made in the field of psychometrics, specifically, the application of Rasch analysis to the instrument development process. It emphasizes the importance of assessing the fundamental scaling properties of an instrument prior to consideration of traditional psychometric indicators. The paper introduces Rasch analysis and shows how it has been applied in the development of needs-based measures in order to ensure that they provide unidimensional measurement. By ensuring that scales are based on the same measurement model and that they fit the Rasch model it is possible for QoL scores to be compared across diseases by means of cocalibration and item banking.

  • 178.
    Timpka, Jonathan
    et al.
    Lund University.
    Svensson, J.
    The Swedish Institute for Health Economics (IHE), Lund.
    Nilsson, M. H.
    Skåne University Hospital, Malmö.
    Pålhagen, S.
    Lund University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Odin, P.
    Lund University.
    Workforce unavailability in Parkinson's disease2017In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 332-338Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD.

    MATERIALS & METHODS: This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Skåne County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis.

    RESULTS: A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P < 0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce.

    CONCLUSIONS: Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.

  • 179.
    Vallén, Christina
    et al.
    Central Hospital, Kristianstad.
    Hagell, Peter
    Department of Health Sciences, Lund University.
    Westergren, Albert
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Validity and user-friendliness of the minimal eating observation and nutrition form version II (MEONF II) for undernutrition risk screening2011In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, no 55, p. 5801-Article in journal (Refereed)
    Abstract [en]

    Objective To analyze the criterion-related validity and user-friendliness of the Minimal Eating Observation and Nutrition Form – Version II (MEONF – II) and Malnutrition Universal Screening Tool (MUST) in relation to the Mini Nutritional Assessment (MNA). In addition, the effect of substituting body mass index (BMI) with calf circumference (CC) was explored for the MEONF-II. Methods The study included 100 patients who were assessed for nutritional status with the MNA (full version), considered here to be the gold standard, and screened with the MUST and the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, BMI (or calf circumference), eating difficulties, and presence of clinical signs of undernutrition. Results The MEONF-II sensitivity (0.73) and specificity (0.88) were acceptable. Sensitivity and specificity for the MUST were 0.57 and 0.93, respectively. Replacing the BMI with CC in the MEONF-II gave similar results (sensitivity 0.68, specificity 0.90). Assessors considered MEONF-II instructions and items to be relevant, easy to understand and complete (100%), and the questions to be relevant (98%). MEONF-II and MUST took 8.8 and 4.7 minutes to complete, respectively, and both were considered relevant and easy to finish. In addition, MEONF-II was thought to reveal problems that allows for nursing interventions. Conclusions The MEONF-II is an easy to use, relatively quick, and sensitive screening tool to assess risk of undernutrition among hospital inpatients, which allows for substituting BMI with CC in situations where measures of patient height and weight cannot be easily obtained. High sensitivity is of primary concern in nutritional screening and the MEONF-II outperforms the MUST in this regard.

  • 180.
    Wann-Hansson, Christine
    et al.
    Faculty of Health and Society, Malmö University.
    Hagell, Peter
    Department of Health Sciences, Lund University.
    Willman, A.
    School of Health Science, Blekinge Institute of Technology.
    Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 13, p. 1718-1727Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: This study aimed to describe and identify risk factors associated with hospital-acquired pressure ulcers among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively.

    BACKGROUND: Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital-acquired pressure ulcers compared with patients with pre-existing pressure ulcers.

    DESIGN: A point prevalence study with a cross-sectional survey design was conducted at a Swedish university hospital.

    METHOD: Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment.

    RESULTS: The prevalence of pressure ulcers was 27% (95% confidence interval, 23-31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure.

    CONCLUSION: The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development.

    RELEVANCE TO CLINICAL PRACTICE: Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.

  • 181.
    Wann-Hansson, Christine
    et al.
    Faculty of Health and Society, Malmö University.
    Klevsgård, Rosemarie
    Department of Health Sciences, Lund University.
    Hagell, Peter
    Department of Health Sciences, Lund University.
    Cross-diagnostic validity of the Nottingham Health Profile Index of Distress (NHPD)2008In: Health and quality of life outcomes, ISSN 1477-7525, Vol. 6, p. 47-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Nottingham Health Profile index of Distress (NHPD) has been proposed as a generic undimensional 24-item measure of illness-related distress that is embedded in the Nottingham Health Profile (NHP). Data indicate that the NHPD may have psychometric advantages to the 6-dimensional NHP profile scores. Detailed psychometric evaluations are, however, lacking. Furthermore, to support the validity of the generic property of outcome measures evidence that scores can be interpreted in the same manner in different diagnostic groups are needed. It is currently unknown if NHPD scores have the same meaning across patient populations. This study evaluated the measurement properties and cross-diagnostic validity of the NHPD as a survey instrument among people with Parkinson's disease (PD) and peripheral arterial disease (PAD).

    METHODS: Data from 215 (PD) and 258 (PAD) people were Rasch analyzed regarding model fit, reliability, differential item functioning (DIF), unidimensionality and targeting. In cases of cross-diagnostic DIF this was adjusted for and the impact of DIF on the total score and person measures was assessed.

    RESULTS: The NHPD was found to have good overall and individual item fit in both disorders as well as in the pooled sample, but seven items displayed signs of cross-diagnostic DIF. Following adjustment for DIF some aspects of model fit were slightly compromised, whereas others improved somewhat. DIF did not impact total NHPD scores or resulting person measures, but the unadjusted scale displayed minor signs of multidimensionality. Reliability was > 0.8 in all within- and cross-diagnostic analyses. Items tended to represent more distress (mean, 0 logits) than that experienced by the sample (mean, -1.6 logits).

    CONCLUSION: This study supports the within- and cross-diagnostic validity of the NHPD as a survey tool among people with PD and PAD. We encourage others to reassess available NHP data within the NHPD framework to further evaluate the strengths and weaknesses of this simple patient-reported index of illness-related distress.

  • 182.
    Wenning, G K
    et al.
    England.
    Odin, P
    Lund University.
    Morrish, P
    England.
    Rehncrona, S
    Lund University.
    Widner, H
    Lund University.
    Brundin, P
    Rothwell, J C
    Lund University.
    Brown, R
    England.
    Gustavii, B
    Lund University.
    Hagell, Peter
    Lund University.
    Jahanshahi, M
    England.
    Sawle, G
    England.
    Björklund, A
    Lund University.
    Brooks, D J
    England.
    Marsden, C D
    England.
    Quinn, N P
    England.
    Lindvall, O
    Lund University.
    Short- and long-term survival and function of unilateral intrastriatal dopaminergic grafts in Parkinson's disease1997In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 42, no 1, p. 95-107Article in journal (Refereed)
    Abstract [en]

    Six patients with Parkinson's disease were followed for 10 to 72 months after human embryonic mesencephalic tissue from four to seven donors was grafted unilaterally into the putamen (4 patients) or putamen plus caudate (2 patients). After 8 to 12 months, positron emission tomography showed a 68% increase of 6-L-[18F]-fluorodopa uptake in the grafted putamen, no change in the grafted caudate, and minor decreases in nongrafted striatal regions. There was therapeutically valuable improvement in 4 patients, but only modest changes in the other 2, both of whom developed atypical features. Patient 4 was without L-dopa from 32 months and had normal fluorodopa uptake in the grafted putamen at 72 months. Overall, the L-dopa dose was reduced by a mean of 10 and 20%, "off" time was reduced by 34 and 44%, and the "off" phase Unified Parkinson's Disease Rating Scale motor score by 18 and 26%, and the duration of the response to a single L-dopa dose increased by 45 and 58% during the first and second years after surgery, respectively. Rigidity and hypokinesia improved bilaterally, but mainly contralateral to the implant. No consistent changes in dyskinesias were observed. We conclude that transplantation of embryonic mesencephalic tissue leads to highly reproducible survival of dopaminergic neurons, inducing clinically valuable improvements in most recipients.

  • 183.
    Westergren, Albert
    Kristianstad University, School of Health and Society. Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Hagquist, Curt
    News from Sweden´s National Metrology Institute. Application for funding of a new Center for Categorical-Based Measures.2019In: Rasch Measurement Transactions (RMT), ISSN 1051-0896, Vol. 32, no 3, p. 1719-1719Article in journal (Other (popular science, discussion, etc.))
  • 184.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Broman, Jan-Erik
    Uppsala universitet.
    Hellström, Amanda
    Blekinge tekniska högskola & Linnéuniversitetet.
    Fagerström, Cecilia
    Blekinge tekniska högskola.
    Willman, Ania
    Blekinge tekniska högskola.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Measurement properties of the Minimal Insomnia Symptom Scale as an insomnia screening tool for adults and the elderly2015In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 16, no 3, p. 379-384Article in journal (Refereed)
    Abstract [en]

    Background

    The psychometric properties of the three-item Minimal Insomnia Symptom Scale (MISS) were evaluated using the classical test theory. Different cut-offs for identifying insomnia were suggested in two age groups (≥6 and ≥7 among adult and elderly people, respectively). The aim of the present study was to test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on differential item functioning by gender and age.

    Methods

    Cross-sectional MISS data from adult (age 20-64 years, n=1075) and elderly (age 65+, n=548) populations were analysed using the Rasch measurement model.

    Results

    Data generally met Rasch model requirements and the scale could separate between two distinct groups of people. Differential item functioning was found by age but not gender. The difference between the adult and elderly samples was lower for the originally recommended ≥6 points cut-off (0.09 logits) than for the ≥7 points cut-off (0.23 logits), but greater at the lower and higher ends of the scale.

    Conclusions

    This study provides general support for the measurement properties of the MISS. Caution should be exercised in comparing raw MISS scores between age groups, but applying a ≥6 cut-off appears to allow for valid comparisons between adults and the elderly regarding the presence of insomnia. Nevertheless, additional studies are needed to determine the clinically optimal cut-score for identification of insomnia.

  • 185.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hedin, Gita
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Improving nursing students research knowledge through participation in a study about nutrition, its associated factors and assessment2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 8, p. 50-58Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of this study were threefold: 1) to explore nursing students perceptions of knowledge development after participating in an actual research project; 2) to explore undernutrition and its relationship to other clinical factors; 3) to explore the user-friendliness of the Minimal Eating Observation and Nutrition Form (MEONF-II) in relation to dependency in Activities of Daily Living (ADL).

    Methods: A pilot study (Study 1, S1) was conducted in October 2010, including 281 patients. After extending the research protocol a second data collection (S2) was conducted in March 2011, including 236 patients (total n=517). First and third year nursing students (n=188) collected the data, during one day of their clinical practice courses by assessing three patients each in hospitals or nursing homes. Students answered questions about their experiences from participating in the study. Patient related assessments included: MEONF-II; ADL dependency (S1 and S2); insomnia; low-spiritedness; and subjective health (S2). In addition, questions about the user-friendliness of MEONF-II were included (S1 and S2).

    Results: Among the nursing students, 51% experienced that their knowledge about nutrition increased and 67% that their understanding for research increased by participating in the project. Out of the patients, 57% were women, 50% were almost independent, 27% had some dependency, 23% were almost totally dependent in ADL, and 48% were at moderate/ high undernutrition risk. In S2, 32% of patients had insomnia, and 46% experienced low-spiritedness. Dependency in 5-6 and 3-4 ADLs (OR, 2.439 and 2.057, respectively), compared to dependency in 0-2 ADLs, were the strongest predictors for undernutrition risk, followed by insomnia (OR 2.124). Nursing students experienced the MEONF-II as easy to understand (93%), easy to answer (94%) and relevant (94%), and the suggestions for measures to take in case of risk as relevant (95%), independent of the patients’ ADL status.

    Conclusions: By participating in an actual research project nursing students gets an understanding for research and tools for working with quality improvements in their future role as professional nurses. Undernutrition, mental and physical factors constitute coexisting problems in need for further investigation. Nursing students perceive the MEONF-II as user-friendly, independent of patient ADL dependency.

  • 186.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Norberg, Erika
    Central Hospital Kristianstad.
    Stubbendorff, Anna
    County Council Skane.
    Hedin, Gita
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap.
    Wetterstrand, Martin
    Kristianstad University, School of Health and Society, Avdelningen för Design och datavetenskap.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Long-term effects of a computer-based nutritional training program for inpatient hospital care2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 4, p. 797-802Article in journal (Refereed)
    Abstract [en]

    Rationale

    A previous short-term study showed that a computer-based training in eating and nutrition increased the probability for hospital inpatients at undernutrition (UN) risk to receive nutritional treatment and care without increasing overtreatment (providing nutritional treatment to those not at UN risk).

    The aim of this study was to investigate if a computer-based training in eating and nutrition influences the precision in nutritional treatment and care in a longer-term perspective.

    Method

    A preintervention and postintervention study was conducted with a cross-sectional design at each time points (baseline and 7 months postintervention). Hospital inpatients > 18 years old at baseline (2013; n = 201) and follow-up (2014; n = 209) were included. A computer-based training was implemented during a period of 3 months with 297 (84%) participating registered nurses and nurse assistants. Undernutrition risk was screened for using the minimal eating observation and nutrition form-version II. Nutritional treatment and care was recorded using a standardized protocol.

    Results

    The share of patients at UN risk that received energy-dense food (+ 25.2%) and dietician consultations (+ 22.3%) increased between baseline and follow-up, while fewer received oral nutritional supplements (-18.9%). "Overtreatment" (providing nutritional treatment to those not at UN risk) did not change between baseline and follow-up.

    Conclusion

    The computer-based training increased the provision of energy-dense food and dietician consultations to patients at UN risk without increasing overtreatment of patients without UN risk.

  • 187.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Norberg, Erika
    Central Hospital Kristianstad.
    Stubbendorff, Anna
    The County Council of Skåne.
    Hedin, Gita
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Wetterstrand, Martin
    Kristianstad University, School of Health and Society, Avdelningen för Design och datavetenskap.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Short-term effects of a computer-based nutritional nursing training program for inpatient hospital care2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 5, p. 799-807Article in journal (Refereed)
    Abstract [en]

    RATIONALE: This study aimed to explore whether a computer-based training in eating and nutrition for hospital nursing staff can influence the precision in nutritional treatment and care.

    METHOD: A pre-intervention and post-intervention study was conducted with a cross-sectional design at each time point. The settings were one intervention (IH) and two control hospitals (CH1 and CH2). Hospital inpatients >18 years old at baseline (2012; n = 409) and follow-up (2014; n = 456) were included. The computer-based training was implemented during a period of 3 months in the IH with 297 (84%) participating registered nurses and nurse assistants. Nutritional risk was screened for using the Minimal Eating Observation and Nutrition Form. Nutritional treatment and care was recorded using a standardized protocol RESULTS: In the IH, there was an increase in the share of patients at UN risk that received energy-dense food (+16.7%) and dietician consultations (+17.3%) between baseline and follow-up, while fewer received feeding assistance (-16.2%). There was an increase in the share of patients at UN risk that received energy-dense food (+19.5%), a decrease in oral nutritional supplements (-30.5%) and food-registrations (-30.6%) in CH1, whereas there were no changes in CH2. 'Overtreatment' (providing nutritional treatment to those not at UN risk) was significantly higher in CH2 (52.7%) than in CH1 (14.3%) and in the IH (25.2%) at follow-up.

    CONCLUSION: The computer-based training seemed to increase the probability for patients at UN risk in the IH to receive nutritional treatment without increasing overtreatment.

  • 188.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Platform for Collaboration for Health.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Norberg, Erika
    Central Hospital Kristianstad .
    Stubbendorff, Anna
    The County Council of Skåne.
    Hedin, Gita
    Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Wetterstrand, Martin
    Kristianstad University, School of Health and Society, Avdelningen för Design och datavetenskap.
    Rosas, Scott R
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Computer-based training in eating and nutrition facilitates person-centered hospital care: a group concept mapping study2018In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 36, no 4, p. 199-207Article in journal (Refereed)
    Abstract [en]

    Studies have shown that computer-based training in eating and nutrition for hospital nursing staff increased the likelihood that patients at risk of undernutrition would receive nutritional interventions. This article seeks to provide understanding from the perspective of nursing staff of conceptually important areas for computer-based nutritional training, and their relative importance to nutritional care, following completion of the training. Group concept mapping, an integrated qualitative and quantitative methodology, was used to conceptualize important factors relating to the training experiences through four focus groups (n = 43), statement sorting (n = 38), and importance rating (n = 32), followed by multidimensional scaling and cluster analysis. Sorting of 38 statements yielded four clusters. These clusters (number of statements) were as follows: personal competence and development (10), practice close care development (10), patient safety (9), and awareness about the nutrition care process (9). First and second clusters represented "the learning organization," and third and fourth represented "quality improvement." These findings provide a conceptual basis for understanding the importance of training in eating and nutrition, which contributes to a learning organization and quality improvement, and can be linked to and facilitates person-centered nutritional care and patient safety.

  • 189.
    Westergren, Albert
    et al.
    Division of Gerontology and Caring Sciences, Department of Health Sciences, Faculty of Medicine, Lund University.
    Hagell, Peter
    Division of Gerontology and Caring Sciences, Department of Health Sciences, Faculty of Medicine, Lund University.
    Initial validation of the Swedish version of the London Handicap Scale2006In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 15, no 7, p. 1251-1256Article in journal (Refereed)
    Abstract [sv]

    Objective: To adapt and evaluate the unweighted version of the London Handicap Scale (LHS) for use in Sweden.

    Materials & Methods: Respondent burden, linguistic validity and patient perceived relevance was assessed in 16 neurologically ill patients. Internal consistency reliability and construct validity were evaluated among 89 stroke survivors six months after discharge.

    Results: Patients perceived the LHS as relevant and easy to understand and complete. Mean time to complete the questionnaire was 10 min. Cronbach’s alpha reliability was 0.85. The LHS differentiated between patients living at home and in special accommodations. As expected, scores correlated strongly and weakly with indices of related and more remote constructs, respectively. There were no floor-, but large ceiling effects.

    Conclusions: The observations reported here are in accordance with previous studies using the original British LHS and provide initial support for the reliability and validity of the instrument for use in Sweden. However, ceiling effects may limit its usefulness as an outcome measure.

  • 190.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Measurement properties of the 12-item Short-Form Health Survey in stroke2014In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 46, no 1, p. 34-45Article in journal (Refereed)
    Abstract [en]

    Background: The 12-item Short-Form Health Survey (SF-12) was developed to measure perceived physical and mental health. Some studies of the psychometric properties, using classical test theory, of the SF-12 provide support for its use in patients with stroke, but it has not been scrutinized using recommended modern test theory approaches such as the Rasch measurement model among stroke survivors.

    Objectives: This study sought to explore the measurement properties of the SF-12 physical and mental health scales among people with stroke using the Rasch measurement model.

    Design: A cross-sectional design was used in this study.

    Methods: All patients discharged from a dedicated stroke unit in southern Sweden during 6 months were asked to participate 6 months later. Of 120 stroke survivors, 89 (74%) agreed to participate. Rasch analysis was used to assess the measurement properties of the SF-12 physical and mental component summary scores (PCS-12 and MCS-12, respectively).

    Results: For the PCS-12, we identified problems with targeting, overall and item-level fit, representing local response dependency, and multidimensionality. For the MCS-12, there were problems related to targeting (the persons felt better than the scale could conceptualize) and response categories that did not function as expected. However, MCS-12 items displayed reasonable model fit without indications of multidimensionality but with signs of local response dependency.

    Conclusion: The measurement properties of the MCS-12 in stroke appear reasonable unless milder mental health problems are of interest, whereas those of the PCS-12 are less acceptable. Given the interdependence between MCS-12 and PCS-12 that is inherent with the standard SF-12 scoring algorithm, such data should be interpreted with caution.

  • 191.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Screening for nutritional risk among home dwelling elderly people without service from the municipality2011In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 6, no Suppl. 1, p. 87-Article in journal (Refereed)
    Abstract [en]

    Risk factors for malnutrition were frequent mamong elderly persons and calls for preventive actions through information about how to eat healthy. This information can be provided during preventive home visits.

  • 192.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Undernutrition, mental and physical factors form a triad of coexisting problems2012In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 7, no Suppl.1, p. 117-Article in journal (Refereed)
  • 193.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hedin, Gita
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Smärta: en studie genomförd med hjälp från studenter i sjuksköterskeprogrammet2014Report (Other academic)
    Abstract [sv]

    Syfte: Syftet med studien var att undersöka förekomst och grad av smärta hos vårdtagare och att jämföra två metoder för skattning av smärta, verbal skattning av smärta samt skattning med hjälp av VAS (Visuell Analog Skala). Vidare är syftet att sjuksköterskestudenterna ska få träna sig med hjälp av olika bedömningsinstrument identifiera problem med smärta samt reflektera över Metod: Sjuksköterskestudenter från första och sista året i utbildningen genomförde skattningar på vårdtagare vid den praktikplats där de genomförde sin verksamhetsförlagda utbildning (VFU) på sjukhus eller i särskilda boenden (SB, här även inkluderat avancerad sjukvård i hemmet (ASIH)). Vårdtagare gav sitt informerade samtycke till att medverka i studien som genomfördes under en dag. Vårdtagarna fick skatta sin smärta med verbal skattning samt med VAS. Totalt ingick 1769 vårdtagare i studien varav 1432 var på sjukhus och 1337 i SB/ASIH. På sjukhus var 54.3% kvinnor och 45.7% män, inom SB/ASIH var fördelningen 63.8% respektive 35.9%.

    Resultat: På sjukhus upplevde 48.4% av respondenterna sin grad av sjukdom som "svår" respektive 30.1% vid SB/ASIH. Vid sjukhus angav 27.8% någon form av smärta när den "var som värst", respektive 31.8% vid SB/ASIH. När smärtan "var som minst" var det 39.9% vid sjukhus som uppgav "ingen smärta" och inom SB/ASIH var det 43.1%. Vad gäller smärta "i genomsnitt" var det 22.1% som uppgav "ingen smärta" vid sjukhus, och 22.3% vid SB/ASIH.

    Slutsats: Smärta var väldigt vanligt både på sjukhus och i SB/ASIH.

  • 194.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Lindgren, Emma
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Sömnsvårigheter inom vård och omsorg: en studie genomförd med hjälp av studenter i sjuksköterskeprogrammet2012Report (Other academic)
    Abstract [sv]

    Syftet med studien var att undersöka förekomsten av sömnsvårigheter bland personer på sjukhus, särskilt boende samt inom hemsjukvård/kvalificerad vård i hemmet (KVH), samt att jämföra sömnen hemma och på sjukhus för de personer som befann sig på sjukhus. Vidare var syftet att högskolestudenter inom sjuksköterskeprogrammet skulle få träning i kritiskt tänkande, reflektion och  att  introducera  evidensbaserade  verktyg/instrument  för  att  underlätta  beslut  rörande patientsäkerhet.

    Metod:  Datainsamlingen  utfördes  av  sjuksköterskestudenter  i  kurs  6  och  16  under  deras verksamhetsförlagda utbildning på sjukhus, särskilt boende, hemsjukvård och KVH, 2011. Även kliniska adjunkter/kliniska lärare och personal i verksamheterna medverkade till genomförandet. Studenterna fick genom datainsamlingen träning i att ge information till personal och patient/ vårdtagare, sammanställa resultat från enheten/avdelningen, samt att återrapportera och reflektera över resultaten. Screening avseende störd nattsömn (insomni) och dagsömnighet gjordes baserat på bedömninsinstrumenten The Pittsburgh Sleep Quality Index (PSQI), Minimal Insomnia Symptom Scale (MISS), Scales for Outcomes in PArkinson’s disease – Sleep (SCOPA-Sleep), Parkinson’s Disease Questionnaire-39 (PDQ-39) och Epworth Sleepiness Scale (ESS). Varje sjuksköterskestudent tillfrågade cirka fyra patienter/vårdtagare om att medverka i studien.

    Resultat: De på sjukhus och inom hemsjukvård/KVH sover i snitt färre timmar per natt jämfört med de på särskilt boende. Det vanligaste sömnproblemet för alla tre grupper var att vakna under natten och insomni var vanligare på sjukhus och inom hemsjukvård/KVH än på särskilt boende. Det vanligaste problemet under dag- och kvällstid för de på sjukhus och inom hemsjukvård/KVH var att somna under tiden när man tittat på TV eller läst. För de på särskilt boende var det vanligaste problemet att plötsligt somna under dag- eller kvällstid. Vid jämförelse av sömntimmar per natt hemma och på sjukhus bland de deltagare som befann sig på sjukhus skiljde sig sömntimmarna inte markant åt. En något större andel bedömde sin sömnkvalitet som ganska dålig eller mycket dålig under sjukhusvistelsen i jämförelse med sömnkvaliteten hemma. Även insomni var något vanligare att uppleva på sjukhus än hemma. Merparten av deltagarna använde ungefär lika mycket eller mer sömntabletter på sjukhuset än hemma. Majoriteten av medverkande studenter ansåg sig ha fått en bättre vetenskaplig förståelse efter genomförd studie, med en särskilt stor andel hos kurs 16 studenterna. En något större andel avkurs 6 studenterna ansåg sig ha ökat sina kunskaper om sömnvanor/sömnproblem i jämförelsemed kurs 16 studenterna. Åtgärder för att underlätta sömnen hos patienter/vårdtagare som föreslogs utav studenterna fokuserade på personalens bemötande, dokumentation och utvärdering samt miljö och hjälpmedel. Majoriteten av studenterna var positiva till genomförandet av studien, samt upplevde att även patienter och vårdtagare förhöll sig positiva till studien. Det var många som däremot kritiserade att frågorna i frågeformuläret var snarlika och att det saknas frågor om vad eventuella sömnsvårigheter berodde på.

    Konklusion: Sjukhusvistelse var delvis associerad med negativ påverkan på sömnen. Generellt rapporterar äldre personer på särskilt boende att de sover ganska bra. Att vara delaktiga i FUSS-projekt bidrar till en bättre vetenskaplig förståelse hos flertalet sjuksköterskestudenter.

  • 195.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Sjödahl Hammarlund, Catharina
    Kristianstad University, School of Health and Society. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Malnutrition and risk of falling among elderly without home-help service: a cross sectional study2014In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 18, no 10, p. 905-911Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aim of this study was to explore the frequency of malnutrition risk and associated risk of falling, social and mental factors among elderly without home-help service. The aim was also to explore factors associated with risk of falling.

    Design

    A cross-sectional design was used.

    Setting

    Elderly persons own homes.

    Participants

    Data were collected during preventive home visits to 565 elderly (age range 73–90 years) without home-help service. Those with complete SCREEN II forms were included in the study (n=465).

    Measurements

    Measurements included rating scales regarding malnutrition risk (SCREEN II) and risk of falling (Downton). In addition, single-items: general health, satisfaction with life, tiredness, low-spiritedness, worries/anxiety and sleeping were used.

    Results

    According to the SCREEN II, 35% of the sample had no malnutrition risk, 35% had moderate risk and 30% had high malnutrition risk. In an ordinal regression analysis, increased malnutrition risk was associated with being a woman living alone (OR 4.63), male living alone (OR 6.23), lower age (OR 0.86), poorer general health (OR 2.03–5.01), often/always feeling tired (OR 2.38), and an increased risk of falling (OR 1.21). In a linear regression analysis, risk of falling was associated with higher age (B 0.020), not shopping independently (B 0.162), and low meat consumption (B 0.138).

    Conclusion

    There are complex associations between malnutrition risk and the gender-cohabitation interaction, age, general health, tiredness, and risk of falling. In clinical practice comprehensive assessments to identify those at risk of malnutrition including associated factors are needed. These have to be followed by individual nutritional interventions using a holistic perspective which may also contribute to reducing the risk of falling.

  • 196.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Platform for Collaboration for Health.
    Sjödahl Hammarlund, Catharina
    Department of Health Sciences, Lund University, Lund, Sweden.
    Undernäring och fallrisk - ett förestående folkhälsoproblem bland yngre pensionärer?2014In: Svensk Geriatrik, ISSN 2001-2047, no 1, p. 11-14Article, review/survey (Other academic)
  • 197.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health.
    Wendin, Karin
    Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap. Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL).
    Sjödahl Hammarlund, Catharina
    Kristianstad University, School of Health and Society. Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Conceptual relationships between the ICF and experiences of mealtimes and related tasks among persons with Parkinson’s disease2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 4, p. 201-208Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate experiences of mealtimes and related tasks among people with Parkinson’s disease (PD) and to link these conceptually to the International Classification of Functioning, Disability and Health (ICF). Data were collected by use of semi-structured interviews of 19 people with PD. Inductive content analysis resulted in five categories: 1) Managing mealtime preparations and related tasks, 2) Compromised physical control, 3) Difficulties enjoying meals, 4) Difficulties eating together with others, and 5) Strategies to maintain conventional norms and independence. Deductive content analysis linked the categories to the ICF categories: body functions (mental, sensory, neuromusculoskeletal and movement-related functions); activities (self-determination and chores); participation (interpersonal interactions and relationships); and environmental factors (conventional norms, attitudes of friends and strangers). Emotional and involuntary movement functions were represented in all five inductively derived categories. Eating difficulties may have negative consequences on participation and the emotional wellbeing of people with Parkinson’s disease.

  • 198.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hedin, Gita
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    10 år med forskargruppen PRO-CARE: jubileumsskrift2014Report (Other (popular science, discussion, etc.))
  • 199.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Khalaf, Atika
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    A Swedish version of the SCREEN II for malnutrition assessment among community-dwelling elderly2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 6, p. 667-71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II) Questionnaire assesses nutritional risk among elderly people living at home. Our aim was to produce a Swedish language version of the SCREEN II and to examine response patterns, data completeness and the relationship between malnutrition and general health.

    METHODS: The SCREEN II was translated into Swedish using dual panel methodology, and then followed up with field test interviews of 24 seniors (median age, 83 years). We used the survey data (n = 565) to assess item and score distribution, missing responses, and the relationship to the subject's general and nutritional health.

    RESULTS: The Swedish SCREEN II was considered easy to understand, respond to, and relevant (n = 21; 88% of subjects found it so in all three respects) and its median completion time was 5 minutes. The level of survey item data completeness was 94-99%, and 82% of surveys had computable total scores. Of those subjects with completed forms, 35% had no nutritional risk; 35% had moderate risk; and 30% were at high risk. The malnutrition risk increased with poorer perceived health.

    CONCLUSIONS: Our study results are similar to those using previous SCREEN II versions, indicating that the scale adaptation was successful and providing initial support for use of the Swedish SCREEN II questionnaire.

  • 200.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, M.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society.
    Lindskov, Susanne
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Adaptation of "Seniors in the community: risk evaluation for eating and nutrition , version ll" (SCREEN ll) for use in  Sweden: report on the translation process and field test2010Conference paper (Refereed)
12345 151 - 200 of 208
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