Anhöriga till cancersjukas upplevelser och behov av psykosocialt stöd inom slutenvården

Aim: The aim of this study was to explore relatives to patients with cancer experiences and needs of psychosocial support within inpatient care. Method: The study was empiric and conducted as a qualitative study with explorative design. Eight relatives were interviewed. The data were transcribed and read through and then subjected to qualitative content analysis according to Graneheim & Lundman. Results: The analysis resulted in four categories: emotional support, appraisal support, informative support and instrumental support. The relatives needed support from friends, family and healthcare. The need for support was individually. They needed to get information about treatment, prognosis and planning. The relatives needed to be confirmed by the medical staff and would like an easy access to the health care for getting their questions answered and to be involved. Deficiencies were found in the support in information in diagnosis, insufficient information on the healthcare routines, inadequate meeting and requirements for participation. Conclusions: The relatives need psychosocial support from the healthcare. Adequate information, access to health care professionals and to be treated with respect were the most valuable support from the professionals. The professionals can improve the psychosocial support by having knowledge of how they can identify relatives who need support and how they can support them. Keywords: psychosocial support, relatives, cancer, qualitative content analysi

A comparing study for methods measuring oxygen demand with and without mercury in wastewater from paper industry

Kvicksilver är ett av de farligaste miljögifter vi känner till. Regeringen har därför arbetat fram ett förslag till förbud mot kvicksilver som kemikaliereagens från år 2004. Detta förbud innebär att många laboratorier måste byta analysmetoder. Vid analys av CODCr används kvicksilversulfat för att minska interferens från klorid. Bravikens pappersbruk använder en CODCr-metod som innehåller kvicksilver. Syftet med denna undersökning har varit att ta fram en lämplig metod för att mäta syreförbrukning som ej innehåller kvicksilver vid analysen. Två olika CODCr-analyser har utförts, en med kvicksilver och en utan. Dessa har sedan jämförts med statistiska tester. Resultatet visar att det är en skillnad mellan metoderna. Metoden utan kvicksilver visar signifikant högre värden än metoden med kvicksilver. En linjär regression visade att det fanns ett signifikant samband mellan metodernas resultat. Från den linjära regressionsanalysen har en ekvation mellan metoderna beräknats. Eftersom denna ekvation är beroende av vattnets kemiska sammansättning kan den dock inte appliceras på alla typer av vatten

Anhöriga till cancersjukas upplevelser och behov av psykosocialt stöd inom slutenvården

Aim: The aim of this study was to explore relatives to patients with cancer experiences and needs of psychosocial support within inpatient care. Method: The study was empiric and conducted as a qualitative study with explorative design. Eight relatives were interviewed. The data were transcribed and read through and then subjected to qualitative content analysis according to Graneheim & Lundman. Results: The analysis resulted in four categories: emotional support, appraisal support, informative support and instrumental support. The relatives needed support from friends, family and healthcare. The need for support was individually. They needed to get information about treatment, prognosis and planning. The relatives needed to be confirmed by the medical staff and would like an easy access to the health care for getting their questions answered and to be involved. Deficiencies were found in the support in information in diagnosis, insufficient information on the healthcare routines, inadequate meeting and requirements for participation. Conclusions: The relatives need psychosocial support from the healthcare. Adequate information, access to health care professionals and to be treated with respect were the most valuable support from the professionals. The professionals can improve the psychosocial support by having knowledge of how they can identify relatives who need support and how they can support them. Keywords: psychosocial support, relatives, cancer, qualitative content analysi

Exercise in patients with cancer : Effects on health-related quality of life, costs, and cost-effectiveness during oncological treatment

Background: Short and long-term side effects of oncological treatment negatively affect daily living and health-related quality of life (HRQoL) in patient with cancer. Exercise during treatment is beneficial for HRQoL, however evidence as to what exercise intensity is most optimal for improving HRQoL and cost-effectiveness is lacking. Cost-effectiveness is important information for decisionmakers when implementing healthcare interventions, such as exercise programmes. The overall aim of this thesis was to study functioning in daily life, HRQoL, costs, and cost-effectiveness of an exercise intervention of different exercise intensities in patients with cancer receiving oncological treatment.  Method: Study I was qualitative and explored how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life. Semi-structured individual interviews (n =21) were performed and analysed with thematic analysis. Studies II–IV were quantitative and used data from a randomised controlled trial (RCT) of high-intensity (HI) and low-to-moderate-intensity (LMI) exercise of combined resistance and endurance training with or without self-regulatory behaviour change support. The RCT was preceded by a descriptive longitudinal study with usual care (UC). Participants were diagnosed with breast, prostate, or colon cancer and received (neo)adjuvant oncological treatment. Study II evaluated the effects on HRQoL of exercising at HI (n =288) and LMI (n =289) versus UC (n =89) up to 18 months after start of oncological treatment, using the EORTC QLQ-C30 questionnaire. Data were analysed using descriptive and multivariate statistics. Study III evaluated resource utilisation and societal costs of the exercise intervention in the RCT (n =534) versus UC (n =85), and of HI (n =269) versus LMI (n =265) exercise 18 months after start of oncological treatment. Societal costs included costs of healthcare resource utilisation (healthcare visits, hospitalisation, prescribed medication), productivity loss (disability pensions and sick leave), and the exercise intervention. Study IV evaluated the cost-effectiveness of the exercise intensities in the RCT (HI: n =99 and LMI: n =90) at 1-year follow-up post intervention. Cost data were retrieved from Study III and health outcome were collected using the EQ-5D-5L questionnaire and calculated for quality-adjusted life-years. Cost-effectiveness was evaluated as the incremental cost-effectiveness ratio (ICER).  Results: Participants experienced impairments from oncological treatment but strove to maintain function in daily life. The exercise programme improved physical and psychological wellbeing during treatment (Study I). There were no significant differences in HRQoL between exercise intensities up to 1 year after the exercise intervention. The exercise groups scored significant better HRQoL compared to UC over time (Study II). There was no significant difference in mean societal costs between the exercise intervention and UC, nor between the exercise intensities (Study III). There was no significant difference in cost or in effect between the exercise intensities. Although the mean ICER indicated that HI was cost-effective compared to LMI, the uncertainty was large (Study IV).  Conclusion: Participating in an exercise programme during oncological treatment was a positive and supportive experience that contributed to increase physical and psychological wellbeing. Exercise of HI and LMI during oncological treatment had similar effect on HRQoL and societal costs. In addition, the exercise group had beneficial effects on HRQoL and no significant difference in societal costs compared to UC, meaning the exercise programme did not save or add societal cost. Thus, based on cost-effectiveness we suggest decisionmakers and clinicians implement exercise programmes including both HI and LMI in cancer care and recommend exercise regardless of intensity according to the patient’s preferences to improve or to maintain aspects of HRQoL during oncological treatment.

Identifiering av upplevelse av smärta hos patienter med cancer som får palliativ vård : en litteraturstudie

One third of all Swedish people will suffer in cancer. Pain is a common symptom in cancer patients. The pain is subjective and includes several dimensions. The dimensions of pain are the physical, psychological, social and spiritual. This is a literature review and the aim with this study was to identify the pain experience in patients with cancer receiving palliative care. Nineteen articles were analysed. The result shows that the physical pain was experienced as chronicle or episodic pain. Psychological pain included fear, distress and anxiety. Social pain was a result of loss of relationships and ability to take part of activities. Spiritual pain was expressed as feelings of meaningless, hopelessness and fear for the future. Different kinds of dimensions cooperate with each other. They can strengthen each other and one dimension of pain can lead to another. The articles that have been analysed focus on several dimension of pain. To be able to relieve the pain and other symptoms, the nurse needs to have a holistic view of patients and to be aware of how all dimensions of pain that is expressed by the patient

Identifiering av upplevelse av smärta hos patienter med cancer som får palliativ vård : en litteraturstudie

One third of all Swedish people will suffer in cancer. Pain is a common symptom in cancer patients. The pain is subjective and includes several dimensions. The dimensions of pain are the physical, psychological, social and spiritual. This is a literature review and the aim with this study was to identify the pain experience in patients with cancer receiving palliative care. Nineteen articles were analysed. The result shows that the physical pain was experienced as chronicle or episodic pain. Psychological pain included fear, distress and anxiety. Social pain was a result of loss of relationships and ability to take part of activities. Spiritual pain was expressed as feelings of meaningless, hopelessness and fear for the future. Different kinds of dimensions cooperate with each other. They can strengthen each other and one dimension of pain can lead to another. The articles that have been analysed focus on several dimension of pain. To be able to relieve the pain and other symptoms, the nurse needs to have a holistic view of patients and to be aware of how all dimensions of pain that is expressed by the patient

Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment - results from the Phys-Can project

Purpose This study aimed to evaluate the effect of high intensity (HI) vs low-to-moderate intensity (LMI) exercise on health-related quality of life (HRQoL) up to 18 months after commencement of oncological treatment in patients with breast, colorectal or prostate cancer. In addition, we conducted a comparison with usual care (UC). Methods Patients scheduled for (neo)adjuvant oncological treatment (n = 577) were randomly assigned to 6 months of combined resistance and endurance training of HI or LMI. A longitudinal descriptive study (UC) included participants (n = 89) immediately before the RCT started. HRQoL was assessed by EORTC QLQ-C30 at baseline, 3, 6 and 18 months (1 year after completed exercise intervention) follow-up. Linear mixed models were used to study the groups over time. Results Directly after the intervention, HI scored significant (P = 0.02), but not clinically relevant, higher pain compared with LMI. No other significant difference in HRQoL was found between the exercise intensities over time. Clinically meaningful improvements in HRQoL over time were detected within both exercise intensities. We found favourable significant differences in HRQoL in both exercise intensities compared with UC over time. Conclusion This study adds to the strong evidence of positive effect of exercise and shows that exercise, regardless of intensity, can have beneficial effects on HRQoL during oncological treatment and also for a substantial time after completion of an exercise intervention. In this study, for one year after. Implications for cancer survivors Patients can be advised to exercise at either intensity level according to their personal preferences, and still benefit from both short-term and long-term improvements in HRQoL.Funding Agencies: Linköping University; Swedish Cancer Society; Swedish Research Council, European Commission; Region Östergötland, Sweden; Oncology Department Foundations Research Fund in Linköping, Sweden</p

Exercise : A positive feature on functioning in daily life during cancer treatment — Experiences from the Phys-Can study

PURPOSE: Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life. METHODS: Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis. RESULTS: Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities. CONCLUSIONS: Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life

Miljöföroreningar i blod och urin och kopplingar till rapporterat matintag i Riksmaten 2010-11 – resultatsammanställning : (Samrapporterat med "Analys av PCB och bromerade flamskyddsmedel i prover insamlade i anslutning till kostenkäten")

Riksmaten 2010-11 är en nationell matvaneundersökning genomförd av Livsmedelsverket mellan maj 2010 och maj 2011. Fem tusen svenskar ombads delta i en fyra dagars kostregistrering samt att fylla i en enkät. En undergrupp på cirka 1000 personer tillfrågades även om att lämna blod och urinprov för undersökning av nutritionsstatus och miljöföroreningar, och av dessa valde 300 individer att delta i biomonitoreringen. Analyser av miljöföroreningar genomfördes under 2011-2012. Exponeringsnivåer för samtliga miljöföroreningar har sammanställts och redovisas i denna rapport. Utöver detta har även samband mellan nivåer av miljöföroreningarna och kost- och livsstilsfaktorer, socioekonomiska variabler och boendemiljö undersökts. Resultaten från de analyserna sammanfattas här kort och redovisas i helhet som separata vetenskapliga publikationer