Correlates and outcomes of posttransplant smoking in solid organ transplant recipients : a systematic literature review and meta-analysis

Despite smoking being an absolute or relative contraindication for transplantation, about 11% to 40% of all patients continue or resume smoking posttransplant. This systematic review with meta-analysis investigated the correlates and outcomes associated with smoking after solid organ transplantation.; We searched PubMed, EMBASE, CINAHL, and PsycINFO from inception until January 2016, using state-of-the art methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were computed for correlates/outcomes investigated 5 times or more.; Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1 in lung transplantation) investigated 95 correlates and 24 outcomes, of which 6 correlates and 4 outcomes could be included in the meta-analysis. The odds of smoking posttransplant were 1.33 times higher in men (95% CI, 1.12-1.57). Older individuals were significantly less likely to smoke (OR, 0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index (OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75), diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant correlates. Posttransplant smokers had higher odds of newly developed posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95), nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality (OR, 1.74; 95% CI, 1.21-2.48).; Posttransplant smoking is associated with poor outcomes. Our results might help clinicians to understand which patients are more likely to smoke posttransplant, guide interventional approaches, and provide recommendations for future research

When parents face the death of their child: a nationwide cross-sectional survey of parental perspectives on their child's end-of life care.

BACKGROUND: Parents facing the death of their child have a strong need for compassionate professional support. Care services should be based on empirical evidence, be sensitive to the needs of the families concerned, take into account the heterogeneity within the medical field of paediatrics, and fit into the local health care system. We need to better understand the perspectives of parents facing the death of their child in order to guide further development and evaluation of specialised paediatric palliative and end-of-life (EOL) care services. METHODS: Questionnaire survey to assess the EOL care perspectives of a Swiss population-based sample of bereaved parents who had lost a child due to a cardiac, neurological or oncological condition, or during the neonatal period in the years 2011 or 2012. The parental perspective was assessed with a newly developed and tested instrument that was structured according to six evidence-based quality domains. Responses regarding parental experiences and perceived satisfaction are described. Differences between the four diagnostic groups are analysed using a generalized estimation equation to account for the dyadic data structure. RESULTS: Of 307 eligible families, 267 could be contacted and 135 (51%) consented to participate in this questionnaire survey. Our findings show positive parental experiences of their child's EOL care and high perceived satisfaction with the care their child received. Parents of a child with cancer rated their experiences highest in most of the six quality domains and reported the highest satisfaction with care. The lowest scores were mainly reported by parents from the neurology group, with the exception of the shared decision making domain, where parents of neonates reported significantly less positive experiences. CONCLUSIONS: Although positive in general, our study results suggest some areas for improvement. The integration of specialised paediatric palliative care has the potential to minimise lost opportunities to support and assist parents

Patterns of paediatric end-of-life care: a chart review across different care settings in Switzerland

BACKGROUND: Paediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland. METHODS: In this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland. RESULTS: Ninety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare. CONCLUSIONS: The study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families

Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis.

BACKGROUND: Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up. METHODS: Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making. RESULTS: Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected. CONCLUSION: These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits. TRIAL REGISTRATION: Clinical Trial Number: NCT02785666 , 30.05.2016

Screening HIV-positive men who have sex with men for hepatitis C re-infection risk: is a single question on condom-use enough? A sensitivity analysis

Hepatitis C virus (HCV) is common in men who have sex with men (MSM) with HIV. The Swiss HCVree Trial targeted a micro-elimination by using a treat and counsel strategy. Self-reported condomless anal intercourse with non-steady partners was used as the selection criterion for participation in a counselling intervention designed to prevent HCV re-infection. The purpose of this study was to assess the ability of this criterion to identify men who engaged in other sexual risk behaviours associated with HCV re-infection.; Men who disclosed their sexual and drug- use behaviours during the prior 6 months, at study baseline, were included in the current study. Using a descriptive comparative study design, we explored self-reported sexual and drug-use risk behaviours, compared the odds of reporting each behaviour in men who reported and denied condomless anal intercourse with non-steady partners during the prior year and calculated the sensitivity/specificity (95% CI) of the screening question in relation to the other at-risk behaviours.; Seventy-two (61%) of the 118 men meeting eligibity criteria reported condomless anal intercourse with non-steady partners during the prior year. Many also engaged in other potential HCV transmission risk behaviours, e.g., 52 (44%) had used drugs. In participants disclosing drug use, 44 (37%) reported sexualised drug use and 17 (14%) injected drugs. Unadjusted odds ratios (95% CI) for two well-known risk behaviours were 2.02 (0.80, 5.62) for fisting and 5.66 (1.49, 37.12) for injecting drug use. The odds ratio for sexualised drug use - a potential mediator for increased sexual risk taking - was 5.90 (2.44, 16.05). Condomless anal intercourse with non-steady partners showed varying sensitivity in relation to the other risk behaviours examined (66.7-88.2%).; Although condomless anal intercourse with non-steady partners was fairly sensitive in detecting other HCV relevant risk behaviours, using it as the only screening criterion could lead to missing a proportion of HIV-positive men at risk for HCV re-infection due to other behaviours. This work also points to the importance of providing access to behavioral interventions addressing other sexual and drug use practices as part of HCV treatment.; Clinical Trial Number: NCT02785666 , 30.05.2016

Stärka barnens integritet : En kvalitativ studie om hur förskolan arbetar med att stärka barnens integritet och förebygga sexuella kränkningar mot barn

2440 cases of sexual child abuse was reported in 2015 in Sweden that is about one out of five children. Research shows that prevention strategies that focus on strengthening children’s integrity have proven effective for helping children recognize abusive behaviors as well as gain confidence to disclose.    The aim of this study is to investigate and describe the preschools role in strengthening children’s integrity to prevent child abuse, and describe how the work is done. The study has a qualitative approach with mix of semi-structured and unstructured interviews, called a qualitative interview form. This study used a purposive selection, four informants with management position within preschool were interviewed. The interviews were recorded and then transcribed, which will serve as a database for analysis.  For this study a content analysis was chosen.    The results showed that the preschool work aims to strengthen children’s integrity, but that the pre-schools do not use any specific strategies to strengthen children’s integrity with the aim of preventing child abuse. The conclusion showed that the preschool does not work consciously to prevent sexual child abuse, instead they are focusing in strengthening children’s integrity and values

Livskvalitet efter en brännskada

Bakgrund: I Sverige brännskadas cirka 20 000 personer om året och cirka 1 363 patienter per år vårdas på sjukhus för sina brännskador. Livskvalitet betyder olika för samtliga människor beroende på vilken situation personen befinner sig i. En brännskada orsakad av en olyckshändelse kan utlösa en psykisk kris. Krisens faser är: chockfas, reaktionsfas, bearbetningsfas och nyorienteringsfas. En persons förmåga att hantera svårigheter i livet kan förstås utifrån känsla av sammanhang (KASAM). KASAM utgår från begreppen begriplighet, hanterbarhet och meningsfullhet.  Syfte: var att beskriva livskvalitet hos vuxna efter en brännskada. Metod: en litteraturstudie med en systematisk sökning med en beskrivande design har genomförts. Dataanalys genomfördes med en modifierad innehållanalys.  Resultat: I studien framkom fem kategorier: Arbete, Allmän hälsa och socialt välbefinnande, Mental hälsa, Fysisk funktion och fysisk hälsa samt Kroppsuppfattning. Förmågan att arbeta främjade livskvaliteten. Brännskadans placering hade betydelse för utveckling av ångest/depression, de patienterna med ansiktsdeformeringar och/eller brännskadade händer fick diagnosen ångest/depression i större utsträckning än resterande patienter. En brännskada medförde en sämre mental hälsa än bland normalpopulationen. Social förmåga, personliga relationer, sexualliv och kärleksrelation påverkade livskvaliteten. Att bearbeta de estetiska och funktionella negativa konsekvenser som brännskadan medfört var betydande för livskvaliteten.    Slutsats: Förmågan att arbeta, brännskadans storlek, djup och placering påverkar livskvaliteten. Brännskadade patienters nuvarande familjesituation är mer tillfredsställande jämfört med normalpopulationen fyra år efter brännskadan. Ansiktdeformeringar och brännskadade händer ger svåra sociala problem.    Sökord: Brännskada, Kris, Livskvalitet och Traum

Robotic Process Automation - Robotic Process Automation and its Effects on Job Characteristics

The automation of work tasks has been of high interest for over a century, where different technologies have been developed to serve this purpose. Robotic Process Automation (RPA) is one of these technologies, which automates the execution of monotonous and repetitive work tasks previously performed by humans. As a consequence, the employee whose job consists of these work tasks might perceive effects on their job characteristics, since these constitute the essential attributes of a job. The use of RPA is becoming vital for organisations to remain competitive in the long run and is predicted to drastically increase during the upcoming years. In line with this, the aim of the study is to describe what effects the employee perceives on their job characteristics on an individual level, from using RPA. It is a qualitative study using semi-structured interviews with eleven participants. The study has focused on the five job characteristics: skill variety, task identity, task significance, autonomy, and feedback. Conclusively, the study identified that the employee perceives effects on all job characteristics except from feedback, due to the use of RPA. Results from this study give further insights into the employee’s perceived effects from the use of RPA