New innovations to support self-care in persons with heart failure

Introduction: Heart failure (HF) in combination with multiple chronic conditions is increasing rapidly, mainly in the elderly. Self-care is presumed to be one of the best practices for chronic illness including HF. Most of HF-related costs are attributed to hospitalizations with poor HF selfcare as an important cause. The complexity of self-care leads to poor adherence to self-care. Mobile health (mHealth) and the use of technology has the possibility to support persons with HF and families to engage in self-care. Other strategies for improving self-care can be physical activities, known to improve cardiorespiratory and muscular fitness/strength, functional health, maintained cognitive function, reduction of anxiety and depression together with improved self-esteem. Self-care with yoga may be an alternative to exercise training and increase quality of life. Aim: The overall aim of this thesis was to describe experiences and evaluate the effects of innovative self-care approaches such as the mHealth system and yoga among persons with heart failure. Methods: The thesis is based on four studies using both quantitative and qualitative methods. Study I and II used an RCT design with follow-up assessment after three and six months including 82 persons with heart failure. The control group received care as usual. Data was collected using questionnaires before and after tree and six months to determine the long-term effects on selfcare, HRQoL, knowledge and hospitalization (I, II). To evaluate the experiences from the mHealth system a qualitative study with interviews where performed including 17 persons in study III. Study IV was conducted as a RCT study with 40 persons with HF, receiving either hydrotherapy or yoga. Evaluation before and after three months included HRQoL, six-minute walk test, sit-to-stand test, clinical variables, anxiety and depression. Results: The mHealth intervention resulted in improved self-care, HRQoL and reduction in hospitalization days after both three and six months. Knowledge improved significantly after six months. Adherence to the mHealth system was high around 85%. Insight in the importance of adherence to self-care through daily weighing, was enhanced by the repeated reminder and instant feed-back from the mHealth system gathered from experiences. Technical adversities were common with a need of quick and easy support. Yoga and hydrotherapy had an equal impact on HRQoL, exercise capacity, clinical outcomes, anxiety and depression. Conclusions: The mHealth tool strengthened adherence to weighing, improved self-care, HRQoL and reduced HF hospitalization days, together with improved HF knowledge after six months. Self2 care was obtained through understanding the deteriorating symptoms and signs, in connection to weight change and how to act. The experiences of mHealth could be determined in relation to “the situation specific theory of heart failure self-care”. Yoga could serve as a complement or alternative to exercise training such as hydrotherapy in persons with heart failure

Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

<p>Abstract</p> <p>Background</p> <p>The decreasing range of joint motion caused by insufficient muscle length is a common problem in children with cerebral palsy (CP), often worsening with age. In 1994 a CP register and health care programme for children with CP was initiated in southern Sweden. The aim of this study was to analyse the development of the passive range of motion (ROM) in the lower limbs during all the growth periods in relation to gross motor function and CP subtype in the total population of children with CP.</p> <p>Methods</p> <p>In total, 359 children with CP born during 1990-1999, living in the southernmost part of Sweden in the year during which they reached their third birthday and still living in the area in the year of their seventh birthday were analysed. The programme includes a continuous standardized follow-up with goniometric measurements of ROM in the lower limbs. The assessments are made by each child's local physiotherapist twice a year until 6 years of age, then once a year. In total, 5075 assessments from the CPUP database from 1994 to 1 January 2007 were analysed.</p> <p>Results</p> <p>The study showed a decreasing mean range of motion over the period 2-14 years of age in all joints or muscles measured. The development of ROM varied according to GMFCS level and CP subtype.</p> <p>Conclusion</p> <p>We found a decreasing ROM in children with CP from 2-14 years of age. This information is important for both the treatment and follow-up planning of the individual child as well as for the planning of health care programmes for all children with CP.</p

Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial

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Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate the prevalence of cerebral palsy (CP) as well as to characterize the CP population, its participation in a secondary prevention programme (CPUP) and to validate the CPUP database.</p> <p>Methods</p> <p>The study population was born 1990–1997 and resident in Skåne/Blekinge on Jan 1^st2002. Multiple sources were used. Irrespective of earlier diagnoses, neuropaediatrician and other professional medical records were evaluated for all children at the child habilitation units. The CPUP database and diagnosis registers at hospital departments were searched for children with CP or psychomotor retardation, whose records were then evaluated. To enhance early prevention, CP/probable CP was searched for also in children below four years of age born 1998–2001.</p> <p>Results</p> <p>The prevalence of CP was 2.4/1,000 (95% CI 2.1–2.6) in children 4–11 years of age born in Sweden, excluding post-neonatally acquired CP. Children born abroad had a higher prevalence of CP with more severe functional limitations. In the total population, the prevalence of CP was 2.7/1,000 (95% CI 2.4–3.0) and 48% were GMFCS-level I (the mildest limitation of gross motor function).</p> <p>One third of the children with CP, who were born or had moved into the area after a previous study in 1998, were not in the CPUP database. The subtype classification in the CPUP database was adjusted in the case of every fifth child aged 4–7 years not previously reviewed.</p> <p>Conclusion</p> <p>The prevalence of CP and the subtype distribution did not differ from that reported in other studies, although the proportion of mild CP tended to be higher.</p> <p>The availability of a second opinion about the classification of CP/CP subtypes is necessary in order to keep a CP register valid, as well as an active search for undiagnosed CP among children with other impairments.</p

Taking Turns: Democracy to Come and Intergenerational Justice

In the face of the ever-growing effect the actions of the present may have upon future people, most conspicuously around climate change, democracy has been accused, with good justification, of a presentist bias: of systemically favouring the presently living. By contrast, this paper will argue that the intimate relation, both quasi-ontological and normative, that Derrida’s work establishes between temporality and justice insists upon another, more future-regarding aspect of democracy. We can get at this aspect by arguing for two consequences of the deconstructive affirmation of sur-vivre, of the alterity of death in life. Firstly, justice is not first of all justice for the living, but intergenerational from the start. This is so because no generation coincides with itself; rather, it dies and is reborn at every moment, and so – and this is the second consequence – consists in taking turns. Affirming life as living-on means affirming that it involves exchanging life’s stations, as the young become the old, and the unborn become the dead. In this sense, the justice of living-on, I will argue, shares an essential feature with democracy, whose principle of exchanging the rulers with the ruled led Derrida to characterize it in terms of the wheel. Democracy consists in the principled assent to power changing hands, a switchover life demands of every generation at every turn. This assent further requires an acceptance of the gift of inheritance without which no life can survive. But as the gift can also never be fully acknowledged or appropriated, it must be passed on to the indefinite, unknown future, in a turning that is the time of life

Användning av dans inom vården av minnessjuka

Denna studie är en integrativ litteraturöversikt om användning av dans inom vården av minnessjuka. Studien är ett beställningsarbete av Konkordiahemmet, ett åldringshem med både service- och demensboende i Tölö, Helsingfors. Syftet med studien var att ta reda på hur dans kan användas inom vården av patienter med minnessjukdomar. Den teoretiska referensramen för denna studie är Katie Erikssons teori om hälsa. I studien besvarades tre frågeställningar: Hur kan dansen spela roll i äldres liv? Kan dans använ-das inom vården av minnessjukdomar? Hur inverkar dansen på människor med minnes-sjukdomar? Litteratursökningen hade några kriterier; forskningarna var inte mer än sju år gamla, de var forskningar, inte artiklar och forskningen tangerade sökorden fullständigt. Totalt tio artiklar valdes för forskningen. En äldre forskning togs med i efterhand fastän denna inte fyllde kriterierna. Metoden som användes för att analysera artiklarna och besvara frågeställningarna var Kvales ad hoc metod. Resultatet delades in i två huvudkategorier: fysiska och psykiska faktorer. Resultatet visar att dans inverkar positivt på äldres fysiska mående; konditionen, balansen, koordinationen samt mobiliteten förbättras. Tack vare dansen upplever de äldre bättre psykisk hälsa; de kommunicerar bättre, de upplever en känsla av samhörighet samt ökad självkännedom, de finner ett sätt att uttrycka sig på annat sätt, gamla minnen väcks till liv, en känsla av välbefin-nande och positivitet strömmar genom dem

Muscular profiling of the lower body of male amateur climbers. : A study of strength and power in the lower extremities on climbers at advanced and moderate level

Klättring som utförs på överhängande ytor blir allt vanligare och kräver mer avancerad användning av underkroppen. Då tidigare forskning i synnerhet undersökt överkroppsstyrka saknas en muskulär profilering av underkroppen hos klättrare vilket således var syftet med denna studie. Frågeställningarna eftersträvade att undersöka om skillnader i styrka och power i nedre extremiteter kan relateras till prestation hos manliga klättrare. Deltagarna var 10 manliga amatörklättrare som delades in i 2 grupper baserat på idrottsspecifik prestationsnivå. Grupp 1 (n=6) kategoriserades som avancerade klättrare och grupp 2 (n=4) som moderata. Ett isokinetiskt styrketest och två olika hopptester genomfördes av samtliga studiedeltagare. Efter statistisk analys framgick det att det inte fanns några signifikanta skillnader (p= 0,05) mellan grupperna gällande relativ styrka i quadriceps, relativ styrka i hamstrings, H/Q-kvot, hopphöjd vid SJ eller hopphöjd vid CMJ. Gruppen med mer avancerade klättrare presterade signifikant högre vid CMJ kontra SJ (p=0,013). Slutsatserna av denna studie är att klättrare har förhållandevis låga resultat både vid mätning av H/Q-kvot vid 90°/s (grupp 1: 51% vs. grupp 2: 53,9%), 210°/s (59,4% vs. 57,9%) och vid vertikala hopptester (SJ: 32,1cm vs. 31,7cm; CMJ: 35,8 cm vs. 33,9 cm) samt att hoppteknik verkar kunna vara en bidragande faktor för prestation inom klättring.Rock climbing performed on overhanging surfaces is becoming more common and requires more advanced use of the lower body. Since previous research has mostly examined upper body strength there is a need for a muscular profiling of the lower body of climbers, which was the purpose of this study. The study sought to investigate whether differences in strength and power in the lower extremities can be related to climbing performance in male climbers. The participants were 10 male amateur climbers divided into two groups based on athletes-specific performance level. Group 1 (n=6) where categorized as advanced climbers and group 2 (n=4) as moderate. An isokinetic strength test and two different jump tests were performed by all study participants. After statistical analysis, there were no significant differences (p= 0,05) between the groups in relative strength in the quadriceps, relative strength in hamstrings, H/Q-ratio, jump height at SJ or jump height at CMJ. The group with more advanced climbers performed significantly higher at CMJ versus SJ (p = 0.013). The conclusions of this study are that climbers have relatively low results when measuring H/Q-ratio at 90°/s (group 1: 51% vs. group 2: 53,9%), 210°/s (59,4% vs. 57,9%) and height at vertical jump tests (SJ: 32,1cm vs. 31,7cm; CMJ: 35,8 cm vs. 33,9 cm) and that jump technique seems to be a contributing factor in climbing performance.