Diabetes among Turkish immigrants in Sweden : a study of prevalence and risk factors

Background Risk factors associated with the difference in susceptibility to diabetes in different ethnic groups are poorly understood. This thesis investigates differences in prevalence of, as well as risk factors for, diabetes, impaired glucose tolerance (IGT) and impaired fasting glucose, and whether there is an effect of migration, in Turkish immigrants in Sweden. Methods Two data sets were used for this thesis, a survey from the Swedish National Board of Health and Welfare (the Immigrant Survey) combined with the Swedish Survey of Living Conditions and a cross-sectional total-population survey on Turkish immigrants in Flemingsberg, Sweden. From the first survey, data were compared between Turkish immigrants in Sweden (n=526) and Swedish controls (n=2,854), all in ages 27-60 years. The second survey, which included a questionnaire, a medical examination, an oral glucose tolerance test (OGTT) and other laboratory analyses, comprised 238 Turkish men and women aged ≥ 20 years, living in Sweden. Data on diabetes and IGT were compared with 1549 participants of the same age, living in the Konya area in Turkey. Risk factors studied in the Turkish group in Flemingsberg were hypertension, obesity, central obesity, high fasting triglycerides, low HDL cholesterol, the metabolic syndrome, smoking and alcohol consumption, physical inactivity, stress, poor self-rated health and socio-economic factors. Results The self-reported diabetes prevalence was higher among Turkish women in Sweden, odds ratio (OR) 3.22, 95% confidence interval (CI) 1.36-7.64, compared to Swedish women. After adjustment for low educational level, unemployment and increased BMI, there was no difference between groups. Self-reported stress (anxiety, sleeping problems and pain) was also more common among Turkish men and women (compared to Swedish controls) even after adjusting for socio-economic factors. The prevalence of diabetes and IGT, was significantly higher among Turkish immigrants in Flemingsberg (11.8% and 15.6%, respectively), compared to controls in Turkey (7.1% and 7.6%, respectively). Turkish women in Sweden had a significantly higher prevalence of diabetes than Turkish women in Turkey (12.8% vs. 7.6%) and IGT was significantly higher among Turkish men in Sweden compared to men in Turkey (17.8% vs 4.9%). Mean onset of diabetes in the Turkish group in Flemingsberg was at 47 years. The fully adjusted odds of Turkish men in Flemingsberg having DGT (Disturbed Glucose Tolerance = diabetes or IGT) were 4-5 times higher if they had hypertension or were smokers or former smokers. Among women risk factors were central obesity and high fasting triglycerides (4.5 times higher odds for DGT). Men who reported smoking and alcohol consumption, were 3 times more likely to be newly diagnosed with DGT (OR 3.58, CI 1.29-9.96). Odds for newly diagnosed DGT were also higher among employed Turkish women in Flemingsberg (OR 2.73, CI 1.05-7.05). There was no association between DGT or the Metabolic Syndrome, with stress factors. Conclusions Turkish immigrants in Sweden are a risk group for diabetes. Culturally adjusted and gender specific intervention programs are urgently needed. Overweight, hypertension, alcohol consumption and smoking should be targeted risk factors. Identification of acculturation factors, such as changes in lifestyle, vitamin D- deficiency or change in microbiota is an important field of research to explain changing risks of diabetes among immigrants

An investigation of nurses’ evalutaion of their own skill in end-of-life care and their attitudes towards using Liverpool care pathway: a pilot study of the end-of-life care questionnaire

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Markmið rannsóknarinnar var að kanna hvernig íslenskir hjúkrunarfræðingar meta eigin færni í lífslokameðferð, skoða tengsl á milli bakgrunnsbreyta og viðhorf þátttakenda til notkunar á Meðferðarferli fyrir deyjandi (Liverpool Care Pathway, LCP). Einnig var tilgangurinn að forprófa réttmæti og áreiðanleika íslenskrar útgáfu á spurningalista um lífslokameðferð (End-of-Life Care questionnaire). Aðferð: Rannsóknaraðferðin var megindleg, lýsandi þversniðsrannsókn. Spurningalisti var sendur til 476 hjúkrunarfræðinga um land allt. Spurt var um þætti tengda umönnun í lífslokameðferð og ánægju þátttakenda með notkun Meðferðarferlis fyrir deyjandi. Framkvæmd var þáttagreining og lýsandi tölfræði beitt til að lýsa eiginleikum tölulegra gagna. Niðurstöður: Svarhlutfall var 40,8% (n=194). Þátttakendur töldu sig hafa sjálfstraust og færni í störfum sínum tengdum lífslokameðferð. Ánægja þeirra með notkun Meðferðarferlis fyrir deyjandi reyndist ekki vera afgerandi. Þáttagreining leiddi í ljós fimm þætti: Kostir Meðferðarferlis fyrir deyjandi, Sjálfsöryggi í umönnun, Sjálfsöryggi í samskiptum, Uppfylling þarfa og Þverfagleg hópvinna. Þáttahleðslur voru á bilinu 0,503-0,864. Cronbachs-alfa áreiðanleikastuðull var á bilinu 0,69-0,94. Marktæk fylgni var á milli hærri aldurs og sjálfsöryggis í umönnun (r=-0,187, p=0,01), starfsaldurs og sjálfsöryggis í umönnun (r=-0,271, p=0,01) og lengri starfsaldurs og sjálfsöryggis í samskiptum (r=-0,208, p=0,01). Þeir sem notuðu Meðferðarferli fyrir deyjandi voru líklegri til að hafa meira sjálfsöryggi í umönnun (p=0,012) og höfðu oftar stuðning af þverfaglegum hópi (p<0,001) en þeir sem ekki notuðu það. Ályktanir: Spurningalisti rannsóknarinnar reyndist hentugur til rannsókna á sviði lífslokameðferðar. Ætla má að hjúkrunarfræðingar búi yfir færni og hafi sjálfstraust þegar kemur að lífslokameðferð og hafi stuðning af þverfaglegum hópi. Þörf er á frekari rannsóknum á Íslandi á gagnsemi Meðferðarferlis fyrir deyjandi í lífslokameðferð.Aim: The aim of this research was to investigate how Icelandic nurses’ evaluate their skills in end-of-life care, to look at correlations between variables and participants’ attitudes towards the use of the Icelandic version of the Liverpool Care Pathway (LCP). Furthermore, the aim was to pilot test the validity and reliability of the Icelandic version of the questionnaire End-of-Life Care. Method: This was a quantitative cross-sectional survey. A questionnaire was sent to 476 nurses across Iceland. Questions included factors related to end-of-life care and satisfaction with the utility of LCP. Exploratory factor analysis and descriptive statistics were performed to describe the characteristics of the data. Results: Response rate was 40,8% (n=194). The participants felt self-confident in their work related to end-of-life care. Their satisfaction with using the LCP was not decisive. Exploratory factor analysis revealed five factors: The benefits of LCP in care of the dying, Self confidence in caring, Self confidence in communication, Fulfilling needs and Interdisciplinary teamwork. Factor loadings were between 0.503 and 0.864. Cronbach’s Alpha range was 0.69 - 0.94. Significant correlation was found between: higher age and self confidence in caring (r=-0.187, p=0.01), work experience and self confidence in caring (r=-0.271, p=0.01), work experience and self confidence in communications (r=-0.208, p=0.01). Those who used LCP were more likely to have more self confidence in caring (p=0.012) and benefitted more often from interdisciplinary teamwork (p<0.001) than those who did not. Conclusion: The questionnaire proved to be suitable for studies in end-of-life care. The inference can be drawn that nurses feel self confident when it comes to end-of-life care and benefit from interdisciplinary teamwork. The usefulness of the Icelandic version of the LCP in end-of-life care needs further investigation.Heilbrigðisstofnun Vestfjarða, Starfsmenntunarsjóður Félags íslenskra hjúkrunarfræðing

Nurses´ attitude towards and knowledge about palliative care in Icelandic nursing homes.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTilgangur rannsóknarinnar var að kanna viðhorf hjúkrunarfræðinga á íslenskum hjúkrunarheimilum til líknarmeðferðar og þekkingu þeirra á henni með skilgreiningu Alþjóðaheilbrigðismálastofnunarinnar (WHO) sem viðmið. Einnig var tilgangurinn að skoða skipulag og framkvæmd líknarmeðferðar sem og fræðsluþörf og hlutverk hjúkrunarfræðinga á þeim hjúkrunarheimilum sem tóku þátt í rannsókninni. Níu hjúkrunarfræðingar á tveimur hjúkrunarheimilum og einni hjúkrunardeild fyrir aldraða á sjúkrahúsi voru valdir til að taka þátt í rannsókninni. Allir þátttakendur gáfu skriflegt samþykki fyrir þátttöku sinni, enginn þeirra óskaði eftir því að draga sig út úr rannsókninni. Níu viðtöl með hálfstöðluðum spurningum voru tekin og gögnin voru þáttagreind. Yfirþema sem endurspeglaði viðhorf þátttakenda til líknarmeðferðar var vellíðan og góð verkja- og einkennameðferð á síðustu dögum lífs í notalegu umhverfi. Þrjú meginþemu komu í ljós, skilningur, lífslok og áhrifaþættir á líknarmeðferð, og hvert þema flokkast í nokkur undirþemu. Niðurstöður gáfu vísbendingar um að skortur væri á þekkingu á viðurkenndum viðmiðunum um líknarmeðferð á þeim hjúkrunarheimilunum sem tóku þátt. Draga má þá ályktun af niðurstöðum að mikilvægt sé að stuðla að því að aldraðir íbúar á hjúkrunarheimilum fái viðeigandi líknarmeðferð sem verði beitt um leið og staðfest er að þeir hafa sjúkdóm sem þarfnast slíkrar meðferðar. Til þess er nauðsynlegt að koma á skipulegri fræðslu um líknarmeðferð og hvenær henni skuli beitt sem heildrænni meðferð samhliða annarri meðferð

Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Acute hospital settings are generally not considered adequate places for end-of-life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future. Aim: The aim of this study was to investigate family caregivers' experiences of end-of-life care in an acute community hospital in Iceland. Methods: Fifteen in-depth qualitative semi-structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis. Findings: Findings indicated that the acute hospital setting is not a suitable environment for end-of-life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end-of-life care; (3) The dying process. Each of the themes encompassed a variety of subthemes. Conclusions: Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well-being. Acknowledging and appreciating the meaning of respect and dignity at the end-of-life from family caregivers' perspective is vital. Keywords: acute hospital settings; bereavement; communication; end-of-life care; environment; family caregivers; grief; palliative care.Science Fund of the University of Akureyri, Icelan

Induced seismicity risk analysis of the hydraulic stimulation of a geothermal well on Geldinganes, Iceland

The rapid increase in energy demand in the city of Reykjavik has posed the need for an additional supply of deep geothermal energy. The deep-hydraulic (re-)stimulation of well RV-43 on the peninsula of Geldinganes (north of Reykjavik) is an essential component of the plan implemented by Reykjavik Energy to meet this energy target. Hydraulic stimulation is often associated with fluid-induced seismicity, most of which is not felt on the surface but which, in rare cases, can be a nuisance to the population and even damage the nearby building stock. This study presents a first-of-its-kind pre-drilling probabilistic induced seismic hazard and risk analysis for the site of interest. Specifically, we provide probabilistic estimates of peak ground acceleration, European microseismicity intensity, probability of light damage (damage risk), and individual risk. The results of the risk assessment indicate that the individual risk within a radius of 2 km around the injection point is below 0.1 micromorts, and damage risk is below 10−2, for the total duration of the project. However, these results are affected by several orders of magnitude of variability due to the deep uncertainties present at all levels of the analysis, indicating a critical need in updating this risk assessment with in situ data collected during the stimulation. Therefore, it is important to stress that this a priori study represents a baseline model and starting point to be updated and refined after the start of the project

Arrival-angle anomalies across the USArray Transportable Array

We construct composite maps of surface-wave arrival-angle anomalies using clustered earthquakes and an array method for measuring wave-front geometry. This results in observations of arrival angles covering the entire footprint of the USArray Transportable Array during 2006–2010. Bands of arrival-angle deviations in the propagation direction indicate the presence of heterogeneous velocity structure both inside and outside of the array. We compare the observed patterns to arrival angles predicted using two global tomographic models, the mantle model S362ANI and the surface-wave-dispersion model GDM52. We use both ray-theory-based prediction methods and measurements on synthetic data calculated using a spectral-element method. Both models and all prediction methods produce similar mean arrival angles and long-wavelength patterns of anomalies which are similar to the observations. Predicted short-wavelength features generally do not agree with the observations. The spectral-element method produces some complexity that is not obtained using the ray-theory-based methods; this predicted complexity is similar in character to the observed patterns, but does not match them

'I couldn't even talk to the patient': barriers to communicating with cancer patients as perceived by nursing students

Communication is closely related to safe practice and patient outcomes. Given that most clinicians fall into routines when communicating with patients, it is important to address communication issues early. This study explores Taiwanese nursing students’ experiences of communication with patients with cancer and their families. Senior nursing students who had cared for cancer patients were recruited to participate in focus group interviews. These semi-structured interviews were recorded and transcribed for content analysis. Among the 45 participants, about 36% of them never received any communication training. Up to 76% of the participants stated that their communication with cancer patients was difficult and caused them emotional stress. Subsequent data analysis revealed four themes: dis-engagement, reluctance, regression, and transition. Students’ negative communication experiences were related to the patients’ terminally ill situation; the students’ lack of training, low self-efficacy and power status, poor emotional regulation, and cultural considerations. The findings of this study provide a deeper understanding of nursing students’ communication experiences in oncology settings within the cultural context. Early and appropriate communication training are necessary to help students regulate their emotions and establish effective communication skills. Further studies are needed to examine the relationship among students’ emotional labor, communication skills and outcomes

Accounting for prediction uncertainty when inferring subsurface fault slip

This study lays the groundwork for a new generation of earthquake source models based on a general formalism that rigorously quantifies and incorporates the impact of uncertainties in fault slip inverse problems. We distinguish two sources of uncertainty when considering the discrepancy between data and forward model predictions. The first class of error is induced by imperfect measurements and is often referred to as observational error. The second source of uncertainty is generally neglected and corresponds to the prediction error, that is the uncertainty due to imperfect forward modelling. Yet the prediction error can be shown to scale approximately with the size of earthquakes and thus can dwarf the observational error, particularly for large events. Both sources of uncertainty can be formulated using the misfit covariance matrix, C_χ, which combines a covariance matrix for observation errors, C_d and a covariance matrix for prediction errors, C_p, associated with inaccurate model predictions. We develop a physically based stochastic forward model to treat the model prediction uncertainty and show how C_p can be constructed to explicitly account for some of the inaccuracies in the earth model. Based on a first-order perturbation approach, our formalism relates C_p to uncertainties on the elastic parameters of different regions (e.g. crust, mantle, etc.). We demonstrate the importance of including C_p using a simple example of an infinite strike-slip fault in the quasi-static approximation. In this toy model, we treat only uncertainties in the 1-D depth distribution of the shear modulus. We discuss how this can be extended to general 3-D cases and applied to other parameters (e.g. fault geometry) using our formalism for C_p. The improved modelling of C_p is expected to lead to more reliable images of the earthquake rupture, that are more resistant to overfitting of data and include more realistic estimates of uncertainty on inferred model parameters

Gradual caldera collapse at Bárdarbunga volcano, Iceland, regulated by lateral magma outflow

Large volcanic eruptions on Earth commonly occur with a collapse of the roof of a crustal magma reservoir, forming a caldera. Only a few such collapses occur per century, and the lack of detailed observations has obscured insight into the mechanical interplay between collapse and eruption.We usemultiparameter geophysical and geochemical data to show that the 110-squarekilometer and 65-meter-deep collapse of Bárdarbunga caldera in 2014-2015 was initiated through withdrawal of magma, and lateral migration through a 48-kilometers-long dike, from a 12-kilometers deep reservoir. Interaction between the pressure exerted by the subsiding reservoir roof and the physical properties of the subsurface flow path explain the gradual, nearexponential decline of both collapse rate and the intensity of the 180-day-long eruption

Gradual caldera collapse at Bárdarbunga volcano, Iceland, regulated by lateral magma outflow

Large volcanic eruptions on Earth commonly occur with a collapse of the roof of a crustal magma reservoir, forming a caldera. Only a few such collapses occur per century, and the lack of detailed observations has obscured insight into the mechanical interplay between collapse and eruption.We usemultiparameter geophysical and geochemical data to show that the 110-squarekilometer and 65-meter-deep collapse of Bárdarbunga caldera in 2014-2015 was initiated through withdrawal of magma, and lateral migration through a 48-kilometers-long dike, from a 12-kilometers deep reservoir. Interaction between the pressure exerted by the subsiding reservoir roof and the physical properties of the subsurface flow path explain the gradual, nearexponential decline of both collapse rate and the intensity of the 180-day-long eruption.</p