A striving for independence: a qualitative study of women living with vertebral fracture

<p>Abstract</p> <p>Background</p> <p>Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.</p> <p>Methods</p> <p>The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.</p> <p>Results</p> <p>The findings of this study revealed three themes related to the influence on HRQOL and daily life: <it>A threatened independence</it>, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; <it>Strategies for maintaining independence</it>, i.e. coping, self-care and support; and <it>The importance of maintaining independence</it>, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. The women were striving for independence or maintaining their independence by trying to manage different types of symptoms and consequences in different ways.</p> <p>Conclusion</p> <p>HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. Information from this study may provide new knowledge and understanding of the women's experiences of living with vertebral fracture from an insider's point of view in order to obtain a deeper understanding of the women's everyday life. However, further evaluation is still needed in larger study groups.</p

Mastery and Autonomy in Medication With a Mobile Self-Report System – A Project in Action

Abstract. The overall aim of this research program is to design and examine if a mobile phone-based self-report system can be used to a) mediate knowledge about hypertension b) improve adherence to antihypertensive treatment and c) increase patient participation and autonomy

Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures

Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms. Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV). Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis. Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways. Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL

http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-51527 BMC Musculoskeletal Disorders

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Interventions in hypothetical elder abuse situations suggested by Swedish formal carers.

In Sweden, public attention has not focused on elder abuse. No common view of interventions or organizational repsonsibilities has been developed. The aim of this study was to describe interventions suggested by Swedish formal carers in three hypothetical, typical cases of elder abuse. From one municipality in Sweden, 71 formal carers (district nurses, home service assistants, and general practitioners0 responded to a questionnaire concerning three cases: "The Spouse Abuse Case," "The Dependent Adult Child Case," and "The Caregiving Relative Case." Cluster analysis of the interventions was performed to explore patterns and reduce the number of variables. The findings showed that the respondents suggested few interventions, mainly vieweing the problem as a social one, more specifically, as one for health care and voluntary organizations, or they suggested all types of interventions. The respondents' professions were significantly related to their suggested interventions, i.e., there was a proportional predominance of district nurses suggesting more interventions of all types. Each professional group and organization seemed to develop their own view of elder abuse. The suggested interventions were related to their professional discipline, the specific type of situation, and the two cultures of health and social care

Narratives by district nurses about elder abuse within families.

Twenty-one district nurses (DNs) narrated 44 cases of elder abuse within families. A phenomenological-hermeneutical analysis revealed that the experiences were complex and often included families providing care for an elderly person. The abuse seemed to be related to the inability of one party to meet the care demands required by the elderly, by him- or herself, or by the situation. It also seemed to be related to an inhibiting dependency between the parties, a negative execution of power over the weaker party, and a history of violence. When the experiences were considered within the perspective of Lögstrup's ethics, it appeared that the DNs tried to remain neutral by not consciously reflecting on the ethical demands in the abuse situations. The findings suggest that nurses need support to enable them to decide about provision of care at home and to judge "the core" in abuse situations. They might gain this support through reflection on a meta-level, taking various perspectives into account, and thus making it possible to achieve new dimensions for decision making

Experiences, expectations and challenges of an interactive mobile phone-based system to support self-management of hypertension: patients and professionals perspectives

Background: A well-controlled blood pressure (BP) reduces cardiovascular complications. Patient participation in care using technology may improve the current situation of only 13.8% of adults diagnosed with hypertension worldwide having their BP under control. Objective: The objective of this study was to explore patients and professionals experiences of and expectations for an interactive mobile phone-based system to support self-management of hypertension. Methods: The self-management system consists of: 1) a mobile phone platform for self-reports, motivational messages and reminders; 2) a device for measuring BP and 3) graphical feedback of self-reports. Patients diagnosed with high BP (n=20) and their treating professionals (n=7) participated in semi-structured interviews, after 8 weeks use of the system in clinical practice. Data were analyzed thematically. Results: The self-reporting of BP, symptoms, medication use, medication side effects, lifestyle and well-being was perceived to offer insight into how daily life activities influenced BP and helped motivate a healthy lifestyle. Taking increased responsibility as a patient, by understanding factors affecting ones well-being, was reported as an enabling factor for a more effective care. Based on the experiences, some challenges were mentioned: for adoption of the system into clinical practice, professionals educational role should be extended and there should be a reorganization of care to fully benefit from technology. The patients and professionals gave examples of further improvements to the system, for example, related to the visualization of graphs from self-reports and an integration of the system into the general technical infrastructure. These challenges are important on the path to accomplishing adoption. Conclusion: The potential of a more autonomous, knowledgeable and active patient, through use of the interactive mobile system would improve outcomes of hypertension treatment, which has been desired for decades. Documentation and visualization of patients self-reports and the possibilities to communicate these with professionals may be a significant resource for person-centered care.Funding Agencies|University of Gothenburg LETStudio; University of Gothenburg Centre for Person-Centred Care (GPCC) in Sweden; Swedish Governments grant for Strategic Research Areas, Care Sciences [2009-1088]; University of Gothenburg, Sweden</p

Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system : a cohort study in primary care

Objectives: To explore relationships between patients’ self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms. Design: This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension. Setting: Four primary healthcare centres situated in urban and suburban communities in Sweden. Participants: 50 patients undergoing treatment for hypertension. Primary and secondary outcome measures: Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling. Results: Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms—dizziness, headache, restlessness, fatigue or palpitations—were significantly associated with BP. Conclusions: Our findings that BP was associated with patients’ BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations. Trial registration number NCT01510301; Pre-results.Funding agencies: Gothenburg Centre for Person-Centred Care (GPCC) in Sweden; Swedish Governments grant for Strategic Research Areas, Care Sciences (Application to Swedish Research Council) [2009-1088]; University of Gothenburg, Sweden</p

Lung function in young adulthood: differences between males and females with asthma

Background There are phenotypic differences in asthma in males and females. Differences in lung function between the sexes at the peak lung function level in young adulthood are so far not directly addressed. The aim of the present study was to assess lung function in early adulthood in males and females depending on asthma onset and remission. Methods Participants were included from the population-based birth cohort BAMSE and classified as having: never asthma, childhood asthma in remission, adolescent onset asthma or persistent asthma. Pre- and post-bronchodilator lung function (in Z-score) and lung clearance index (LCI) were measured at age 24 years. Lung function was compared stratified for sex between the never asthma and asthma groups univariately and in multiple linear regression analyses adjusted for maternal and paternal asthma, maternal smoking during pregnancy, secondary smoking, daily smoking, early respiratory syncytial virus infection, traffic pollution, childhood allergic sensitisation, and body mass index at age 24 years. Results All asthma phenotypes were associated with a lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) post-bronchodilation at 24 years. This was most pronounced in males with persistent asthma compared to males with never asthma (regression coefficient: −0.503; 95% CI: −0.708– −0.298). Childhood asthma (in remission or persistent) was associated with a lower FEV1. After adjustment, the associations remained significant for males. For females, the significant associations with lower FEV1 and FEV1/FVC remained only for subjects with asthma in remission. Persistent asthma was associated with higher LCI in females. Conclusions In females, in contrast to males, the association between asthma and lower lung function was attenuated after adjustment for known risk factors