I have to quit! : factors that influence quit attempts in smokers with COPD

Background and aim: The most effective treatment for patients with chronic obstructive pulmonary disease (COPD) is to quit smoking. Despite this, many patients with COPD continue to smoke. In Sweden, most patients with COPD are treated in primary health care settings. The general aims of the doctoral project presented in this thesis were to describe the care of patients with COPD from the perspective of district nurses and to describe factors that can negatively influence COPD patients’ smoking cessation efforts. A further aim was to develop a valid and reliable instrument to assess difficulties smokers with COPD deal with, and that would be useful in dialogues about smoking that are held in a clinical setting. Material and methods: This mixed method thesis project included 4 studies. Study I used phenomenographic approach to analyze data from interviews with 20 nurses responsible for the care of patients with COPD in primary health care settings. Study II used grounded theory method to analyze data from interviews with 14 patients with COPD (smokers and formers smokers) and develop a theoretical model describing the process of trying to quit smoking. The results of Study II were used to construct the Trying to Quit smoking (TTQ) instrument, and Study III used exploratory factor analysis on data from 63 smokers with COPD to investigate the psychometric properties of the TTQ. In Study IV, 109 smokers with COPD answered the TTQ at baseline and after 3 months. Unconditional logistic regression was used to analyze the association between the TTQ scale and making a quit attempt, reducing the intensity of smoking and achieving complete abstinence. Results: Study I identified 4 perceptions of care of patients with COPD among nurses and 2 perspectives on care: task-oriented and individual-oriented. Nurses expressed feelings of frustration and powerlessness in their encounters with patients with COPD who smoked and could not quit smoking. Study II found that patients with COPD can develop pressure-filled mental states in the process of quitting smoking. These can be burdensome and patients use a variety of constructive or destructive pressure-relief strategies to find relief. The constructive pressure-relief strategies led to success in quitting or continued efforts to quit. The destructive pressure-relief strategies could lead to loss of hope and resignation to continued attempts in quitting. The TTQ was developed to measure these mental states and strategies. The final instrument includes three factors 1) development of pressure-filled mental states, 2) use of destructive pressure relief strategies, and 3) ambivalent thoughts when trying to quit smoking. Studies III and IV found that the TTQ is a reliable instrument. It can be used to predict factors that have a negative impact on quit attempts in this group of patients, especially pressure-filled mental states in patients ready to try to quit and ambivalent thoughts in patients not ready to try to quit. Conclusion: Care for patients with COPD depended of whether the patient met, a task-oriented or individual-oriented nurse. Both the theoretical model "The process of trying to quit smoking" and use of the TTQ contributes to a better understanding of the negative experiences of some patients with COPD in the process of trying to quit. The model and instrument can help health care providers individualize smoking cessation counseling. Moreover, patients' own awareness of these states and strategies may facilitate their efforts to quit

Screening of intact yeasts and cell extracts to reduce Scrapie prions during biotransformation of food waste

Yeasts can be used to convert organic food wastes to protein-rich animal feed in order to recapture nutrients. However, the reuse of animal-derived waste poses a risk for the transmission of infectious prions that can cause neurodegeneration and fatality in humans and animals. The aim of this study was to investigate the ability of yeasts to reduce prion activity during the biotransformation of waste substrates—thereby becoming a biosafety hurdle in such a circular food system. During pre-screening, 30 yeast isolates were spiked with Classical Scrapie prions and incubated for 72 h in casein substrate, as a waste substitute. Based on reduced Scrapie seeding activity, waste biotransformation and protease activities, intact cells and cell extracts of 10 yeasts were further tested. Prion analysis showed that five yeast species reduced Scrapie seeding activity by approximately 1 log10 or 90%. Cryptococcus laurentii showed the most potential to reduce prion activity since both intact and extracted cells reduced Scrapie by 1 log10 and achieved the highest protease activity. These results show that select forms of yeast can act as a prion hurdle during the biotransformation of waste. However, the limited ability of yeasts to reduce prion activity warrants caution as a sole barrier to transmission as higher log reductions are needed before using waste-cultured yeast in circular food systems

Vilken funktion fyller den sociala dokumentationen i hemvården och hur påverkas arbetssituationen av IT som dess arbetsredskap?

Idag talas det mycket om den sociala dokumentationens och IT:s betydelse inom omsorgen. Kontentan av denna debatt är dels att den sociala dokumentationen är nödvändig och dels att IT är ett bra hjälpmedel. I den tidigare forskning som belyser detta område är personalen positivt inställd till både dokumentationen och användandet av IT. När det gäller den sociala dokumentationen så är den lagstadgad, tillsynsmyndigheten är i detta fall Länsstyrelsen. Länsstyrelsen har ofta kommit med kritik över hur denna dokumentation sköts. Detta väckte vårt intresse för hur personalen upplever den sociala dokumentationen och IT som arbetsredskap. Syftet med vår undersökning är därför att belysa personalens upplevelse av den sociala dokumentationens funktion i det dagliga arbetet och vilken roll IT-arbetsredskapet har i sammanhanget. För att belysa detta syfte har vi valt en kvalitativ metod som utgår ifrån intervjuer. Den vetenskapsteoretiska utgångspunkten har varit grundad teori. Resultatet visar på en rad olika faktorer som har betydelse för personalens upplevelse av vikten att genomföra den sociala dokumentationen och att använda sig av IT-arbetsredskapet. För att ytterligare utröna faktorernas betydelse har dessa även kopplats till en motivationsteori och en motivationsmodell

Late Reminders Nine Years Post Disaster in Adults Who As Children or Adolescents Were Exposed to the 2004 Southeast Asian Tsunami

Objective: The main aim of this study was to determine if young adults, who as children and adolescents were heavily exposed to the 2004 tsunami in Southeast Asia, had late reminders of this disaster nine years post disaster and, if so, how they handled these late reminders. Method: The subjects who had been exposed when they were between 10 and 15 years old were interviewed nine years post disaster when they had reached adulthood. Results: All those interviewed stated that they had experienced different late reminders of the 2004 tsunami even nine years later. They said that they could plan in advance or deal with late reminders should they occur. Two types of reminders were identified, one type designated as external and the other as internal. The interview subjects described how they had handled these reminders by striving for balance by thinking, talking, letting feelings out, doing something else or by avoiding. Conclusions: These young adults strived to find a balance between their function as adults in society and continued effects from the 2004 tsunami. A person, even if not affected functionally, can be affected in different ways in adulthood by the natural disaster they had experienced during childhood or adolescence. This is something important for anyone to think about when he or she meets persons who have been heavily exposed to a natural disaster many years earlier

Children or adolescents who lost someone close during the Southeast Asia tsunami 2004 – The life as young

Introduction: To lose a person close suddenly, during childhood or adolescence, can be devastating. Many children or adolescents experienced the 2004 Indonesian tsunami when they were between 10- and 15-years-old. This study, from Stockholm, Sweden, describes the long-term effects of loss, eight- or nine-years post disaster, in young adulthood. Method: A mixed-method approach was used including statistical analyses (n = 210) and interpretative phenomenological analysis (IPA). Results: It was shown that there was a significant difference between bereaved (n=34) and nonbereaved (n = 176) respondents concerning, psychological distress, posttraumatic stress symptoms, and self-rated health. Three themes were found by using the IPA approach (n=9): Living in traumas, carrying heavy baggage, and living with change. Conclusion: The respondents described personal feelings of grief that are not expressed in their outward appearance or behavior in their daily living. When meeting young adults that have lost someone close in childhood or adolescence, this is important to have in mind.Funding: Kempe Carlgrenska fonden</p

Systematik och kompetensstöd för sjukdomsförebyggande insatser för patienter - fokus på levnadsvanor

Sammanfattning De flesta av våra stora folksjukdomar är möjliga att förebygga genom rökstopp, minskad alkoholkonsumtion, ökad fysisk aktivitet samt hälsosamma matvanor. Socialstyrelsens nationella riktlinjer beskriver god evidens för effekten av rådgivande samtal om levnadsvanor i hälso- och sjukvården och att detta är mycket kostnadseffektivt. Av flera skäl går införandet av dessa arbetssätt ganska långsamt. För att uppnå en hälso- och sjukvård där preventivt arbete är en självklar del, och inte ett sidospår, krävs förändringar av kunskap, attityder och arbetssätt. Organisering, ledning och styrning är avgörande för att skapa strukturella förutsättningar för det förebyggande arbetet med tydliga uppdrag, tid och resurser till kompetensutveckling och redskap så att levnadsvanearbete systematiskt integreras i befintliga vårdprocesser.Abstract Our main public health diseases are possible to prevent by influencing the lifestyles tobacco use, alcohol, physical activity and food choices. The Swedish national guidelines for disease prevention demonstrate evidence for professional counselling in health services and that this is cost effective. Still, development of this work is rather slow. This is a consequence of several causes. To achieve a health service where prevention is a natural part, there is a need for changes in knowledge and attitudes. Organization, leadership and governance are crucial to create structural conditions for preventive work with clear assignments, time and recourses for development of competence, and tools to make preventive lifestyle interventions systematically integrated into existing care processes