Coping with chronic pain: In-depth interviews with children suffering from Juvenile Chronic Arthritis

This study examined from the perspective of children with Juvenile Chronic Arthritis, their experiences of coping with chronic pain in daily life. In-depth interviews were conducted with 22 children (6–17 years). The grounded theory method was applied for analysing the taped and transcribed interviews. Seven descriptive categories were grounded in the data, labelled (1) “controlling strategies”, (2) “avoidance strategies”, (3) “cognitive strategies”, (4) “compliance with the treatment”, (5) “seeking social support”, and (6) “recovering”. A core category was identified and labelled “making me different”. The children seem to be caught in a dilemma. In one way the chosen coping strategy reduces chronic pain and in another way the strategy increases stress and feelings of being different from non-disabled peers. Our results indicate the great importance of social support from the children's environment

Wishing for deburdening through a sustainable control after bariatric surgery

The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants' relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome

Determination of undrained shear strength with advanced methods in practice: Interim report 1b, Results from an International Questionnaire

The undrained shear strength of clay, cu, is a geotechnical parameter that is used in a number of different design situations such as Slope Stability, Earth Pressure and Support Structures and Friction Piles in clay. Through the years, the tradition for how cu is determined in Sweden has developed, but still varies some between different consulting companies and parts of the country. There exists a number of standards for how most methods are to be performed and interpreted, but the same strict rules do not exist for how to interpret a characteristic value. The Swedish Transport Administration therefor took the initiative to enlighten this issue as open-minded as possible. It was then found important to, not only study standards and research reports in the area, but also by means of a questionnaire map how the undrained shear strength is determined and evaluated in different countries where soft clays are often found. This report presents the result from this questionnarie.Bestämning av skjuvhållfasthet med avancerade metoder i praktiska tillämpninga

Bestämningar av odränerad skjuvhållfasthet med specialiserade metoder i praktiska tillämpningar: Delrapport 1a, Resultat från en internationell enkätundersökning

En leras odränerade skjuvhållfasthet, cu, är en geoteknisk parameter som används i en rad olika dimensioneringssituationer som släntstabilitet, jordtryck och stödkonstruktioner samt kohesionspålars bärförmåga. Genom åren har traditionen för hur cu bestäms i Sverige utvecklats, men varierar en hel del mellan olika konsultbolag och landsändar. Det finns i och för sig standarder för varje enskild metods genomförande, men det finns inte samma strikta regler eller riktlinjer för hur en sammanvägning av olika resultat skall göras. Trafikverket har därför tagit ett initiativ för att så allsidigt som möjligt belysa denna fråga. Det var då naturligt att inte bara gå igenom standarder och forskningsrapporter i ämnet utan även genom en enkät skaffa en bild av hur man i realiteten/verkligheten går tillväga i olika länder när man bestämmer en lös leras skjuvhållfasthet. Rapporten redovisar resultatet av denna enkätunderökning.Bestämning av skjuvhållfasthet med avancerade metoder i praktiska tillämpninga

Long-term Morbidity and Socioeconomic Outcome among Nordic Childhood Cancer Survivors

Survival after childhood cancer has improved dramatically during the past four decades, resulting in a five-year survival rate of 80% in children recently treated for cancer in the Nordic countries. However, these advances in treatment and survival has come at a price, and many survivors face significant treatment-induced sequelae, most of which only become clinically apparent many years after the child has been cured. Previous studies have highlighted the need for better characterization of these late complications and their risk factors, in order to improve the basis for individual patient counselling and optimal long-term follow-up care. The main objective of the studies presented in this thesis was to investigate some of the diseases that contribute to long-term morbidity in childhood cancer survivors, as well as the late socioeconomic effects after treatment for acute lymphoblastic leukaemia (ALL) in childhood. All the studies presented in this thesis are population-based, retrospective cohort studies. Studies I and II are register-based studies of late socioeconomic effects and hospital-related morbidity, respectively, among 213 five-year survivors of ALL in the southern region of Sweden, compared to a population comparison cohort. Studies III–V included 33,160 one-year survivors of childhood cancer diagnosed between the start of cancer registration in the 1940s and 1950s up to and including 2008, identified in the national cancer registries of Denmark, Finland, Iceland, Norway and Sweden, and 212,892 comparison subjects, selected from national population registers. The study subjects in Studies III–V were linked to the national hospital registers and standardized hospitalization rate ratios and absolute excess risks of specific diseases were calculated. ALL survivors were married, had children, attained a high level of education and were employed to a lesser extent than the comparison subjects. Young age at diagnosis and cranial radiotherapy were risk factors for these negative late socioeconomic effects. Increased morbidity among ALL survivors, measured in terms of health care utilization, was primarily confined to those treated with cranial irradiation. Nordic childhood cancer survivors exhibited an increased risk of diabetes mellitus, which persisted throughout life. In addition, survivors were found to have a substantially increased risk of other endocrine disorders. The diagnoses of pituitary hypofunction, hypothyroidism and dysfunction of the gonads were the most frequent endocrine disorders found among the survivors. Childhood cancer survivors also showed an increased risk of various autoimmune diseases; increased risk ratios were seen in survivors of leukaemia, Hodgkin’s lymphoma, renal tumours and central nervous system neoplasms. The findings of these studies underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors