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De-tabooing dying control - a grounded theory study.

Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was "what is going on in the field of dying today?" What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS)

Condictio indebiti - En kritisk analys av rättsvetenskapens slutsatser kring reglerna om misstagsbetalningar

När en betalning skett av misstag har betalaren sedan gammalt under vissa förutsättningar haft rätt att kräva pengarna åter enligt den romerska rättsprincipen condictio indebiti. Det finns inga lagar som direkt fastställer principen i svensk rätt men den tillämpas i rättspraxis. Om betalaren ska medges en återkravsrätt gentemot mottagaren beror på en avvägning av de motstående intressen som gör sig gällande. Å ena sidan bör en mottagare inte få behålla medel som denne mottagit av misstag och därmed inte har något rättsligt anspråk på. Samtidigt finns det ett intresse av att betalningsmottagare kan lita på att mottagna betalningar blir bestående och inte orsakar skada. I svensk rätt gäller som huvudregel att betalaren har en återkravsrätt till de medel som betalts av misstag. Huvudregeln har i rättspraxis förenats med åtskilliga modifikationer för när återbetalningsskyldighet inte bör åläggas mottagaren. En framträdande undantagssituation är när betalningen mottagits i god tro, och mottagaren därefter spenderat pengarna, eller på annat sätt inrättat sig efter betalningen. Ju längre betalaren väntar med att meddela mottagaren om sitt misstag desto större sannolikhet att mottagaren kan anses ha inrättat sig. Vidare bör principen om condictio indebiti ses som en självständig rättsregel i förhållande till andra rättsfigurer som obehörig vinst. Principen har dessutom karaktären av specialregel vid misstag som rör betalningar även om den praktiska betydelsen inte är så stor i förhållande till reglerna om förklaringsmisstag. Eftersom reglerna om misstagsbetalningar inte är lagstadgade förekommer vissa oklarheter angående rättsläget. Exempelvis är det oklart när staten som betalningsmottagare, eller annan betalningsmottagare som förhåller sig passiv, kan inrätta sig efter en betalning. Dessa oklarheter har diskuteras inom rättsvetenskapen där vissa slutsatser visat sig vara för långdragna och inte helt förenliga med modern prejudikathantering och tolkning. I situationer där rättsläget är oklart är det viktigt att skilja på vad som är en beskrivning av rättsläget och vad som är argumentation för hur rättsläget borde se ut. Endast då kan en rättvis bild av principen om condictio indebiti ges i rättsvetenskapen.When a payment has been made by mistake, the payer has traditionally under certain circumstances been entitled to recover the funds according to the Roman legal principle of condictio indebiti. There are no laws that directly establish the principle in Swedish law but it is applied in case law. If the debtor is to be granted a right of recourse against the beneficiary depends on a balancing of the conflicting interests that apply. On the one hand, a receiver should not be allowed to retain funds received by mistake, and thus lacking a legal claim against. Meanwhile, there is an interest that payees can rely on that the payments they receive are permanent and do not cause any damage. As a general rule in Swedish law the payer has a right of recourse to funds paid by mistake. The general rule has been in law joined with several modifications for when repayment obligation should not be imposed on the recipient. A prominent situation of exception is when the payment is received in good faith, and the receiver then spends the money, or otherwise establishes himself after the payment. The longer the payer waits to notify the recipient of the error, the greater the probability for that the recipient may be considered to have established himself after the payment. Furthermore, the principle of condictio indebiti is seen as an autonomous rule in relation to other legal figures such as unjust enrichment. The principle also has the character of a special rule for mistakes concerning payments although the practical importance is not that important in relation to the rules of explanation mistakes. Since the rules about payments by mistake are not statutory some portions of ambiguities occur regarding the proper legal position. For example, it is unclear when the state as payee, or other payees who remain passive, can establish themselves after a payment. These uncertainties have been discussed in jurisprudence where some conclusions sometimes have been proved to be too lengthy and not fully compatible with modern precedent processing and interpretation. In situations where the legal situation is unclear, it is important to distinguish between what is a description of the legal situation and what is argumentation regarding what the legal position should be. Only then can a fair idea of the principle of Condictio indebiti be given in jurisprudence

Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

<p>Abstract</p> <p>Background</p> <p>Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain.</p> <p>Methods</p> <p>The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD), the Toronto Alexithymia Scale-20 (TAS-20), the Visual Analogue Scale for pain assessment (VAS-pain), the European Quality of Life health barometer (EQoL) and the Stress and Crisis Inventory-93 (SCI-93). After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS.</p> <p>Results</p> <p>The AS intervention was completed by 54 out of 59 (92%) patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006) as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings) were seen (p = 0.0001, and p = 0.0008) while the EOT factor (Externally Oriented Thinking) did not change. Improvements of HAD-depression scores (p = 0.04), EQoL (p = 0.02) and self-assessed changes in relations to others (p < 0.001) were also seen. After Bonferroni Correction for Multiple Analyses the TAS-20 test score reduction was still significant as well as Bergdahl's test after group sessions. The HAD, EQoL, SCI-93, and VAS-pain scores were not significantly changed. The AS-intervention was ranked high by the participants.</p> <p>Conclusions</p> <p>This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.</p

The Perceived Support From Light and Color Before and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study

Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire

Psychosomatic problems and countermeasures in Japanese children and adolescents

In Japan there are a number of children and adolescents with emotion-related disorders including psychosomatic diseases (orthostatic dysregulation, anorexia nervosa, recurrent pains), behavior problems and school absenteeism. According to our previous report, the Japanese children had significantly higher score of physical symptoms and psychiatric complaints than did the Swedish children, and these were more strongly influenced by school-related stress than by home-related stress. To enforce countermeasures for psychosomatic problems in children, the Japanese Society of Psychosomatic Pediatrics (established in 1982) have started several new projects including multi-center psychosomatic researches and society-based activities. In this article, we present an outline of our study on mental health in Japanese children in comparison with Swedish children. Countermeasures including clinical guidelines for child psychosomatic diseases are reviewed and discussed

Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

<p>Abstract</p> <p>Background</p> <p>One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women.</p> <p>Methods</p> <p>In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique.</p> <p>Results</p> <p>Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD.</p> <p>Conclusions</p> <p>In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.</p