The Dawn of a New, New International Economic Order

OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. less thanbrgreater than less thanbrgreater thanDESIGN: A cross-sectional population-based study. less thanbrgreater than less thanbrgreater thanSETTING: Linkoping, Sweden. less thanbrgreater than less thanbrgreater thanPARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authoritys register. less thanbrgreater than less thanbrgreater thanMEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. less thanbrgreater than less thanbrgreater thanRESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI andgt;= 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normalweight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). less thanbrgreater than less thanbrgreater thanCONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.Funding Agencies|Health Research Council of the South-East of Sweden||County of Ostergotland||Janne Elgqvist Family Foundation||</p

Формы и системы оплаты труда на предприятии (на примере ОАО «Речицкий метизный завод»)

OBJECTIVES: To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations. BACKGROUND: Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation. METHODS: A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations. RESULTS: The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups. CONCLUSIONS: Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management

Аутстаффинг, прекаризация и лизинг персонала как инструменты повышения эффективности его использования на предприятии (на примере КУП «Петриковский райжилкомхоз»)

To access publisher's full text version of this article click on the hyperlink at the bottom of the pagePatient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled.To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions.A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery.Two Finnish, three Icelandic and two Swedish hospitals.The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women.Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations.Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected knowledge.In order to better support patients by education it is necessary to assess their emotional state, educational level and knowledge expectations before surgery

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research

No gender differences in fatigue and functional limitations due to fatigue among patiens with COPD

Aims and objectives. To examine gender differences in experiences of fatigue and functional limitations due to fatigue in patients with chronic obstructive pulmonary disease and a comparison group. Background. Fatigue is a major problem for patients with chronic obstructive pulmonary disease. The prevalence rate of chronic obstructive pulmonary disease in females is increasing and to our knowledge there are few studies reporting gender differences in one of their worst symptoms, fatigue and functional limitations due to fatigue. Design. This study has a descriptive cross-sectional design. Methods. Patients with chronic obstructive pulmonary disease (n = 345) and a comparison group of the same gender and age from the same region as the patients (n = 245) answered mailed questions about the frequency, duration and severity of fatigue and the fatigue impact scale. Results. High frequency (≥20 days/month), long duration (≥6 hours/day) and great severity (one of my worst symptoms) of fatigue were experienced by 51%, 54% and 44% of the male patients with chronic obstructive pulmonary disease, respectively and 60%, 55% and 51% of the female patients with chronic obstructive pulmonary disease, respectively. The figures for the males from the comparison group were 14%, 24% and 17% and for the females 30%, 42% and 32%, respectively. There were no gender differences regarding fatigue (frequency, duration and severity) or functional limitations due to fatigue in the chronic obstructive pulmonary disease patients, while the differences between males and females from the comparison group were statistically significant for frequency and severity of fatigue as well as functional limitation due to fatigue. Conclusion. In the comparison group, there were gender differences regarding fatigue, as well as functional limitations due to fatigue. This was not observed in the chronic obstructive pulmonary disease group. Relevance to clinical practice. The results of this study suggest that nurses should not take for granted that female patients with chronic obstructive pulmonary disease experience more fatigue than men.This is the authors’ version of the following article:Kersti Theander and Mitra Unosson, No gender differences in fatigue and functional limitations due to fatigue among patiens with COPD, 2011, Journal of Clinical Nursing, (20), 9-10, 1303-1310.which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2702.2010.03625.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.htm

Well-established nutritional structure in Scandinavian hospitals is accompanied by increased quality of nutritional care

The aim of this study was to investigate Scandinavian nurses self-reported attitudes, practice and barriers towards nutrition practice, and to explore whether nurses working in departments with a well defined structure (w-DS) for nutritional aspects, have better nutritional practise. Preventing and treating undernutrition is shown to be complicated. Investigations are needed to priority efforts. The design is a questionnaire-based investigation of Scandinavian hospital nurses attitudes and practise to clinical nutrition. A questionnaire regarding nutritional care process sent to 6000 nurses in Scandinavia. A definition of w-DS and p-DS (less defined structure) was made according to ESPEN Guidelines. Nurses were classified as working at w-DS or p-DS departments, if three or more of five organisational structure markers were met. Overall 2759 responded. Discrepancy was found between attitudes and practise (p less than 0.0001). W-DS was found in 49%. Nurses who worked at departments with w-DS had higher frequency for nutrition actions (p less than 0.0001). Knowledge and time past graduation, were amongst independent factors for good nutritional structure (p less than 0.0001). Differences were seen between countries and specialities (p less than 0.0005). Organisation structure recommended by ESPEN seems important. Knowledge and experience were independent factors for good nutrition structure. The content of nutrition education needs consideration.Original Publication:M. Holst, H.H. Rasmussen and Mitra Unosson, Well-established nutritional structure in Scandinavian hospitals is accompanied by increased quality of nutritional care, 2009, e-SPEN, (4), 1.http://dx.doi.org/10.1016/j.eclnm.2008.09.002Copyright: Elsevier Science B.V. Amsterdamhttp://www.elsevier.com

Individually adjusted meals for older people with protein-energy malnutrition: A single-case study

• The objective of this study was to investigate the effect of a 3‐month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein‐energy malnourished on admission to a municipal care Institution. • Using a single‐case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week. • During a 3‐month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin‐fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity. • We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents

Postoperative recovery and its association with health-related quality of life among day surgery patients

BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first Postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe Postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between Postoperative recovery and healthrelated quality of life 30 days after discharge. METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery recovery scale and the quality of recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate Postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between Postoperative recovery and health-related quality of life. RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p&lt;0.001). The orthopaedic patients had lower Postoperative recovery on day 14 compared to the general and the gynaecological patients (p&lt;0.001). health-related quality of life was lower among orthopaedic patients (p&lt;0.001), even if significant improvements over time were seen in all groups. recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p&lt;0.05). CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life

Postoperative recovery after different orthopaedic day surgical procedures

Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure

Common Symptoms and Distress Experienced Among Patients with Colorectal Cancer: A Qualitative part of Mixed Method Design

Background : Colorectal cancer is one of the most common types of tumour in the world. Treatment side effects, together with the tumour symptoms, can result in a ‘symptom burden’. To understand the patient’s burden during chemotherapy treatment and plan effective symptom relief there is a need for more knowledge about the experience of symptoms from the patients’ perspective. Objectives : The study was designed to qualitatively identify and describe the most common symptoms among patients treated for colorectal cancer, and discover whether there are barriers to reporting symptoms. Methods : Thirteen Swedish patients diagnosed with colorectal cancer and treated with chemotherapy were interviewed face-to-face. The interviews were audio-taped and transcribed verbatim. The transcripts were analysed by following the principles of qualitative content analysis. Results : Nine symptoms/forms of distress were identified. Those most frequently expressed were fatigue, changed bowel habits, and affected mental well-being, closely followed by nausea, loss of appetite and neurological problems. Of particular note were the affected mental well-being, the magnitude of the neurological problems described, the symptoms related to skin and mucous membrane problems, and the reports of distressing pain. Barriers to symptom control were only expressed by the patients in passing and very vaguely. Conclusion : This study confirms other reports on most common symptoms in colorectal cancer. It also highlights the early onset of symptoms and provides data on less well-studied issues that warrant further study, namely affected mental well-being, the magnitude of the neurological problems and symptoms related to the skin and mucous membranes. Nurses need to be sensitive to the patients’ need presented and not only noting symptoms/distresses they have guidelines for