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Background: Residential care homes (RCHs) are increasingly becoming a common place of death for older people. Aim: The aim of this study was to describe family members' experiences of care of the dying in RCHs where the Liverpool care pathway for the dying patient was used.

Methods: This study had a descriptive qualitative study design. Fifteen (n=15) individual interviews were analysed using qualitative content analysis.

Results: The analysis resulted in three themes: being confident in a familiar and warm atmosphere, being involved vs not being involved in end-of-life (EoL) care, and being consoled by witnessing the health professional's endeavour to relieve suffering.

Significance of results: The results indicated that taking part in a care plan seems to increase family members' feelings of involvement in EoL care. This study also highlights the family members' needs for increased possibilities for EoL discussions with the GP.

Background: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed.

Objective: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals.

Design: This is a national register study.

Setting/Subjects: The study included 3981 patients with diagnosed heart failure as the underlying cause of death.

Measurements: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients’ last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies.

Results: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory.

Conclusion: The results indicate inadequate palliative care for patients with heart failure during their last week of life.

Patienters erfarenheter av livet efter att ha drabbats av stroke – en kvalitativ litteraturstudie

Abstrakt 

Bakgrund: I Sverige drabbades omkring 25700 personer av stroke 2019. Ungefär 70% av de som överlever stroke drabbas av komplikationer som t.ex. trötthet, depression, smärta, fysiska komplikationer, svårigheter med att läsa, skriva, tala och minnesstörningar vilket kan leda till andra konsekvenser som t.ex. försämrad självständighet, förändrad identitet och social förlust.

Syfte: Att beskriva patienters erfarenheter av livet efter att de drabbats av stroke.

Metod: En kvalitativ litteraturstudie innehållande 12 artiklar som hittades genom sökningar i databaserna Cinahl och Pubmed analyserades med Fribergs femstegsmodell. 

Resultat: Tre kategorier och 10 subkategorier identifierades. De tre kategorierna var: “Uppleva förlust”, “Sträva efter kontroll” och “Våga möta andra människor”. 

Konklusion: Patienter som drabbats av en stroke upplever många utmaningar med både en förändrad kropp, förmåga att utföra meningsfulla aktiviteter, förändrade sociala roller och möjligheten att leva självständigt. Utmaningarna och komplikationer är ofta kopplade till en försämrad hälsa men acceptans och framsteg i återhämtning kan med tiden bidra till en förbättrad hälsa.

This study aims to analyze how middle-level health systems' managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: IPV is a complex issue that generates activism and/or resistance, The mandate to integrate a health sector response to IPV: a priority not always prioritized, and The Spanish health system: respectful with professionals' autonomy and firmly biomedical. The core category, Developing diverse responses to IPV integration, crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Bolivia, particularly in the rainforest of Cochabamba, in the municipality of Villa Tunari. The precarious, dispersed, and poorly accessible settlements in these farming communities make it difficult to study them, and there are no epidemiological studies in the area. The aim of the present study was to identify the risk factors associated with cutaneous leishmaniasis.

Methods: A cross-sectional study was conducted in August 2015 and August 2016 in two communities of Villa Tunari, Cochabamba. The cases were diagnosed through clinical examinations, identification of the parasite by microscopic examination, and the Montenegro skin test. Risk factors were identified through logistic regression.

Results: A total of 274 participants (40.9% female and 59.1% male) were surveyed, of which 43% were CL positive. Sex was the only factor associated with CL with three times more risk for men than for women; this finding suggests a sylvatic mechanism of transmission in the area.

Conclusions: It is advisable to focus on education and prevention policies at an early age for activities related to either leisure or work. Further research is needed to assess the influence of gender-associated behavior for the risk of cutaneous leishmaniasis.

Background: Rwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far.

Methods: Cost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD.

Results: The societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities.

Conclusions: The unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households' time cost as a possible barrier to the use of antenatal care.

Small firearm shooting emits residues of energetic materials as well as heavy metals of different particle sizes into the air, posing a risk to human health. The current study assessed concentrations of Pb, Cu, Ni and Zn in 14 different size fractions of particulate matter at indoor military shooting ranges. Air samples were collected using ELPI+ over two hour period and filters analysed with ICP-MS and ICP-OES.

Background: Health managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers' capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers' capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter.

Methods: A critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers' capacity. The critical interpretive synthesis method's approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25: 104-111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains.

Results: Five elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers' capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning.

Conclusions: The five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers' capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.

Although the number of different types of EVs is increasing, they still constitute only a small share of the total vehicle market. There are a number of barriers to car owners' adoption of an EV: travel needs, charging infrastructure, the individual car owner's socio-economic characteristics, attitudinal factors, and environmental concern. In this study, the characteristics and geographic location of all private car owners in Sweden (N = 4,447,118) are charted. Through analysis of survey data (N = 1192), the importance of socio-demographic attributes, geographic conditions, car interest, personal and social norms, and environmental concern is estimated. Mapping EV ownership shows that, so far, EV adoption has mainly occurred in metropolitan areas and also to some extent in hotspots outside the metropolitan areas, and that these hotspots are tourist regions that may be exposed to EVs via, for example, Norwegian tourists in the Swedish case. Logistic regression analyses show that age and education level have positive impacts on EV ownership. Residential area also has an influence to some extent, pointing to a slight neighborhood effect in EV adoption. However, the most important factor influencing EV ownership is the individual's personal norms. In addition to showcasing EV adoption patterns in Sweden, the contribution of this study is to point to the importance of the attitudinal factor of personal norm even when geographical conditions and socio-demographic characteristics are controlled for. Implications of the findings are discussed.