Gymnastik- och idrottshögskolan, GIH

Studiens syfte var att undersöka hur existerande riktlinjer för fysisk aktivitet för kvinnor under graviditet ser ut och hur de tillämpas på mödravårdscentraler. Undersökningen gjordes på de barnmorskor som arbetar på mödravårdscentraler kopplade till Stockholms läns landsting. 

Frågeställningar:

1. Hur ser rekommendationerna för fysisk aktivitet ut för kvinnor under graviditet? 
2. Hur tillämpas dessa på mödravårdscentraler i Stockholms län?

Metod:

Studien undersökte och granskade existerande styrdokument för rekommendationer av fysisk aktivitet vid graviditet, dessa användes därefter till ett underlag för ett utformande av en enkät. På hemsidan för Stockholms läns landsting finns 33 mödravårdscentraler angivna, samtliga centraler kontaktades via mail. Därefter skickads en enkät ut, utformad på en tjänst på internet, som skickades per mail via en länk. Samtliga centraler hade möjlighet att delta, dock var deltagandet frivilligt. Enkäten avsåg bland annat att undersöka barnmorskornas erfarenheter av fysisk aktivitet under graviditet, om de ansåg detta som positivt eller negativt, deras egen inställning till fysisk aktivitet samt hur deras råd till patienter var utformade. De redan granskade styrdokumenten med riktlinjer för fysisk aktivitet, författade av de största aktörerna och Stockholms läns landsting analyserades återigen. En sammanfattning togs därefter fram för att sammanställa vilka rekommendationer som var relevanta och användbara för att besvara studiens frågeställningar.

Resultat:

17 barnmorskor deltog i studien. Mer än hälften av respondenterna anser att fysisk aktivitet vid graviditet är positivt, men att anpassningar krävs, samt att det är viktigt att lyssna på kroppen och dess signaler. En mer kontrollerad viktuppgång, minskad smärta i rygg/bäcken, mindre komplikationer generellt och även bättre psykiskt välmående var några positiva effekter av fysisk aktivitet som var återkommande i svaren. De nackdelar som nämndes var foglossning, samt smärta i bäckenbotten/rygg kan förvärras vid promenader och gång i trappor. Fler nackdelar som angavs var att fysisk aktivitet kan även medföra högt tryck på anklar/vrister, vilket kan medföra komplikationer då dessa blir sköra under graviditet. Dock använde majoriteten sig av mer generella råd till sina patienter. Dessa kom övervägande från vårdguiden, vilket lyder ca 30 minuters rörelse om dagen.

Slutsats:

Det behövs mer utbildning för dessa barnmorskor vad gäller fysisk aktivitet vid graviditet. Utbildningen bör leda till mer kunskap kring personligt anpassad information och individuella råd om fysisk aktivitet till gravida.

BACKGROUND: As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. 'Saga Stories in health talks' is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material.

METHODS: This study used a qualitative design. The material 'Saga Stories in health talks' was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.

RESULTS: Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children's interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks' was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child's interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.

CONCLUSIONS: This pilot study show that the material 'Saga Stories in health talks' was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

BACKGROUND: In prevention, sedentary behaviour and physical activity have been associated with risk of cardiovascular disease and mortality. Less is known about associations with utilization of hospital care.

AIM: To investigate whether physical activity level and sedentary behaviour prior to cardiac ward admission can predict utilization of hospital care and mortality among patients with cardiovascular disease.

METHODS: Longitudinal observational study including 1148 patients admitted and treated in cardiac wards in two hospitals. Subjective reports of physical activity levels and sedentary time prior to admission were collected during inpatient care and categorized as low, medium or high. The associations between physical activity level and sedentary time with hospital stay, readmission and mortality were analysed using linear, logistic and Cox regressions.

RESULTS: Median hospital stay was 2.1 days. One higher step in the physical activity level, or lower sedentary time, was related to an approximately 0.9 days shorter hospital stay. Sixty per cent of patients were readmitted to hospital. The risk of being readmitted was lower for individuals reporting high physical activity and low sedentary time (odds ratios ranging between 0.44 and 0.91). A total of 200 deaths occurred during the study. Mortality was lower among those with high and medium physical activity levels and low sedentary time (hazard ratios ranging between 0.36 and 0.90).

CONCLUSION: Both physical activity level and sedentary time during the period preceding hospitalization for cardiac events were predictors of hospital utilization and mortality. This highlights the prognostic value of assessing patients' physical activity and sedentary behaviour.

Background

People with intellectual disabilities are less physically active and suffer from ill-health more than the general population. Support staff play an important role in the person's life. This study aimed to explore the support staff's experiences regarding the feasibility of adapted web-based exercise for people with intellectual disabilities.

Method

Participants with intellectual disabilities living in community-based settings were recruited for a web-based exercise study. Eight semi-structured interviews were carried out with their support staff before and after the intervention period.

Results

The main theme, ‘Support staff are crucial for feasibility’ encompasses the importance of communication, structure, and motivation in improving physical activity for people with intellectual disabilities.

Conclusion

The experiences of support staff, indicate that a web-based exercise program is feasible for the target group, and one way to overcome challenges for PA, where the role of the staff is crucial.

INTRODUCTION: Stress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women's sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women's suffering. But knowledge on women's experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood.

METHODS: Ricoeur's interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion.

RESULTS: These women's experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women's suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

Aim:

The aim is to delineate the patients’ opinions and experience of the treatment in the medical care- and prophylaxis chain when they received prescription of physical activity in Östergötland. The questions are:

• What is the patients’ opinions and experience of the treatment they got at the medical clinic when they received prescription of physical activity?

• What is the patients’ opinions and experience of the treatment they got from Korpens staff when they were phoned?

• What is the patients’ opinions and experience of the treatment they got from the leader during the physical activity?

Method:

The investigation was realized on patients who lived in small cities and in the countryside in the county Östergötland. Korpen has agreements with eight local authoritys to organize and accomplish “Prescription of physical activity” work. These were all chosen for the investigation. The selection was made by random sample from these local authoritys,by those who got “Prescription of physical activity” during 2005, with stratification for sex and age. Total 71 persons were selected for the investigation. The investigation was made through questionnaire interviews by telephone. The external falling off became 29 persons. Interviews were realized with 59 % by those who were selected for the investigation.

Results:

It is mostly nurses, physiotherapists and doctors who has written “Prescription of physical activity”. The patients experience are that they have got good or very good treatment by those who have made the prescription. 57 % have not been informed that the activity is not subventioned by the government, which many would have liked to know. When it comes to being phoned by Korpens staff most of the participates have the experience that it is positive to get a little extra pressure to pull through with the activity. Most of the participates also thought that the price was reasonable, even though quite a lot thought that it was expensive in the beginning before they felt the results. The leaders of the activities was overall very popular by the participantes.

Conclusions:

The majority of the responders thought that they have got good treatment by all three persons or instances that the questionnaire was about. The things that were not so good among the questionnaire answers were mostly about faults in the organization among “Prescription of physical activity” work and that there is too few activities to choose from in the smaller cities.

BACKGROUND: Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses' views and experiences of caring for malnourished patients in Saudi Arabia (KSA).

METHODS: Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis.

RESULTS: The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: 'Potentials for nurses to provide good nutrition and physical activity', and 'Having the ability but not the power to promote proper nutrition and physical activity'. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women's weight gain in KSA society.

CONCLUSIONS: The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses' views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.

Syfte: Syftet med föreliggande studie var att identifiera faktorer som skulle kunna få personal med förskrivningsrätt av FaR, verksam vid husläkarmottagningar i Uppsala kommun, att i högre utsträckning skriva ut fysisk aktivitet på recept. Syftet var även att ta reda på i vilken utsträckning som fysisk aktivitet på recept skrivs ut av undersökningsgruppen idag samt vilken inställning de har till arbetsmetoden.

Metod: En enkätstudie genomfördes på sju husläkarmottagningar, geografiskt spridda inom Uppsala kommun. Enkäten bestod av både öppna och slutna frågor och har lämnats ut och samlats in vid samma tillfälle. 35 husläkare och 26 sjuksköterskor/distriktssköterskor har besvarat enkäten.

Resultat: Resultaten visar på en övervägande positiv inställning till FaR bland vård¬personalen vid husläkarmottagningar i Uppsala kommun. 61 % av de svarande har förskrivit FaR, vilket visar på att antalet förskrivare ökat väsentligt sedan den kartläggning som gjordes av Folkhälsoenheten 2004. Fortfarande har förhållandevis få recept skrivits ut, då 81 % av förskrivarna har skrivit ut 0-5 recept under det senaste året och ingen av de svarande har förskrivit mer än 10 recept. De faktorer som skulle kunna få vårdpersonalen i Uppsala kommun att i högre utsträckning förskriva FaR är: mer tid för varje patient, en samordnare eller en central instans dit patienterna kan vända sig för att få hänvisning till lämplig aktivitet, ett bättre organiserat aktivitetsutbud, möjlighet till återkoppling och uppföljning av patienten, större vana och mer rutin, ytterligare kunskaper och utbildning samt ett enklare sätt att skriva recept.

Slutsats: För att vårdpersonalen i högre utsträckning ska skriva ut fysisk aktivitet på recept krävs att förskrivningen är enkel. En tydlig organisation för hur och var patienterna kan hänvisas med sitt recept samt ett väl fungerande kontaktnät mellan sjukvård och friskvård behöver etableras. Projektet ”friskvårdslots”, som sedan oktober 2005 drivs i samarbete mellan Uppsala läns landsting och Upplands Idrottsförbund, torde därför ha en mycket positiv inverkan på den fortsatta implementeringen av FaR i kommunen. För att få in FaR i de dagliga rutinerna skulle även en ansvarig person vid varje mottagning vara av värde.

Few studies to date have investigated retained work ability. The aim of this explorative study was to describe female assistant nurses' experiences of high work attendance over the years The setting is a municipality in mid-Sweden that employs 466 female assistant nurses permanently within municipal elderly care. A qualitative methodology was chosen and thematic, open-ended, interviews were carried out with 12 female assistant nurses. The interviewees were selected from the 117 women who had taken the least amount of sick leave over the past five years, which meant no sick leave at all or no more than 5 days. The interviews were transcribed verbatim, and thereafter a content analysis was carried out. Three main themes connected with the aim of the study emerged from the interviews: "a desirable job, despite low status", "supportive social networks", and "coping ability". In order to strengthen work ability among female employees in elderly care, the findings indicate that it is crucial to support mobility in working life, and to promote social support and networks at the workplace and in private life, as well as a coping-oriented approach to health issues and social life.

Purpose While bariatric surgery generally shows successful weight loss outcomes in patients with obesity, weight regain exists. The aim of this qualitative study was to improve understanding of how patients with substantial weight regain after bariatric surgery experienced the support from family, friends, and healthcare providers, and what kind of support they had preferred. Materials and Methods Qualitative data were collected from semi-structured interviews with 16 participants. Mean weight regain from surgery to interview was 36%. The transcribed interviews were analyzed with thematic analysis. Results Two main themes and seven sub-themes were formulated. The theme, A lonely struggle, illustrates patients' feelings of abandonment and struggle during weight regain due to lack of support or unfavorable treatment. Participants commonly blamed themselves for re-gaining weight, and shame made them reluctant to engage in social activities or seek medical care. The theme, Others as sources of compassion and control, covers what support they desired, as well as had perceived to be helpful. Exercising or eating healthy with others was appreciated and felt supportive. Pro-active healthcare support and access to dietitians, physiotherapists, and psychological support were desired. Conclusion To optimize the effect of bariatric surgery, support may need to be individualized and lifelong. Since shame and self-blame in patients with weight regain may hinder seeking professional help, care providers may need to initiate follow-up visits. Empathetic and non-judgmental support, access to multidisciplinary healthcare team, as well as peer-support groups may be beneficial to counteract weight regain post-bariatric surgery.