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Skellefteå, Sweden

Pihkala H.,Skelleftea Hospital | Sandlund M.,Umea University | Cederstrom A.,University of Stockholm
International Journal of Social Psychiatry | Year: 2012

Background: Beardslee's family intervention (FI), which is a family-based preventive method for children of mentally ill parents, has been implemented on a national level in Sweden. Material: Fourteen children and parents from nine families were interviewed about how the FI was for the children. Data were analysed by qualitative content analysis. Discussion: A central finding was children's sense of relief and release from worry because of more knowledge and openness about the parent's illness in the family. Conclusion: The results indicating relief for the children are encouraging. © 2011 The Author(s).

Brannstrom M.,Umea University | Forssell A.,Skelleftea Hospital | Pettersson B.,Heart Failure Clinic
European Journal of Cardiovascular Nursing | Year: 2011

Background: Although heart disease is the single most common cause of death knowledge about palliative care for this group of patients is deficient. Aim: The aim of this study was to describe physicians' experiences of palliative care for heart failure patients. Methods: Fifteen physicians at a medical geriatrics clinic were interviewed. The interviews were analysed using thematic content analysis. Results: The results show that the physicians are confronted with patients with an unpredictable disease trajectory, including patients with severe symptoms, uncertainty about anticipating the course of dying and encountering close relative's anxiety and frustration. The physicians face difficult situations regarding whether to continue or withdraw care and medical treatment which means deciding concerning 'active' medical treatment, cardio pulmonary resuscitation and an implantable cardioverter-defibrillator (ICD). The physicians acknowledge the necessity for better structured follow-ups and cooperation with outpatient settings. They recognize that there is a lack of follow-ups and continuity of care and treatment at the hospital, involving their passing on or retaining responsibility for the patients' medical care. Conclusion: From the physicians' view clarification of who is principally responsible for the patient's medical care, being involved throughout the disease trajectory and cooperating more closely with palliative care services are necessary to further improve the way in which care is delivered to patients dying of heart failure. © 2010 European Society of Cardiology.

Pihkala H.,Skelleftea Hospital | Sandlund M.,Umea University | Cederstrom A.,Orebro University
International Journal of Social Psychiatry | Year: 2012

Background: Beardslee's family intervention (FI) is a family-based intervention to prevent psychiatric problems for children of mentally ill parents. The parents' experiences are of importance in family-based interventions. Method: Twenty five parents were interviewed about their experiences of FI. Data were analysed by qualitative methods. Discussion: Confidence and security in the professionals and in FI as a method were prerequisites for initiating communication about the parents' mental illness with the children. Conclusions: FI provides a solid base for an alliance with the parents and might be a practicable method when parenthood and children are discussed with psychiatric patients.

Sodergren A.,Umea University | Karp K.,Umea University | Boman K.,Skelleftea Hospital | Eriksson C.,Umea University | And 5 more authors.
Arthritis Research and Therapy | Year: 2010

Introduction: In this study we aimed to investigate whether there are indications of premature atherosclerosis, as measured by endothelial dependent flow-mediated dilation (ED-FMD) and intima media thickness (IMT), in patients with very early RA, and to analyze its relation to biomarkers of endothelial dysfunction, taking inflammation and traditional cardiovascular disease (CVD) risk factors into account.Methods: Patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study of CVD co-morbidity. Of these, all patients aged ≤60 years were consecutively included in this survey of CVD risk factors (n = 79). Forty-four age and sex matched controls were included. IMT of common carotid artery and ED-FMD of brachial artery were measured using ultrasonography. Blood was drawn for analysis of lipids, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA)-mass, VonWillebrand factor (VWF), soluble intercellular adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), sE-selectin, sL-selectin and monocyte chemotactic protein-1 (MCP-1). In a subgroup of 27 RA patients and their controls the ultrasound measurements were reanalysed after 18 months.Results: There were no significant differences between RA patients and controls in terms of IMT or ED-FMD at the first evaluation. However after 18 months there was a significant increase in the IMT among the patients with RA (P < 0.05). Patients with RA had higher levels of VWF, sICAM-1 (P < 0.05) and of MCP-1 (P = 0.001) compared with controls. In RA, IMT was related to some of the traditional CVD risk factors, tPA-mass, VWF (P < 0.01) and MCP-1 and inversely to sL-selectin (P < 0.05). In RA, ED-FMD related to sL-selectin (P < 0.01). DAS28 at baseline was related to PAI-1, tPA-mass and inversely to sVCAM-1 (P < 0.05) and sL-selectin (P = 0.001).Conclusions: We found no signs of atherosclerosis in patients with newly diagnosed RA compared with controls. However, in patients with early RA, IMT and ED-FMD were, to a greater extent than in controls, related to biomarkers known to be associated with endothelial dysfunction and atherosclerosis. After 18 months, IMT had increased significantly in RA patients but not in controls. © 2010 Södergren et al.; licensee BioMed Central Ltd.

Nilsson L.M.,Umea University | Wennberg M.,Umea University | Lindahl B.,Umea University | Eliasson M.,Umea University | And 3 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2010

Background and aim: In northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI. Methods and results: The study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption ≥4 times/day versus ≤1 time/day 1.73 (95% CI 1.05-2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08-5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant. Conclusion: Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted. © 2009 Elsevier B.V.

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