Search PubMed⌕ Search

Biomedical subjects

Björn Bergdahl

Publications and source records attributed to Björn Bergdahl.

14 recordsLinked to original sources
PubMed2005

Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease.

BACKGROUND: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL. METHODS: 207 consecutive patients <70 years of age with a recent event of CAD were randomised to a PBL group (n=104) or a control group (n=103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP). RESULTS: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year. CONCLUSIONS: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.

Aged↗
PubMed2005

Lectures in problem-based learning--why, when and how? An example of interactive lecturing that stimulates meaningful learning.

Even though opinions differ as to whether lecturing is compatible with problem-based learning (PBL) or not, lectures are still a common form of instruction in PBL curricula. This paper discusses the lecture in the framework of theories of learning in general and the medical problem-based learning tradition in particular. An example of how theories of learning can be implemented in the lecture hall is presented. Theories that underpin PBL as an educational philosophy rather than as a method of instruction are reviewed. A lecture form, organized in introductory, in depth and application lectures, that responds to important factors for stimulating deep processing of knowledge and meaningful learning is discussed. Examples of and practical points about how to renew and restructure lectures in a way that counteracts surface approaches to learning, teacher centering and student passivity are presented. We argue that, with proper awareness of possible drawbacks of the large format, lectures can be used as valuable tools for learning also in a PBL curriculum.

Education, Medical↗
PubMed2005

Incentives for lifestyle changes in patients with coronary heart disease.

AIM: This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis. BACKGROUND: Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour. METHODS: A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998-2000. FINDINGS: Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives. CONCLUSION: The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

Aged↗
PubMed2004

[The EDIT project. Problem-based learning on the web challenges students' thinking].

EDIT is short for Educational Development using Information Technology. The EDIT project was initiated by the Faculty of Health Sciences at Linköping University. The aim was to develop web-based scenarios for problem-based learning (PBL). Patient case studies and other medical problems or situations are illustrated by using realistic texts and multimedia, e.g. pictures and short films. Since the project started in 2001, EDIT-scenarios have been developed for six undergraduate programmes. The project covers two years of the medical programme. The use of multimedia has introduced new possibilities to challenge students' thinking by stimulating more senses. The different parts of a scenario are designed to raise questions without providing answers. Both students and tutors have perceived EDIT-scenarios as more motivating and interesting than the case studies on paper previously used. EDIT has contributed to improving and updating PBL-scenarios. This process has helped vitalise the discussions about pedagogical issues. For students as well as teachers, the project has lead to increased general familiarity with IT. In this paper, the project concept, practical aspects of the implementation, and pedagogical outcomes are discussed.

Education, Medical↗
PubMed2004

Effect of problem-based learning on stages of change for exercise behaviour in patients with coronary artery disease.

BACKGROUND AND PURPOSE: Physical activity plays an important part in preventing coronary artery disease and is targeted in most rehabilitation and education programmes. The aim of the present study was to evaluate stages of change for exercise behaviour in patients with a recent event of coronary artery disease. METHOD: A randomized two-group, pre--post-test design was used. Fifty-seven subjects were included in the problem-based learning intervention group and 61 subjects were included in the traditional rehabilitation control group. Data were analysed by intention-to-treat. A single-item five-category scale, based on the 'Stages of Change' model was used to measure the level of exercise behaviour. The statistical analysis used two non-parametric approaches for ordered categorical data. RESULTS: There was a significant systematic change over time towards the extreme scale categories in both groups. This suggested that individuals who were inactive before the intervention regressed, whereas individuals with some interest in physical activity remained static or improved. No significant differences between groups were found. CONCLUSION: Problem-based learning did not significantly influence patients' progression through exercise behaviour stages. Rehabilitation teams should be observant of inactive participants and their greater risk of regression.

Coronary Artery Disease↗
PubMed2004

Coronary heart disease: causes and drug treatment--spouses' conceptions.

BACKGROUND: Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event. AIMS AND OBJECTIVES: To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event. DESIGN: Qualitative with an empirical and inductive approach. METHODS: Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework. RESULTS: Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease. CONCLUSION: A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour. RELEVANCE TO CLINICAL PRACTICE: Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

Adaptation, Psychological↗
PubMed2004

Rehabilitation after coronary heart disease: spouses' views of support.

BACKGROUND: Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles. AIM: The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes. METHOD: Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework. FINDINGS: The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation. CONCLUSION: Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Adult↗
PubMed2003

Patients' conceptions of coronary heart disease--a phenomenographic analysis.

Readjustment after an event of coronary heart disease (CHD) is defined to comprise cognitive, instrumental and affective components. The cognitive dimension refers to understanding of the disease. Twenty-three patients (<60 years) with CHD were interviewed about the nature of their disease and encouraged to use their own words. The study was conducted 1 year after the event of myocardial infarction (MI) and some patients had also been revascularized. The interviews were transcribed in extenso and analysed according to the phenomenographic approach. The main finding was the great variation of conceptions revealed. Six different conceptions were found concerning CHD. Some patients comprehended MI by involving (A) blood and vessels, (B) either blood or vessel or referred to (C) risk factors/symptoms. Angina pectoris was expressed as (A) insufficient heart capacity, (B) atherosclerosis/contracted vessel or as (C) symptoms. Several patients found it difficult to expand their answers and some expressed misconceptions about the course of events. Patients' pre-existing knowledge and their way of reasoning about central phenomena related to their disease should be taken into consideration in patient education and is also applicable in individual encounters with patients.

Adaptation, Psychological↗
PubMed2002

Conceptions on treatment and lifestyle in patients with coronary heart disease--a phenomenographic analysis.

Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients' understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

Coronary Disease↗
PubMed2002

Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease.

A patient education programme applying problem-based learning (PBL) was developed for patients with coronary artery disease (CAD). Groups with 6-8 patients and a tutor from the rehabilitation team met nine times for 1.5h each. The feasibility and validity of the model was evaluated using patient questionnaires, interviews with tutors and video observations of tutorials. The participants were active (69% of all input) and discussions of acquired knowledge and lifestyle changes took place in all groups. A total of 89% of the patients reported implementation of lifestyle changes and over 90% rated their learning and overall experience of the programme as acceptable or high and the demands as acceptable. Shortcomings were the limited use of some of the steps in the problem-solving process and tutors' difficulties in adapting to their new role; their answering of questions was higher than planned (35% of their total input). The programme was feasible in clinical routine.

Coronary Artery Disease↗
PubMed2002

The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking.

The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3.2, 4.8 and 6.4 km h-1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4-5) with an elastic belt. The mean (+/- SD) activity counts were 1208 +/- 429, 3258 +/- 753 and 5351 +/- 876 counts min-1, at the three speeds, respectively (P < 0.001). Activity counts were significantly correlated to speed (r = 0.92; P < 0.001), VO2 (ml kg-1 min-1; r = 0.87; P < 0.001) and EE (kcal min-1; r = 0.85, P < 0.001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts.

Acceleration↗
PubMedDate not supplied

Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease.

PURPOSE: To evaluate the effects of a problem-based learning (PBL) rehabilitation program on physical activity. METHODS: We randomized 207 consecutive patients younger than 70 years, with a recent event of coronary artery disease (CAD), to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in a 1-year program with 13 sessions in small groups, where learning needs and behavior change were focused upon. Physical activity was assessed by means of interviews with all patients and by an activity monitor in 69 patients at pretest and in 175 after 1 year. RESULTS: Only small differences between groups were found at posttest. Interview data revealed significantly less activity at low-intensity level in the control group, whereas the activity monitor showed no significant differences. No changes were found in total physical activity during the year within the 2 groups. The self-reported physical activity indicating a level of brisk walking was markedly higher than that measured by the activity monitor, the latter indicating that only 35% of the patients achieved a 10-minute period of continued physical activity per day on an adequate level. CONCLUSIONS: Our PBL program had no important impact on the physical activity pattern of patients with CAD. The activity monitor is a feasible way of measuring physical activity in these patients, indicating a lower level of physical activity than interview data.

Aged↗
PubMedDate not supplied

[Renewed medical education in Linkoping. Problem-based learning, basic science and public health intensified].

A complete undergraduate medical programme in Linköping started 1986. The curriculum was innovative applying problem-based learning, community-orientation, and multi-professional training. After almost 20 years, a revision is implemented to vitalise the original educational principles. A curriculum committee coordinates seven multi-disciplinary theme-groups, mainly based on organ systems, responsible for planning and implementation of their parts during the whole curriculum. Critical appraisal, professional development, and population health are strengthened. Problem based learning is improved by using web-based scenarios and information technology. Phase I (2 semesters) focuses on basic concepts in basic science in relevant contexts, and Phase II (3 semesters) on normal structure, pathophysiology, diagnostic methods, and treatment. Phase III starts with a semester for a student research project and an elective period. The following five semesters deal with clinical medicine in hospitals and health centres with clerkships in four week periods changing with two week theoretical blocks related to the themes.

Biomedical Research↗