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Biomedical subjects

G Larsson

Publications and source records attributed to G Larsson.

At least 91 records · Page 5Linked to original sources
PubMed1994

Elderly patients' experiences of pain and distress in intensive care: a grounded theory study.

The aim of the present study was to develop a theoretical understanding of elderly patients' experiences of pain and distress in intensive care, using a grounded theory approach. 18 patients, 7 women and 11 men, were interviewed and observed in an intensive care unit (ICU). Their average age was 76.5, varying from 70-85. A model was generated from data, according to which elderly patients' experiences of pain and distress in intensive care can be described as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. 16 categories form the four dimensions. The categories, in turn, are grounded in a number of interview and observational data. The sensory dimension is formed by the categories physical pain, physical discomfort, fatigue, and breathing problems, and the intellectual dimension by the categories not knowing, difficulty in expressing oneself/not being understood and confused perception of reality. The categories in the emotional dimension are worry, fear, resignation, bitterness, anger/irritation and dependency. Finally, the existential dimension is formed by the categories despair, threat to life and death acceptance. The categories within the four dimensions may be separate, but often they interact and influence each other in various ways. The model is discussed in relation to existing models and definitions of pain, where the intellectual and existential dimensions in particular have not been emphasized in a similar way.

Aged↗
PubMed1994

Changes of nursing organization in a surgical department: effects on work satisfaction and quality of care.

The aim of the study was to evaluate the effects of an organizational change programme in a surgical department in Sweden (the introduction of modular nursing) on the nursing staff's perception of job satisfaction and quality of care, and to identify factors which promote or hinder this organizational change. Planning and implementation of the change programme took about 1 year and comprised structural changes and staff training. Assessments of job satisfaction and quality of care were made immediately before, and 1 year after, implementation of the change programme. Data were collected from the staff of two wards. Virtually no statistically significant changes were found when looking at the department as a whole. However, considerable differences were noted between the two wards, particularly in the following areas: relationships with colleagues, identification and commitment, and perceived quality of care. The quality of the interpersonal relationships, and the leadership of the wards' head nurses, appeared to be crucial determinants of the outcome.

Adult↗
PubMed1994

Evaluation of the prognostic value of the health assessment form among patients clinically ready for discharge.

The aim of the study was to identify patterns of physical, psychological, and social conditions that may be of prognostic value when it comes to assessing continued care of patients clinically ready for discharge; a related aim was to evaluate instruments used for this identification, especially a Swedish version of the health assessment form. The sample consisted of 53 consecutive patients (mean age 82.8 years, SD = 6.6 years) All patients came from their own homes and were admitted to surgical and orthopaedic departments. Interviews were carried out on the day the patients were assessed as medically ready for discharge, and a second time 1 month later. The health assessment form measured the persons' social and environmental situation, health history, and functional health status, and another instrument measured the persons' sense of coherence. Few significant differences in functional health status were noted between persons who could return to their homes (n = 25) and persons who were referred to institutions after discharge (n = 17). However, the persons being referred to institutions showed less favourable scores within the areas of mood, sense of coherence, and worries about their home accommodation situation. When another sub-group was included (patients who died between the interview occasions; n = 8), significant differences were also noted in the health functions breathing, digestion, elimination, and body movement. Sense of coherence had a significant prognostic value for the continued care after discharge irrespective of whether the deceased patients were included or not.

Activities of Daily Living↗
PubMed1994

Quality of care. Development of a patient-centred questionnaire based on a grounded theory model.

In a previous study (Wilde et al. 1993), we developed a model of quality of care from a patient perspective using a grounded theory approach. The aim of the present study was to derive an instrument from this model. A questionnaire, Quality from Patients' Perspective (QPP), was developed which consisted of 56 items. Each item was evaluated in two ways by the respondent; assessment of perceived reality and evaluation of subjective importance (Likert scales). A personal quality of care index was computed on the basis of the relationship between these two scores. The QPP was tested on two samples, patients with infectious diseases (n = 147, mean age: 60 years) and nursing students (n = 103, mean age: 27 years). Patient's scores were factor analysed (principal factoring with oblique rotation) and 17 factors were extracted. Subgroups of patients were compared and correlations were computed between factor scores and self-rated health and well-being. Students also responded to a short form of the QPP (41 items) and personality scales. Correlations between these sets of variables were computed. The QPP was discussed in relation to existing scales.

Humans↗
PubMed1994

Serum lipids and mood in working men and women in Sweden.

STUDY OBJECTIVE: To explore the link between serum cholesterol and suicide by investigating the relation between serum lipids and depressive symptoms. DESIGN: This was a cross sectional study of the relation between serum cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides on the one hand and depressive symptoms as expressed in a questionnaire on the other. SETTING: An organisational development programme in industry with assistance from occupational health care. PARTICIPANTS: A total of 644 male and 261 female employees (mainly white-collar workers) participated. MAIN RESULTS: Total cholesterol and LDL cholesterol values were lower in those men who, sometimes, often, or very often, had experienced low mood or glumness during the past month compared with those who had not. Serum triglyceride concentrations did not differ between the groups. In women, however, the serum triglyceride value, but not the total cholesterol or LDL cholesterol, was lower in those who reported low mood, depression, or anxiety during the past six months. CONCLUSIONS: Decreasing appetite as a consequence of depression in men would probably lead to both decreasing cholesterol and triglyceride concentrations. Thus, these data indicate the presence of some other explanation for the relation between the level of LDL cholesterol and depressive symptoms in men.

Adult↗
PubMed1994

Multiple leiomyomata of the urinary bladder in a hysterectomized woman.

A 47 year-old previously hysterectomized para 0 gravida 0 presented with hematuria, abdominal pain and a palpable pelvic mass. Cystoscopy was normal. An ovarian tumor was suspected. At operation three leiomyomata originating from the bladder wall were found. This is a rare disease with only about 160 cases hitherto reported in the literature. The present case represents, as far as I know, the first case of multiple bladder leiomyoma reported in a woman. Bladder leiomyomata are a very rare differential diagnosis to ovarian tumors.

Female↗
PubMed1994

Psychologic factors in the etiology of amalgam illness.

Eleven patients with amalgam illness aged 33-50 years were investigated by psychodynamic methods. Six of them, all women, were dental nurses and hygienists exposed to amalgam/mercury both from their own dental fillings and occupationally. Four men and one woman were exposed only to amalgam/mercury from their own fillings. Assays of mercury in urine samples and in the ambient air during work routines involving the heaviest exposure indicated that the exposure was far below the levels at which even subclinical symptoms could be indicated by psychometric tests. The psychologic investigation indicated that the symptoms of amalgam illness were psychosomatic. All patients had experienced important psychic traumata in close connection with the first appearance of symptoms. It can be concluded from the psychodynamic dialogues that they had not been able to mourn for a loss in an adequate manner and that the body had been forced to symbolize the great pain in their souls.

Adult↗
PubMed1993

Can the birth of a large infant predict risk for atherosclerotic vascular disease in the mother?

We have previously demonstrated that women who had given birth to large infants had a six-fold increased risk of developing Type 2 (non-insulin-dependent) diabetes mellitus compared with a control group matched for age and parity. However, the patients were extremely obese which explained, in part, the increased risk. In the present investigation we studied whether the delivery of large infants correlated with risk factors for atherosclerotic vascular disease other than obesity and diabetes, and therefore could serve as early markers for syndrome X. The study consisted of 73 women who 20-27 years earlier had given birth to large infants weighing 4,500 g or more. Another group of 73 women matched for age, parity and BMI who had delivered infants weighing less than 4,500 g within a 3-month period served as a control group. Of these 73 patient/control pairs, 48 (66%) were able to participate in the investigation. Mean age was 52.2 years (range 40-66 years). No differences were noted for family history of diabetes and medication prescribed for vascular disease between the groups. An oral glucose tolerance test was performed and glucose, insulin and C-peptide at 0 and 2 h were estimated. Triglycerides, cholesterol, LDL and HDL cholesterol were analysed at baseline. We found no tendency towards hyperinsulinaemia and hyperglycaemia in the patients and both groups had the same relative increase in levels of insulin and C-peptide. No difference between the groups regarding manifest symptoms of vascular disease, either in blood pressure or in proteinuria were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The long-term effects of copper surface area on menstrual blood loss and iron status in women fitted with an IUD.

The long-term effects of copper surface area on menstrual blood loss (MBL) and iron status (hemoglobin, hematocrit, red cell count and indices, and serum ferritin) were evaluated in 25 healthy women who were observed for a period of 3 years following insertion of an intrauterine device. MBL was determined objectively by the alkaline hematin method. The women (mean age 37.2 +/- 1.6 yr, range 27-46 yr) were fitted with a Multiload intrauterine device (IUD) with a copper surface area of either 250 mm2 (MLCu-250, n = 13) or 375 mm2 (MLCu-375, n = 12). MBL prior to IUD insertion was 55 +/- 8 ml for women subsequently fitted with a MLCu-250 and 59 +/- 9 ml for women fitted with a MLCu-375. An increase in MBL was recorded at all measurement points following IUD insertion (MLCu-250/MLCu-375: 3 months: 55/49%; 6 months: 58/49%; 12 months: 64/41%; 24 months: 55/49%; 36 months: 47/39%, NS). There were no significant differences in iron status parameters before IUD insertion between groups nor were there any significant changes recorded in any of these parameters after IUD insertion. Our findings that the increase in copper surface area from 250 mm2 to 375 mm2 had no effect on MBL were thus substantiated by the hematological findings. Based on the results of the present study, women from developed countries apparently tolerate an increased MBL of approximately 45% without developing anemia. Iron stores were unchanged indicating an adequate adaptive increase in intestinal iron absorption.

Adult↗
PubMed1993

Community types, socio-economic structure and IHD mortality--a contextual analysis based on Swedish aggregate data.

The importance of social and economic conditions for people's health has been receiving more and more attention during the past 10 years. The question that is raised in this study is if the link between socio-economic factors in society, seen in the more composite sense, and cardiovascular mortality are dependent on different socio-geographical contexts? Two contextual situations are used; one concerns the dimension which places the analysis in an urban-rural context and the other, the dimension placing it in a context which describes people's forms of work. The study is based on aggregated data on the social and economic conditions for men in the municipalities in Sweden for the period 1983-1987. The results show that the link between various dimensions of the socio-economic structure and IHD rates is more pronounced in the urban and white-collar community types than in rural and blue-collar communities. In the community type where the links are more pronounced the IHD rate is lower and in the type where the links are less pronounced the IHD rate is higher. The results are discussed in relation to different theoretical perspectives.

Cardiovascular Diseases↗
PubMed1993

Personality development during nursing education--a Swedish study.

The aim of the study was to explore personality development during nursing education. The sample consisted of 122 Swedish nursing students. Ninety-three per cent of the students were female and the mean age at the beginning of the nursing education (which lasts for two years) was 27.6 years. Personality inventories were administered at the beginning and end of the education. The post-education assessment rendered several statistically significant differences of means. Compared with the pre-education assessment, the nursing students reported a more positive profession-oriented self-perception at the end of the education, a stronger ideal, real, and mirror identity, a reduced trait anxiety, stronger needs for achievement, exhibition, autonomy, dominance, and nurturance, and a weaker abasement need. The practical significance of the results was discussed.

Adult↗
PubMed1993

Quality of care from a patient perspective--a grounded theory study.

The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty-five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person-related and physical- and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.

Adult↗
PubMed1992

Crystal structure of a dUTPase.

The enzyme dUTPase catalyses the hydrolysis of dUTP and maintains a low intracellular concentration of dUTP so that uracil cannot be incorporated into DNA. dUTPase from Escherichia coli is strictly specific for its dUTP substrate, the active site discriminating between nucleotides with respect to the sugar moiety as well as the pyrimidine base. Here we report the three-dimensional structure of E. coli dUTPase determined by X-ray crystallography at a resolution of 1.9 A. The enzyme is a symmetrical trimer, and of the 152 amino acid residues in the subunit, the first 136 are visible in the crystal structure. The tertiary structure resembles a jelly-roll fold and does not show the 'classical' nucleotide-binding domain. In the quaternary structure there is a complex interaction between the subunits that may be important in catalysis. This possibility is supported by the location of conserved elements in the sequence.

Amino Acid Sequence↗
PubMed1992

The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status.

The influence of a low-dose combined oral contraceptive (ethinyl estradiol 30 micrograms + desogestrel 0.15 mg) on menstrual blood loss (MBL) was evaluated in 20 healthy, young women. MBL prior to commencing oral contraception was 60.2 +/- 5.6 ml (range 22-116 ml), and decreased (p < 0.001) to 36.5 +/- 5.2 ml (range 7-80 ml) and 33.7 +/- 4.1 ml (range 5-70 ml) after 3 and 6 months' oral contraceptive medication, respectively. The reduction in MBL during oral contraception was most apparent during the first two days of menstruation. Five women had an MBL > 80 ml prior to commencing oral contraceptive medication. In all of these women, MBL during the 6th menstrual period after commencing oral contraception was < 80 ml. All the women included in this study had a normal blood hemoglobin concentration, hematocrit and erythrocyte indices and there were no significant changes in these variables during the course of the study. Serum ferritin concentration prior to commencing oral contraception was 44.2 +/- 9.0 micrograms/l and was largely unchanged after 6 months' oral contraception (39.7 +/- 6.3 micrograms/l). On admission to the study, two women had a serum ferritin < 10 micrograms/l, indicative of low iron stores. Both these women had an MBL > 80 ml at the baseline assessment. Serum ferritin concentration increased during oral contraceptive medication in both women (from 8.5 micrograms/l to 12.0 micrograms/l and from 5.4 micrograms/l to 6.8 micrograms/l, respectively). The duration of menstruation (p < 0.01) and the number of women suffering from dysmenorrhea (p < 0.05) was reduced during oral contraception.

Adolescent↗
PubMed1992

Nursing theory based changes of work organisation in an ICU: effects on quality of care.

The study evaluated the effects of an organisational change programme on quality of care in a Swedish intensive care unit (ICU). The programme included: structural components e.g. converting assistant nurse positions to nurse positions; behavioural components e.g. improvements of report routines; and attitudinal components e.g. explication of what quality of care could mean in the ICU. Planning and implementation of the programme took about 1 year. Quality of care was studied on 40 patients 3 months before the intervention and on 40 patients 18 months after. An observation and question scheme was used for data collection. using Henderson's (1960) nursing model of patient's needs as point of departure. Statistically significant improvements of quality of care were noted on several observations at the postintervention assessment. Most of the improvements were noted on activities aimed at assisting the patient with basic physical needs such as breathing, nutrition, elimination, movement, sleep and rest, and avoiding dangers. No effects were noted on activities aimed at assisting the patient with psychological and spiritual needs. Discussing the results, the multimodal character of the intervention programme was believed to be a significant factor.

Clinical Nursing Research↗
PubMed1992

Diagnostic and preventive possibilities of excessive drinking in antenatal care.

Alcoholism among women has increased during the last decades. Thus it is likely that an increasing number of pregnancies will involve risk of alcohol damage to the fetus. In this article, two antenatal programs are presented to identify pregnancies at risk. Adequate alcohol information seems to be sufficient for socially drinking women, whereas alcoholic women need extensive support to abstain from alcohol. The psychosocial support was not experienced as intrusive.

Alcoholism↗