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  • 1.
    Aho, Anna Carin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Renmarker, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jakobsson, Jenny
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Experiences of Playing Volt Hockey With Focus on Well-Being According to Positive Emotion, Engagement, Relationships, Meaning, Achievement: An Interview Study2022In: Adapted Physical Activity Quarterly, ISSN 0736-5829, E-ISSN 1543-2777, Vol. 39, no 2, p. 160-178, article id apaq.2021-0035Article in journal (Refereed)
    Abstract [en]

    Volt hockey is a team sport developed for persons with physical disabilities, but its influence on well-being is unknown. Elements of well-being have been described as positive emotions, engagement, relationships, meaning, and achievement constituting a theoretical framework referred to as PERMA. The purpose of this study was to describe how well-being according to PERMA is reflected in the experiences of playing volt hockey. Data were collected through focus group and individual interviews including 21 players. A deductive analysis was conducted using the elements in PERMA as preexisting main categories with an additional main category, named resources needed. Findings showed that all five elements constituting well-being according to PERMA were reflected in the experiences of playing volt hockey. In addition, players emphasized the importance of having the resources needed to play volt hockey. In conclusion, having the opportunity to enjoy playing volt hockey enabled the players to flourish and experience feelings of subjective well-being.

  • 2.
    Al Musawi, Ahmed
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Hellström, Lina
    Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar; Pharmaceutical Department, Region Kalmar County, Kalmar.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Midlöv, Patrik
    Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Cheng, Yuanji
    Malmö University, Faculty of Technology and Society (TS), Department of Materials Science and Applied Mathematics (MTM).
    Eriksson, Tommy
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions2024In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711Article in journal (Refereed)
    Abstract [en]

    Background Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient’s medication use at home.

    Aim In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients and data collection to reduce medication discrepancies at discharge and improve medication adherence and (2) to explore the outcomes of the interventions.

    Method Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.

    Results Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.

    Conclusion Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

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  • 3.
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Astma: personlighet och personliga mål med medicineringen har betydelse för följsamhet till läkemedelsbehandling2017In: Bestpractice : Lungmedicin, ISSN 1902-7583, no 2017-05-09Article in journal (Other academic)
  • 4.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Backman, Helena
    Umeå Univ, Sect Sustainable Hlth, Dept Publ Hlth & Clin Med, OLIN Unit, Umeå, Sweden..
    Nwaru, Bright I.
    Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden.;Univ Gothenburg, Inst Med, Wallenberg Ctr Mol & Translat Med, Gothenburg, Sweden..
    Stridsman, Caroline
    Umeå Univ, Div Med, Dept Publ Hlth & Clin Med, OLIN unit, Umeå, Sweden..
    Vanfleteren, Lowie
    Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden.;Univ Gothenburg, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Resp Med & Allergol, COPD Ctr, Gothenburg, Sweden..
    Hedman, Linnea
    Piirila, Paivi
    Univ Cent Hosp, Unit Clin Physiol, HUS Med Diagnost Ctr, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Jalasto, Juuso
    Univ Cent Hosp, Unit Clin Physiol, HUS Med Diagnost Ctr, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Langhammer, Arnulf
    Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, HUNT Res Ctr, NTNU, Levanger, Norway..
    Kankaanranta, Hannu
    Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden.;Seinajoki Cent Hosp, Dept Resp Med, Seinajoki, Finland.;Univ Tampere, Fac Med & Life Sci, Tampere, Finland..
    Radinger, Madeleine
    Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden..
    Ekerljung, Linda
    Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden..
    Ronmark, Eva
    Umeå Univ, Sect Sustainable Hlth, Dept Publ Hlth & Clin Med, OLIN Unit, Umeå, Sweden..
    Lindberg, Anne
    Umeå Univ, Div Med, Dept Publ Hlth & Clin Med, OLIN unit, Umeå, Sweden..
    The extent and characterization of underdiagnosis and misclassification of COPD in Sweden2023In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 62, no Suppl. 67, article id OA3167Article in journal (Other academic)
  • 5.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN unit, Umeå University, Umeå, Sweden.
    Nwaru, Bright I
    Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Vanfleteren, Lowie
    Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN unit, Umeå University, Umeå, Sweden.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, University Central Hospital, Helsinki, Finland and University of Helsinki, Finland.
    Jalasto, Juuso
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, University Central Hospital, Helsinki, Finland and University of Helsinki, Finland.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Kankaanranta, Hannu
    Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Seinäjoki, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
    Rådinger, Madeleine
    Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Underdiagnosis and misclassification of COPD in Sweden - A Nordic Epilung study2023In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 217, article id 107347Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The prevalence of COPD tends to level off in populations with decreasing prevalence of smoking but the extent of underdiagnosis in such populations needs further investigation.

    AIM: To investigate underdiagnosis and misclassification of COPD with a focus on socio-economy, lifestyle determinants and healthcare utilization.

    METHOD: was defined according to the fixed post-bronchodilator spirometric criteria FEV1/FVC<0.70 in combination with respiratory symptoms.

    RESULTS: , the underdiagnosis was 83.6% (n = 107) of which 57.9% were men. The undiagnosed participants were younger, had higher FEV1% of predicted and less frequently a family history of bronchitis. One in four of the undiagnosed had utilized healthcare and had more frequently utilized healthcare due to a burden of respiratory symptoms than the general population without COPD. Underdiagnosis was not related to educational level. Misclassification of COPD was characterized by being a woman with low education, ever smoker, having respiratory symptoms and having a previous asthma diagnosis.

    CONCLUSION: In the high income country Sweden, the underdiagnosis of COPD was highly prevalent. Reduced underdiagnosis can contribute to risk factor modification, medical treatment and self-management strategies in early stages of the disease, which may prevent disease progression and improve the quality of life among those affected. Therefore, there is a need to increase the use of spirometry in primary care to improve the diagnostic accuracy.

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  • 6.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Backman, Helena
    Vanfleteren, Lowie
    Stridsman, Caroline
    Ekerljung, Linda
    Eriksson, Berne
    Nwaru, Bright
    Ronmark, Eva
    Kankaanranta, Hannu
    Lindberg, Anne
    Lundback, Bo
    Underdiagnosis and misclassification of COPD in Sweden2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no S64, article id 1395Article in journal (Other academic)
  • 7.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bahtsevani, Christel
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Neziraj, Merita
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Persson, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    A registry study of oral health problems and preventive interventions among older persons receiving municipal healthcare - PROSENIOR2023In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 2, p. 525-534Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care. Design: Cross-sectional register study. Methods: Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (>= 65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed. Results: A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

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  • 8.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bjork, Benita
    The Knowledge Centre for Allergy, Asthma and COPD, Region Skåne, Skåne County, Sweden.
    Berg, Ulrika
    The Knowledge Centre for Allergy, Asthma and COPD, Region Skåne, Skåne County, Sweden.
    Persson, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Effect of an Educational Program on Healthcare Professionals' Readiness to Support Patients with Asthma, Allergies, and Chronic Obstructive Lung Disease for Improved Medication Adherence2020In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2020, p. 1-11, article id 1585067Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study was to strengthen the healthcare professionals' readiness to support patients who have asthma, an allergy, and COPD for better medication adherence. Methods. The design was an educational intervention in a study population (n = 70) consisting of 66 nurses and four other allied healthcare professionals working in primary care with patients diagnosed with asthma, allergy, or COPD in a county in southern Sweden. As part of two training days, an educational intervention-consisting of lectures and workshops-was conducted. Both qualitative and quantitative data were collected. The qualitative data were collected during the workshops when the participants worked with fictitious patient cases. They documented in writing how they, based on the theoretical content in the educational intervention in combination with their clinical experiences, reasoned that the fictitious patients could be supported for better adherence. This documentation constituted qualitative data. The quantitative data were collected through questionnaires, which the participants completed before and after the intervention. Data from the questionnaires were statistically analyzed using descriptive statistics and paired t-tests. The qualitative data collected from the workshops were analyzed with content analysis. Results. The intervention increased the participants' knowledge of adherence (pre mean 3.95 versus post mean 4.18, p=0.001) and how to better support patients' adherence to medication (pre mean 3.71 versus post mean 3.98, p=0.001). Moreover, their knowledge of how to measure patients' adherence behavior (pre mean 3.02 versus post mean 3.54, p=0.001) and how to communicate with patients effectively about adherence was heightened (pre mean 3.92 versus post mean 4.13, p=0.011). Furthermore, participants felt that their readiness to support patients for better adherence had strengthened (pre mean 3.78 versus post mean 4.13, p=0.001). Individual adherence support for three fictitious patients with different adherence issues was developed. Conclusion. An educational intervention focusing on adherence and communication equipped healthcare professionals with tools to support patients with asthma, an allergy, or COPD for better medication adherence.

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  • 9.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Björk, Benita
    Region Skåne.
    Berg, Ulrika
    Region Skåne.
    Persson, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Behövs ett undervisningspaket med syfte att stärka vårdpersonals följsamhetsberedskap?2021In: BestPractice Nordic, no April 2021Article in journal (Other (popular science, discussion, etc.))
  • 10.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Björk, Benita
    Berg, Ulrika
    Persson, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Empower nurses to empower patients to better medication adherence2019Conference paper (Other academic)
  • 11.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ekerljung, Linda
    Eriksson, Jonas
    Hagstad, Stig
    Rönmark, Eva
    Lötvall, Jan
    Lundbäck, Bo
    Chronic bronchitis in West Sweden: a matter of smoking and social class2016In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 3, article id 30319Article in journal (Refereed)
    Abstract [en]

    Background: Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries. Aim: The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers. Methods: From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009 2013. A total of 1,172 subjects aged 17 79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms. Results: The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD. Conclusion: The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.

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  • 12.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ekerljung, Linda
    Lundbäck, Bo
    Boost self-efficacy for better health outcomes in adult asthmatics!2017Conference paper (Other academic)
    Abstract [en]

    Boost self-efficacy for better health outcomes in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda 2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Self- efficacy i.e. confidence in ability to handle challenges in everyday life could influence how individuals suffering from long-term disease such as asthma manage the disease, the medication treatment and symptoms, which in turn could influence both disease progression and health-related quality of life (HRQL). Aim: to explore the function of concerns with asthma medication and asthma control as mediators between self-efficacy and HRQL. Method: Adult asthmatics (n=479, 60% women) aged between 19 and 78 years selected from West Sweden Asthma Study completed questionnaires on self-efficacy, concerns with asthma medication, asthma control and HRQL. Two path models with self-efficacy as independent variable, mental and physical HRQL as dependent variables and concerns with asthma medication and asthma control as mediators were conducted. Results: In both path models, self-efficacy was negatively associated with concerns with asthma medication (β= -.130, p=0.005) and positively associated with asthma control (β =.100, p=0.027). In both path models, the effect of concerns with asthma medication on both mental and physical HRQL went through that of asthma control (β=-.138, p=0.003). Both concerns with asthma medication and asthma control mediated the effect of self-efficacy on both mental (β =.132, p=0.002) and physical HRQL (β =.455, p=0.001). Conclusion: Adult asthmatics with lower self-efficacy need support to strengthen their self-efficacy and assistance to overcome their concerns with the asthma medication in order to improve their asthma control. Better self-efficacy and reduced concerns with asthma medication will increase asthma control, which in turn most likely will have a positive effect on both mental and physical HRQL in adult asthmatics.

  • 13.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ekerljung, Linda
    Lundbäck, Bo
    Consider personality, medication adherence and asthma control in efforts to improve health-related quality of life in adult asthmatics!2017Conference paper (Other academic)
    Abstract [en]

    Consider personality, medication adherence and asthma control in efforts to improve health-related quality of life in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Asthma is a common respiratory disease, which often requires regular medication treatment. In individuals with asthma, assessments of health-related quality of life (HRQL) serve as an essential health outcome as they capture personal perspectives and experiences of everyday life with asthma and the ongoing medication treatment. Personality, adherence to medication treatment and asthma control are important influential factors of HRQL in adult individuals with asthma. However, these factors have rarely been investigated together. Therefore, the aim was to elucidate associations between personality, adherence, asthma control and HRQL in adult asthmatics. Methods: Adult asthmatics (n=337) with prescribed regular asthma medication treatment selected from West Sweden Asthma Study, participated by completing questionnaires on personality, adherence to asthma medication treatment, asthma control and HRQL. Two path models with the personality traits Neuroticism and Conscientiousness as independent variables, HRQL as dependent variable and adherence and asthma control as mediators were tested. Results: In the first path model, Neuroticism was negatively associated with adherence to asthma medication treatment and the mediated effect of adherence on HRQL went through that of perceived asthma control. In the second path model, both adherence and perceived asthma control functioned as mediators between Conscientiousness and HRQL. In this model, the effect of adherence on HRQL also went through that of perceived asthma control. Conclusion: Improving adherence in adult asthmatics scoring higher on the personality trait Neuroticism or lower on the personality trait Conscientiousness would most likely have a positive impact on their perceived asthma control, which in turn would increase their HRQL. In efforts to improve HRQL in adult asthmatics, individual differences, adherence to asthma medication treatment and perceived asthma control need to be taken into consideration

  • 14.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ekerljung, Linda
    Lundbäck, Bo
    The Significance of Asthma Follow-Up Consultations for adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control2015In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2015, article id 139070Article in journal (Refereed)
    Abstract [en]

    Objective.The aim was to investigate adherence to asthmamedication treatment,medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews. Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3%) but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2 agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma followup consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control. Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved.

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  • 15.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ekerljung, Linda
    Lundbäck, Bo
    Lötvall, Jan
    Personality and unachieved treatment goals related to poor adherence to asthma medication in a newly developed adherence questionnaire: a population-based study2016In: Multidisciplinary Respiratory Medicine, ISSN 1828-695X, E-ISSN 2049-6958, Vol. 11, no 42, article id 42Article in journal (Refereed)
    Abstract [en]

    Background Health-care professionals have a responsibility to be attentive to patients’ adherence behavior but it could be difficult to identify poor adherence in the context of clinical practice. Assessment of personality could be used to identify individuals who are in need for support with their adherence behavior. To our knowledge, existing adherence questionnaires are not based on individuals reflecting asthmatics in the general population and there is limited research describing adherence with asthma medication in relation to personal goals with the treatment. The aim was to develop and validate an adherence questionnaire in adult individuals with asthma from the general population and to assess adherence in relation to personality traits and goals with the asthma medication using the developed questionnaire. Methods The study was conducted in three phases: 1. A preliminary postal 46-item questionnaire was refined after psychometric testing (n = 157). 2. The questionnaire was validated (n = 104). 3. The developed adherence questionnaire was analyzed in relation to personality traits and achieved goals with the asthma medication. Adult respondents with physician diagnosed asthma using asthma medications were selected from the population-based West Sweden Asthma Study. The respondents completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory and the Medication Adherence Report Scale and stated their goals with the asthma medication. Data were analyzed using t-tests, correlations, multiple regression and principal component analysis. Results A final questionnaire was developed consisting of ten items organized in three subscales - “medication routines”, “self-adjusting the medication” and “concerns about side-effects”. Two of the subscales - “medication routines” and “self-adjusting the medication” – were associated with the Medication Adherence Report Scale. The subscale “medication routines” was associated with the personality traits – Conscientiousness and Neuroticism and unachieved goals with the asthma medication. Conclusions The developed questionnaire appears to be useful for measuring adherence to asthma medication in adult individuals with asthma. The study suggests that both individual differences and personal treatment goals need to be addressed in efforts to promote adherence to asthma medication treatment.

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  • 16.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ilmarinen, Pinja
    Backman, Helena
    Ekerljung, Linda
    Hedman, Linnea
    Langhammer, Arnulf
    Lindberg, Anne
    Lindqvist, Ari
    Nwaru, Bright I
    Pallasaho, Paula
    Sovijärvi, Anssi
    Vähätalo, Iida
    Kankaanranta, Hannu
    Hisinger-Mölkänen, Hanna
    Piirilä, Päivi
    Rönmark, Eva
    Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland: the Nordic EpiLung study2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 9, p. 1196-1207Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland.Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland.Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2% versus 6.3-6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found.Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

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  • 17.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jakobsson, Jenny
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Which nursing students are more ready for interprofessional learning? A cross-sectional study2019In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 79, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Background: It has been argued that the significance of personality in relation to students' readiness for interprofessional collaboration is an area where more research is needed. Nursing students in particular seem to be unsure about their role in the interprofessional team. Objective: To explore associations between nursing students' readiness for interprofessional learning and personality traits with regard to biological sex, and previous work experience from health care. Design: A cross-sectional questionnaire study. Setting: Nursing students in year one and three enrolled in a three-year undergraduate bachelor in nursing programme. Participants: Nursing students (n = 284) in semester two and six. Methods: The participants completed the Readiness for Interprofessional Learning Scale and the Neuroticism, Extraversion, and Openness to experience Five Factor Inventory-3. The data were statistically analyzed by descriptive statistics, t-tests, correlations and linear regressions. Results: Four of the five investigated personality traits – Extraversion, Openness to experiences, Agreeableness and Conscientiousness - were associated with nursing students' readiness for interprofessional learning. Moreover, nursing students in semester six were more ready for interprofessional learning regarding Negative professional identity and Roles and responsibilities than students in semester two. Female students were more ready for Teamwork and collaboration than male students. Conclusions: Nursing students being more outgoing, open-minded, agreeable or conscientious seem to be more ready for interprofessional learning. Consequently, personality is of significance for nursing students' readiness for interprofessional learning.

  • 18.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Gudmundsson, Petri
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Skane Univ Hosp, Vasc Ctr, Dept Cardiothorac & Vasc Surg, Malmo, Sweden..
    Jakobsson, Jenny
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Translation and validation of the Swedish version of the IPECC-SET 9 item version2022In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 36, no 6, p. 900-907Article in journal (Refereed)
    Abstract [en]

    Interprofessional Education (IPE) is essential to prepare future health-care professionals for collaborative practice, but IPE requires evaluation. One psychometrically sound instrument is the Interprofessional Education Collaborative Competence Self-Efficacy Tool consisting of nine items (IPECC-SET 9). This tool does not, to date, exist in a Swedish version. Therefore, the aim of this study was to translate and validate the Swedish version of the IPECC-SET 9. The English version was translated into Swedish and tested among 159 students in the 3-year Bachelor Programs in Nursing and in Biomedical Laboratory Science. The psychometric analysis was guided by a Rasch model, which showed that the items functioned well together, confirming unidimensionality, and that the person misfit was also lower than the set criterion. The separation index was 2.98, and the Rasch-equivalent Cronbach-alpha measure was estimated to .92, supporting internal consistency. No systematic differences on item level in IPECC-SET 9 further supported fairness in testing. The Swedish IPECC-SET 9 demonstrates sound psychometric properties and has the potential to be used as a measure of self-efficacy for competence in interprofessional collaborative practice among health profession students. However, the IPECC-SET 9 is recommended to be further tested in larger samples representing the entirety of health-care teams.

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  • 19.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Leander, Mai
    Backman, Helena
    Hedman, Linnea
    Rönmark, Eva
    Sleep disturbances and physical inactivity impair health related quality of life in adult asthmatics2017Conference paper (Other academic)
    Abstract [en]

    Background: Sleep disturbances and physical inactivity have only sparsely been studied in relation to health related quality of life (HRQL) in adult asthmatics. Aim: to investigate sleep disturbances and physical inactivity in relation to HRQL in adult asthmatics. Method: The sample (n=737), aged between 21 and 85 years, selected from the OLIN-studies participated in structured interviews about respiratory health, sleep, physical activity and questionnaires on mental and physical HRQL. Results: Sleep disturbances were more common in asthmatics than in non-asthmatics: snoring (p=0.018), difficulties falling asleep (p=0.025), many nocturnal awakenings (p=0.001), daytime sleepiness (p=0.001), early awakenings (p=0.002). Lower mental HRQL was found in asthmatics with difficulties falling asleep (p=0.001), in asthmatics reporting daytime sleepiness (p=0.010) than asthmatics without sleep disturbances. Lower physical HRQL was found in asthmatics with daytime sleepiness (p=0.002), early awakenings (p=0.001) and many nocturnal awakenings (p=0.039) than asthmatics without these sleep disturbances. Lower physical HRQL was found in physically inactive asthmatics than in physically active asthmatics (p=0.034). Physical activity (p=0.008) and asthma control (p=0.049) were stronger predictors of low physical HRQL than sleep disturbances. Difficulties falling asleep (p=0.001) and many nocturnal awakenings (p=0.04) were identified as negative predictors of mental HRQL while asthma control was a non-significant predictor. Conclusion: Helping adult asthmatics to improve their sleeping habits and to increase their physical activity will have a positive impact on their HRQL. Malin Axelssona, Mai Leanderb, Helena Backmanc, Linnea Hedmanc, Eva Rönmarkc a Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden b Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden c Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden

  • 20.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Lindberg, Anne
    Kainu, Annette
    Rönmark, Eva
    Jansson, Sven-Arne
    Respiratory symptoms increase health care consumption and affect the everyday life: a cross-sectional population-based study from Finland, Estonia and Sweden2016In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 3, article id 31024Article in journal (Refereed)
    Abstract [en]

    Background: Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption. Aim: The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life. Method: In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n 1,337), Estonia (n 1,346), and Sweden (n 1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed. Results: Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI 25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland. Conclusion: Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.

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  • 21.
    Axelsson, Malin
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Persson, Lena
    Höglund-Nielsen, Birgitta
    Living in the Wake of Chronic Obstructive Pulmonary Disease and Long-Term Oxygen Therapy2016In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, p. 376-385Article in journal (Refereed)
    Abstract [en]

    Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.

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  • 22.
    Axelsson, Malin
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Schonning, Viktor
    Bockting, Claudi
    Buysse, Ann
    Desmet, Mattias
    Dewaele, Alexis
    Giovazolias, Theodoros
    Hannon, Dewi
    Kafetsios, Konstantinos
    Meganck, Reitske
    Ntani, Spyridoula
    Rutten, Kris
    Triliva, Sofia
    Van Beveren, Laura
    Vandamme, Joke
    Overland, Simon
    Hensing, Gunnel
    Lived experiences: a focus group pilot study within the MentALLY project of mental healthcare among European users2020In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1Article in journal (Refereed)
    Abstract [en]

    BackgroundMental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.MethodIn total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N=7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.ResultsThe theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.ConclusionFacilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.

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  • 23. Backlund, Anja
    et al.
    Holmbeck, Olga
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    A registry study of nursing assessments, interventions and evaluations according to nutrition for persons living in municipal residential care homes2018In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 3, p. 341-350Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to explore planned nursing interventions and evaluations of such interventions, in older people at risk for malnutrition living in municipal residential care homes. Designs: A registry study. Methods: The study was conducted using data from the Swedish national quality registry Senior Alert. Data on all persons assessed and registered in Senior Alert living in municipal residential care homes in a mid‐sized town between January and December 2014 were subjected to statistical analysis. Results: In total, 677 nutritional risk assessments were performed among the participants (N = 587), who were between 65‐109 years. A larger proportion of women were estimated as being at risk for malnutrition compared with men. The three most common prescribed nursing interventions were nutritional treatment, dietary support and weight control; however, interventions were not prescribed for all participants at risk for malnutrition. Lesser than 50% of the interventions were evaluated, with dietary support, pharmaceutical review and weight control the three most likely to be evaluated. Further, planned interventions for participants at risk of malnutrition were implemented more often for men than for women.

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  • 24. Backman, Helena
    et al.
    Vanfleteren, Lowie
    Lindberg, Anne
    Ekerljung, Linda
    Stridsman, Caroline
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nilsson, Ulf
    Nwaru, Bright I
    Sawalha, Sami
    Eriksson, Berne
    Hedman, Linnea
    Rådinger, Madeleine
    Jansson, Sven-Arne
    Ullman, Anders
    Kankaanranta, Hannu
    Lötvall, Jan
    Rönmark, Eva
    Lundbäck, Bo
    Decreased COPD prevalence in Sweden after decades of decrease in smoking.2020In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 21, no 1, article id 283Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: COPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.

    METHODS: /FVC < lower limit of normal (LLN) criterion.

    RESULTS: Based on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009-2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.

    CONCLUSIONS: The prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.

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  • 25.
    Bashir, Muwada Bashir Awad
    et al.
    Krefting Research Centre, Institute of Medicine, University of Gothenbur.
    Basna, Rani
    Krefting Research Centre, Institute of Medicine, University of Gothenbur.
    Zhang, Guo-Qiang
    Krefting Research Centre, Institute of Medicine, University of Gothenbur.
    Backman, Helena
    Section of Sustainable Health/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Section of Medicine/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hedman, Linnea
    Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Vanfleteren, Lowie
    COPD Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Section of Sustainable Health/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Nwaru, Bright I
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Computational phenotyping of obstructive airway diseases: protocol for a systematic review2022In: Systematic Reviews, E-ISSN 2046-4053, Vol. 11, no 1, p. 1-5, article id 216Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Over the last decade, computational sciences have contributed immensely to characterization of phenotypes of airway diseases, but it is difficult to compare derived phenotypes across studies, perhaps as a result of the different decisions that fed into these phenotyping exercises. We aim to perform a systematic review of studies using computational approaches to phenotype obstructive airway diseases in children and adults.

    METHODS AND ANALYSIS: We will search PubMed, Embase, Scopus, Web of Science, and Google Scholar for papers published between 2010 and 2020. Conferences proceedings, reference list of included papers, and experts will form additional sources of literature. We will include observational epidemiological studies that used a computational approach to derive phenotypes of chronic airway diseases, whether in a general population or in a clinical setting. Two reviewers will independently screen the retrieved studies for eligibility, extract relevant data, and perform quality appraisal of included studies. A third reviewer will arbitrate any disagreements in these processes. Quality appraisal of the studies will be undertaken using the Effective Public Health Practice Project quality assessment tool. We will use summary tables to describe the included studies. We will narratively synthesize the generated evidence, providing critical assessment of the populations, variables, and computational approaches used in deriving the phenotypes across studies CONCLUSION: As progress continues to be made in the area of computational phenotyping of chronic obstructive airway diseases, this systematic review, the first on this topic, will provide the state of the art on the field and highlight important perspectives for future works.

    ETHICS AND DISSEMINATION: No ethical approval is needed for this work is based only on the published literature and does not involve collection of any primary or human data.

    REGISTRATION AND REPORTING: SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020164898.

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  • 26.
    Borglin, Gunilla
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Nursing Education, Lovisenberg Diaconal University College, 0456, Oslo, Norway.
    Eriksson, Miia
    Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden.
    Rosén, Madeleine
    Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered nurses' experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study2020In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 19, no 1, article id 124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to describe registered nurses' (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units.

    BACKGROUND: One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs' experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing.

    DESIGN: A qualitative descriptive study.

    METHOD: Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis.

    RESULTS: Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke.

    CONCLUSIONS: The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs' knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.

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  • 27. Ekerljung, Linda
    et al.
    Bjerg, Anders
    Bossios, Apostolos
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Torén, Kjell
    Wennergren, Göran
    Lötvall, Jan
    Lundbäck, Bo
    Five-fold increase in use of inhaled corticosteroids over 18 years in the general adult population in West Sweden2014In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, no 5, p. 685-693Article in journal (Refereed)
    Abstract [en]

    Introduction: Asthma medication was increasingly used during the second part of the past century. There are few detailed data from population studies on use of asthma medication. The current study aimed to determine the use and determinants of asthma medication in West Sweden and to assess changes during the last two decades. Methods: From a random population sample participating in a survey on respiratory symptoms, 2000 individuals were randomly selected for clinical examinations and structured interviews, 1172 participated. All subjects reporting asthma (n Z 1524) were also invited, and 834 participated. In total, 964 subjects with asthma participated. Asthma medication use was assessed in the general population and among two severity categories of asthma: multi-symptom asthma (MSA) and “other” asthma (having fewer symptoms). Current data, from 2010, was compared with data from 1992. Results: Asthma medication was used by 11% of the population, 4.4% used ICS with concurrent use of LABA, 3.3% used ICS without LABA, while 3.2% only used SABA. Compared with 1992, the prevalence of asthma medication use had increased with 54%, and use of ICS had increased from 1.5% to 7.7%.Conclusion: Subjects with MSA reported using asthma medication more frequently and at higher doses, and a higher proportion used ICS.A shift in asthma medication use has occurred since 1992, with increased use of ICS and decreased use of SABA only, implying better asthma Control on a population level. Multi-symptom asthma should alert the treating physician to consider under-medication and/or poor treatment adherence.

  • 28. Eriksson, Berne
    et al.
    Backman, Helena
    Ekerljung, Linda
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Lindberg, Anne
    Rönmark, Eva
    Lundbäck, Bo
    Pattern of Cardiovascular Comorbidity in COPD in a Country with Low-smoking Prevalence: Results from Two-population-based Cohorts from Sweden2018In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 15, no 5, p. 454-463Article in journal (Refereed)
    Abstract [en]

    Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009–2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV1/FVC <0.70 and the lower limit of normal (LLN5th percentile) of the ratio of FEV1/FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p<0.001; LLN definition: 42% vs. 24%, p¼0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.

  • 29.
    Gustavsson, Kristoffer
    et al.
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    van Diepen, Cornelia
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands..
    Fors, Andreas
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bertilsson, Monica
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hensing, Gunnel
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Healthcare professionals' experiences of job satisfaction when providing person-centred care: a systematic review of qualitative studies2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e071178Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: This qualitative systematic review aimed to explore and synthesise healthcare professionals' (HCPs) experiences of job satisfaction when providing person-centred care (PCC) in healthcare settings in Europe.

    METHOD: This systematic review of qualitative studies was followed by a thematic synthesis applying an inductive approach. Studies concerning HCPs and different levels of healthcare in Europe were eligible for inclusion. The CINAHL, PubMed and Scopus databases were searched. Study titles, abstracts and full texts were screened for relevance. Included studies were assessed for methodological quality using a quality appraisal checklist. Data were extracted and synthesised via thematic synthesis, generating analytical themes.

    RESULTS: Seventeen studies were included in the final thematic synthesis, and eight analytical themes were derived. Most studies were conducted in Sweden and the UK and were performed in hospitals, nursing homes, elderly care and primary care. Thirteen of these studies were qualitative and four used a mixed-method design in which the qualitative part was used for analysis. HCPs experienced challenges adapting to a new remoulded professional role and felt torn and inadequate due to ambiguities between organisational structures, task-oriented care and PCC. Improved job satisfaction was experienced when providing PCC in line with ethical expectations, patients and colleagues expressed appreciation and team collaboration improved, while learning new skills generated motivation.

    CONCLUSION: This systematic review found varied experiences among HCPs. Notably, the new professional role was experienced to entail disorientation and uncertainty; importantly, it also entailed experiences of job satisfaction such as meaningfulness, an improved relationship between HCPs and patients, appreciation and collaboration. To facilitate PCC implementation, healthcare organisations should focus on supporting HCPs through collaborational structures, and resources such as time, space and staffing.

    PROSPERO REGISTRATION NUMBER: CRD42022304732.

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  • 30.
    Hansen, Michael Ulrich
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Vejzovic, Vedrana
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ambulance nurses' experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study.2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 63, p. 1-7, article id 101195Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain.

    AIM: To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome.

    METHOD: A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis.

    RESULTS: Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines.

    CONCLUSIONS: The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.

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  • 31.
    Jakobsson, Jenny
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Örmon, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The Face of Workplace Violence: Experiences of Healthcare Professionals in Surgical Hospital Wards2020In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2020, article id 1854387Article in journal (Refereed)
    Abstract [en]

    Background: Though workplace violence (WPV) is a global problem for healthcare professionals, research within in-hospital care has mainly focused on WPV in emergency healthcare settings. Thus, the number of qualitative studies that explores experiences of WPV in general hospital wards with a longer length of stay is limited.

    Aim: The aim of this study was to explore how healthcare professionals in surgical hospital wards experience and manage WPV perpetrated by patients or visitors.

    Method: . Exposure to WPV is a problem for healthcare professionals in surgical wards and has consequences for the patients. Preventive strategies, guidelines, and action plans are urgently needed to minimise the risk of WPV and to ensure a safe work and care environment.

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  • 32.
    Jakobsson, Jenny
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Centre for Work Life and Evaluation Studies (CTA).
    Örmon, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). The Västra Götaland Region Competence Center on Intimate Partner Violence, Gothenburg, Sweden.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berthelsen, Hanne
    Malmö University, Centre for Work Life and Evaluation Studies (CTA). Malmö University, Faculty of Odontology (OD).
    Exploring workplace violence on surgical wards in Sweden: a cross-sectional study2023In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 22, no 1, article id 106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

    METHODS: This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

    RESULTS: The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

    CONCLUSION: Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.

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  • 33.
    Jakobsson, Jenny
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Örmon, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). The Västra Götaland Region Competence Center on Intimate Partner Violence, Gothenburg, Sweden.
    Berthelsen, Hanne
    Malmö University, Centre for Work Life and Evaluation Studies (CTA). Malmö University, Faculty of Odontology (OD).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study2022In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 30, no 6, p. 1523-1529Article in journal (Refereed)
    Abstract [en]

    AIM: The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents.

    BACKGROUND: Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff.

    METHOD: Fifteen semistructured interviews were analysed using qualitative content analysis.

    RESULTS: Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents.

    CONCLUSION: While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis.

    IMPLICATIONS FOR NURSING MANAGEMENT: To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.

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  • 34. Jansson, Sven-Arne
    et al.
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hedman, Linnea
    Leander, Mai
    Stridsman, Caroline
    Rönmark, Eva
    Subjects with well-controlled asthma have similar health-related quality of life as subjects without asthma2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, p. 59-64Article in journal (Refereed)
    Abstract [en]

    Background: The burden of asthma and rhinitis on health-related quality of life (HRQL) among adults has been assessed mainly in studies of patients seeking health-care, while population-based studies are relatively scarce. The objective of this study was to investigate HRQL among subjects with asthma and rhinitis derived from a random population sample and to identify factors related to impairment of HRQL. Methods: A randomly selected cohort was invited to participate in a postal questionnaire survey. Of those who responded, a stratified sample of 1016 subjects was invited to clinical examinations and interviews, and 737 subjects in ages 21-86 years participated. Of these, 646 completed HRQL questions. HRQL was assessed with the generic SF-36 Health Survey. Results: The physical score was lower among subjects with asthma vs. subjects without asthma (p < 0.001). No significant difference was found in the mental score. Subjects with well-controlled asthma had higher physical score compared to subjects with partly and un-controlled asthma (p=0.002). Actually, subjects with well-controlled asthma had similar physical HRQL as subjects without asthma. Asthmatics who were current smokers had lower physical score compared to those who were non-smokers (p = 0.021). No significant differences in physical or mental scores were found between subjects with and without rhinitis. Subjects with both asthma and rhinitis had lower physical score compared to subjects without these conditions (p < 0.001), but subjects with asthma alone had even worse physical score. Conclusions: The physical score was significantly lower in asthmatics compared to subjects without asthma. Importantly, non-smoking and well-controlled asthmatics have similar HRQL compared to subjects without asthma. Thus, subjects with asthma should be supported to achieve and maintain good asthma control and if they smoke, be offered smoking cessation as means to improve their HRQL.

  • 35. Jansson, Sven-Arne
    et al.
    Hedman, Linnea
    Stridsman, Caroline
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kriit, Hedi Katre
    Lindberg, Anne
    Lundback, Bo
    Ronmark, Eva
    Backman, Helena
    Life-years lost due to asthma2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no S63, article id PA5063Article in journal (Other academic)
  • 36.
    Jansson, Sven-Arne
    et al.
    Umeå University.
    Hedman, Linnea
    Umeå University; Luleå University of Technology.
    Stridsman, Caroline
    Umeå University; Luleå University of Technology.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Lindberg, Anne
    Umeå University.
    Lundbäck, Bo
    University of Gothenburg.
    Rönmark, Eva
    Umeå University.
    Backman, Helena
    Umeå University.
    Life-years lost due to asthma and COPD2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no S64, article id 1400Article in journal (Other academic)
  • 37. Jansson, Sven-Arne
    et al.
    Leander, Mai
    Hedman, Linnea
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, OLIN Unit, Umea, Sweden..
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Stridsman, Caroline
    Rönmark, Eva
    Health-related quality of life in adults with asthma and rhinitis2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 46Article in journal (Other academic)
  • 38. Johansson, Ann-Caroline
    et al.
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berndtsson, Ina
    Brink, Eva
    Illness Perception in Relation to Cancer Care Settings and Healthcare Information2014Conference paper (Other academic)
    Abstract [en]

    Background: Our knowledge about illness perceptions among persons treated for colorectal cancer (CRC) and their partners is incomplete, as is our knowledge about how the context of cancer care environments affects illness perceptions. The aim of the present study was to explore illness perception in relation to cancer care settings and healthcare information among CRC survivors and their partners. Methods: Nine survivors and nine partners were interviewed, and grounded theory was undertaken,using the method presented by Katy Charmaz. Findings: The results were presented in the core category Outlook on the cancer diagnosis in a ‘quick-fix’ environment, which illustrated how the illness perceptions of survivors and partners were in3uenced in various ways by environment and healthcare semantics as well as personal approaches and lay beliefs described in the conceptual categories outlook on the cancer diagnosis, experiencing a ‘quick-fix’ environment, approaching information and interpreting healthcare language. Discussion: Healthcare professionals should pay attention to illness perceptions among survivors and partners and adjust the information provided to different perceptions. The commonsense model of illness representations offers the practical guidance needed to recognize the potential of illness perceptions and to achieve the goals of contemporary cancer care

  • 39. Johansson, Ann-Caroline
    et al.
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berndtsson, Ina
    Brink, Eva
    Illness perceptions in relation to experiences of contemporary cancer care settings among colorectal cancer survivors and their partners2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, no 23581, article id 23581Article in journal (Refereed)
    Abstract [en]

    Illness is constituted by subjective experiences of symptoms and their psychosocial consequences. Illness perceptions concern people’s lay beliefs about understandings and interpretation of a disease and expectations as to disease outcome. Our knowledge about illness perceptions and coping in relation to the cancer care context among persons with colorectal cancer (CRC) and their partners is incomplete. The aim of the present study was to explore illness perceptions in relation to contemporary cancer care settings among CRC survivors and partners. The present research focused on illness rather than disease, implying that personal experiences are central to the methodology. The grounded theory method used is that presented by Kathy Charmaz. The present results explore illness perceptions in the early recovery phase after being diagnosed and treated for cancer in a contemporary cancer care setting. The core category outlook on the cancer diagnosis when quickly informed, treated, and discharged illustrates the illness perceptions of survivors and partners as well as the environment in which they were found. The cancer care environment is presented in the conceptual category experiencing contemporary cancer care settings. Receiving treatment quickly and without waiting was a positive experience for both partners and survivors; however partners experienced the information as massive and as causing concern. The period after discharge was being marked by uncertainty and loneliness, and partners tended to experience non-continuity in care as more problematic than the survivor did. The results showed different illness perceptions and a mismatch between illness perceptions among survivors and partners, presented in the conceptual category outlook on the cancer diagnosis. One illness perception, here presented among partners, focused on seeing the cancer diagnosis as a permanent life-changing event. The other illness perception, here presented among survivors, concentrated on leaving the cancer diagnosis behind and moving forward. The importance of illness perceptions among survivors, and the differences in illness perceptions between survivors and partners, should be recognized by healthcare professionals to achieve the goals of person-centered contemporary cancer care.

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  • 40. Johansson, Ann-Caroline
    et al.
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berndtsson, Ina
    Brink, Eva
    Self-reorientation following colorectal cancer treatment: a grounded theory study2015In: Open Nursing Journal, E-ISSN 1874-4346, Vol. 9, p. 25-31Article in journal (Refereed)
    Abstract [en]

    After colorectal cancer (CRC) treatment, people reorganize life in ways that are consistent with their understanding of the illness and their expectations for recovery. Incapacities and abilities that have been lost can initiate a need to reorient the self. To the best of our knowledge, no studies have explicitly focused on the concept of self-reorientation after CRC treatment. The aim of the present study was therefore to explore self-reorientation in the early recovery phase after CRC surgery. Grounded theory analysis was undertaken, using the method presented by Charmaz. The present results explained self-reorientation as the individual attempting to achieve congruence in self-perception. A congruent self-perception meant bringing together the perceived self and the self that was mirrored in the near environs. The results showed that societal beliefs and personal explanations are essential elements of self-reorientation, and that it is therefore important to make them visible.

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  • 41. Johansson, Ann-Caroline
    et al.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grankvist, Gunne
    Berndtsson, Ina
    Brink, Eva
    Symptoms, Illness Perceptions, Self-Efficacy and Health-Related Quality of Life Following Colorectal Cancer Treatment2018In: Open Journal of Nursing, Vol. 8, no 9, article id 87222Article in journal (Refereed)
    Abstract [en]

    Introduction: Lower health-related quality of life (HRQoL) is associated with fatigue, poor mental and poor gastrointestinal health during the first three months after colorectal cancer (CRC) treatment. Research indicates that maintaining usual activities has a positive impact on HRQoL after treatment for CRC. Illness perceptions have been associated with HRQoL in other cancer diseases, and self-efficacy has been associated with HRQoL in gastrointestinal cancer survivors. Our knowledge about illness perceptions and selfefficacy in relation to maintaining everyday activities and HRQoL following CRC treatment is incomplete. Aim: To explore associations between HRQoL, fatigue, mental health, gastrointestinal health, illness perceptions and selfefficacy in relation to maintaining everyday activities, three months after surgical CRC treatment. A further aim was to test the Maintain Function Scale in a CRC population. Method: The study was cross-sectional. Forty-six persons participated. Data were collected using questionnaires. Descriptive and analytical statistics were used. Results: Persons who were more fatigued, depressed, worried, and had more diarrhea were more likely to report lower HRQoL. Increased fatigue and diarrhea were associated with decreased HRQoL. Concerning illness perceptions, persons who reported negative emotions and negative consequences of CRC were more likely to report lower HRQoL. Persons scoring higher on self-efficacy were more likely to report higher HRQoL. Increased self-efficacy was associated with increased HRQoL. The Maintain Function Scale was suitable for assessing self-efficacy in relation to maintaining everyday activities. Conclusions: Nursing support to improve self-efficacy and illness perceptions and to minimize symptoms during recovery should have a favorable impact on HRQoL.

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  • 42. Johansson, Ann-Caroline
    et al.
    Brink, Eva
    Cliffordson, Christina
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The function of fatigue and illness perceptions as mediators between self-efficacy and health-related quality of life during the first year after surgery in persons treated for colorectal cancer.2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. e1537-e1548Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To measure changes in health‐related quality of life, two dimensions of illness perceptions (i.e., consequences and emotional representations), fatigue and self‐efficacy in persons treated for colorectal cancer during the first year after surgical treatment, and to study how fatigue, illness perceptions and self‐efficacy measured at 3 months affect health‐related quality of life at 12 months postsurgery. Background: There are fluctuations in health‐related quality of life during the first year after treatment for colorectal cancer, and fatigue may negatively influence health‐related quality of life. Illness perceptions (consequences and emotional representations) and self‐efficacy have been shown to be associated with health‐related quality of life in other cancer diagnoses. Concerning colorectal cancer, there is a lack of knowledge concerning how illness perceptions and self‐efficacy change during recovery, and how these variables and fatigue at 3 months relate to health‐related quality of life at 12 months. Design: A prospective longitudinal design. Methods: Thirty‐nine persons surgically treated for colorectal cancer, of whom 17 had a colostomy, participated. Health‐related quality of life, fatigue, illness perceptions and self‐efficacy were assessed using QLQ‐C30, the Revised Illness Perception Questionnaire and the Maintain Function Scale. Descriptive and analytical statistics were used. Results: No changes were reported in levels of health‐related quality of life, fatigue or illness perceptions. Self‐efficacy was lower at 12 months compared to 3 months. Fatigue and one dimension of illness perceptions mediated the effect of self‐efficacy at 3 months on health‐related quality of life at 12 months. Conclusion: Persons treated for colorectal cancer who have lower self‐efficacy 3 months postsurgery are inclined to have more negative illness perceptions concerning emotions and to experience more fatigue. Relevance to clinical practice: Nurses need to support persons with fatigue and negative illness perceptions concerning emotions and to bolster their self‐efficacy, that is carry out follow‐up consultations focusing on illness management, symptoms, emotions and information on ways to increase self‐efficacy.

  • 43.
    Kumlien, Christine
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hellman, Peter
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Neziraj, Merita
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Magdalena
    Malmö Stad.
    PROSENIOR-prevention av fall, trycksår, undernäring och dålig munhälsa hos äldre personer i samverkan med personal, äldre personer och Senior Alert2021In: Ä : en tidning för Riksföreningen sjuksköterskan inom äldrevård : geriatriker, dietister inom geriatrik samt alla professioner runt den äldre patienten, ISSN 2001-1164Article in journal (Other (popular science, discussion, etc.))
  • 44. Mincheva, Roxana
    et al.
    Ekerljung, Linda
    Bjerg, Anders
    Axelsson, Malin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Popov, A Todor
    Lundbäck, Bo
    Lötvall, Jan
    Frequent cough in unsatisfactory controlled asthma: results from the population-based West Sweden Asthma Study2014In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 15Article in journal (Refereed)
    Abstract [en]

    Background: Asthma is a complex disease presenting with variable symptoms which are sometimes hard to control. The purpose of the study was to describe the prevalence of asthma symptoms, use of asthma medications and allergic sensitization in subjects with asthma. We also related those indices to the level of asthma control, lung function and in particular, cough. Methods: An extensive questionnaire was sent to randomly selected adults from the West Sweden region. Clinical examinations and interview were performed in a subset. Of the participants, 744 were defined as having an ongoing asthma - reported ever having asthma or physician diagnosed asthma and one of the following – use of asthma medications, recurrent wheeze or attacks of shortness of breath with or without wheeze in the last 12 months. A respiratory disease-free control group of 847 subjects was also described. Results: According to GINA guidelines, 40.6% of the asthmatics had partly controlled and 17.8% had uncontrolled asthma. Asthmatic subjects reported significantly more symptoms in the last 12 months than the control group – wheezing (79.4 vs 9.2%), shortness of breath (36.1 vs 2.5%), wheezing with shortness of breath (58.7 vs 1.3%). Important complaints were morning cough (42.5 vs 15.5%), cough with sputum production (36.1 vs 6.8%) and longstanding cough (32.5 vs 11.1%), which bothered two thirds of the uncontrolled and one third of partly controlled subjects. Asthma medications were used by 87.5% of the asthmatics, although around 30% of them who had insufficiently controlled disease used only short-acting beta-agonists. Asthmatics also had lower lung function, reacted to lower doses of methacholine that the controls and 13.6% of them had a FEV1/FVC ratio below 0.7. Allergic rhinitis was reported by 73.8% of the asthmatics and they were more frequently sensitized to several common allergens. Conclusions: Approximately 60% of asthmatics from this population-based study had insufficiently controlled asthma and persistent complaints, despite a high use of asthma medications. These self-reported symptoms were supported by clinical examination data. Increased cough frequency is an indicator of a more severe and difficult to control disease and should be considered when asthma is characterized.

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  • 45.
    Murray, Bridget
    et al.
    RCSI Univ Med & Hlth Sci, Sch Nursing & Midwifery, Dublin, Ireland..
    Smith, Sheree
    Univ Western Sydney, Sch Nursing & Midwifery, Sydney, Australia..
    Roberts, Nicola
    Edinburgh Napier Univ, Sch Hlth & Social Care, Edinburgh, Scotland..
    Padilha, Miguel Jose
    Escola Super Enfermagem Porto ESEP, Nursing Sch Porto, CINTESIS RISE, Porto, Portugal..
    Sajnic, Andreja
    Univ Hosp Ctr, Dept Resp Dis Jordanovac, Zagreb, Croatia..
    Narsavage, Georgia
    West Virginia Univ, Sch Nursing, Morgantown, WV USA..
    Christensen, Helle Marie
    Univ Southern Denmark, Odense Univ Hosp, Dept Resp Med, Odense, Denmark.;Univ Southern Denmark, Dept Clin Res, Odense, Denmark..
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carme, Hernandez
    Hosp Clin Barcelona Univ Barcelona, August Pi & Sunyer Biomed Res Inst IDIBAPS, Med & Nursing Direct, CIBERES Barcelona, Barcelona, Spain..
    Poot, Betty
    Victoria Univ Wellington, Sch Nursing Midwifery & Hlth Practice, Wellington, New Zealand..
    Kelly, Carol
    Edge Hill Univ, Cardioresp Res Ctr, Ormskirk, England..
    Existing respiratory nursing curriculum, frameworks, and other documentation relevant to respiratory nursing education: A Scoping Review2023In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 62, no Suppl. 67, article id OA3173Article in journal (Other academic)
  • 46.
    Narsavage, G.
    et al.
    West Virginia Univ SON, Morgantown, WV USA..
    Sajnic, A.
    Univ Hosp Ctr, Zagreb, Croatia..
    Kelly, C.
    Edge Hill Univ, Ormskirk, England..
    Smith, S.
    Western Sydney Univ, Penrith, NSW, Australia..
    Roberts, N.
    Glasgow Caledonian Univ, Glasgow, Lanark, Scotland..
    Heslop-Marshall, K.
    RVI Hospita, Newcastle Upon Tyne, Tyne & Wear, England..
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Padilha, M.
    Nursing Sch Porto, Porto, Portugal..
    Hernandez, C.
    Univ Barcelona, Hosp Clin Barcelona, Barcelona, Spain..
    Murray, B.
    RCSI Univ Med & Hlth Sci, Dublin, Ireland..
    Poot, B.
    Victoria Univ Wellington, Wellington, New Zealand..
    Development of an international curriculum for respiratory nurses (ICRN): A global needs survey2022In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 60, no Suppl 66, article id 204Article in journal (Other academic)
    Abstract [en]

    Introduction: A coronavirus pandemic confirmed that respiratory nurses are critical healthcare providers. Knowledge about appropriate education for quality respiratory nursing care is limited. The ERS Nurses Chair formed the ICRN group to develop a core curriculum for respiratory nurses.

    Aims: The study surveyed the need for an international core respiratory nursing curriculum and current curricula that exist globally.

    Methods: A 39-item survey was sent to 33 respiratory nursing experts in 27 countries. Items included current roles, perception of need/expectations for a core curriculum, and respiratory content in nursing education in their countries.

    Results: Thirty responses from 25 countries were analyzed; participants worked in academia (53%)/clinical practice (40%). The need for a core respiratory nursing curriculum was confirmed (97%). Post-registration nursing programs at bachelor (63.3%) and masters (43.3%) levels included internal/medical nursing care; less than half identified separate respiratory nursing content. Consensus was that a core educational program should include knowledge (70%), skills (60%), and competencies (50%), with separate pediatric and adult content.

    Conclusion: The vast variation in formal respiratory nursing education globally confirms the need for a core respiratory curriculum. The ICRN will next use a Delphi study to identify core curricular elements for respiratory nursing education.

  • 47.
    Neziraj, Merita
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Magdalena
    Department of Health and Social Care, Strategic Development, Unit of Research, Quality and Education, Malmö, Swede.
    Hellman, Peter
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden.
    Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers2021In: International Journal of Nursing Studies Advances, ISSN 2666-142X, Vol. 3, article id 100056Article in journal (Refereed)
    Abstract [en]

    Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n = 21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.

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  • 48.
    Neziraj, Merita
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Skanes universitetssjukhus Malmö, Malmö, Sweden.
    Hellman, Peter
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Magdalena
    Health and Social Care, Strategic Development, Unit of Research and Development and Competence Centre, Malmö, Sweden.
    The STAIR OF KNOWLEDGE-a codesigned intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes in Sweden: development of a complex intervention2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 8, article id e072453Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the development of a codesigned complex intervention intended to prevent the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes.

    DESIGN: : Nursing homes in the municipality in southern Sweden.

    PARTICIPANTS: End users (n=16) in nursing homes (n=4) codesigned the intervention together with the research group in workshops (n=4) in March-April 2022. Additionally, stakeholders (n=17) who were considered to play an important role in developing the intervention participated throughout this process. Data were analysed using reflexive thematic analysis.

    RESULTS: Four workshops were conducted with end users (n=16) and 13 meetings with stakeholders (n=12) were held during the development process. The intervention aims to bridge the evidence-practice gap regarding the preventive care process of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The intervention is aimed at end users, lasts for 3 weeks and is divided into two parts. First, end users obtain knowledge on their own by following written instructions. Second, they meet, interact and discuss the knowledge acquired during part 1.

    CONCLUSION: The intervention is robustly developed and thoroughly described. The study highlights the extensive process that is necessary for developing tailored complex interventions. The description of the entire development process may enhance the replicability of this intervention. The intervention needs to be tested and evaluated in an upcoming feasibility study.

    TRIAL REGISTRATION NUMBER: NCT05308862.

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  • 49.
    Neziraj, Merita
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hellman, Peter
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Magdalena
    Malmö Stad.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls: a register study among older persons receiving municipal health care in southern Sweden2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 265Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although pressure ulcers, malnutrition, poor oral health and falls are common among older persons, causing deteriorated health status, they have not been studied altogether among older persons receiving different types of municipal health care. The aim of this study was to determine the prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls among older persons aged ≥65 years receiving municipal health care in southern Sweden.

    METHODS: A retrospective cross-sectional study (n = 12,518 persons aged ≥65 years) using data from the national quality registry Senior Alert was conducted. The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was calculated based on categorical data from the instruments available in Senior Alert. T-tests, chi-square test, the Mantel- Haenszel test and logistic regression models were performed.

    RESULTS: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was 27.9, 56.3, 34.2 and 74.5% respectively. Almost 90% of the older persons had at least one health risk. The prevalence of risk for pressure ulcers, poor oral health and falls was significantly higher in dementia care units compared to short term nursing care, home health care and nursing homes. The prevalence of risk for malnutrition was significantly higher among older persons staying in short term nursing care compared to other types of housing. The odds of having a risk for malnutrition were higher in short term nursing care compared to other types of housing. The oldest age group of 95-106 years had the highest odds of having a risk for falls. The presence of multiple health risks in one subject were more common in dementia homes compared to nursing homes and home health care but not compared to short term nursing care.

    CONCLUSION: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was high, implying that these health risks are a great concern for older persons receiving municipal health care. A comprehensive supporting preventive process to prevent all the investigated health risks among older persons receiving municipal health care is recommended.

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  • 50. Nwaru, Bright I
    et al.
    Ekerljung, Linda
    Rådinger, Madeleine
    Bjerg, Anders
    Mincheva, Roxana
    Malmhäll, Carina
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennergren, Göran
    Lotvall, Jan
    Lundbäck, Bo
    Cohort profile: the West Sweden Asthma Study (WSAS): a multidisciplinary population-based longitudinal study of asthma, allergy and respiratory conditions in adults.2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 6, article id e027808Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The West Sweden Asthma Study (WSAS) is a population-representative longitudinal study established to: (1) generate data on prevalence trends, incidence and remission of asthma, allergy and respiratory conditions, (2) elucidate on the risk and prognostic factors associated with these diseases, (3) characterise clinically relevant phenotypes of these diseases and (4) catalyse relevant mechanistic, genomic, genetic and translational investigations. PARTICIPANTS: WSAS comprised of randomly selected individuals aged 16 to 75 years who are followed up longitudinally. The first stage involved a questionnaire survey (>42 000 participants) and was undertaken in 2008 and 2016. A random sample (about 8000) of participants in the initial survey undergoes extensive clinical investigations every 8 to 10 years (first investigations in 2009 to 2012, second wave currently ongoing). Measurements undertaken at the clinical investigations involve structured interviews, self-completed questionnaire on personality traits, physical measurements and extensive biological samples. FINDINGS TO DATE: Some of our key findings have shown a 54% increase in the use of asthma medications between the 1990s and 2000s, primarily driven by a five-fold increase in the use of inhaled corticosteroids. About 36% of asthmatics expressed at least one sign of severe asthma indicator, with differential lung performance, inflammation and allergic sensitisation among asthmatics with different signs of severe asthma. Multi-symptom asthmatics were at greater risk of having indicators of severe asthma. In all adults, being raised on a farm was associated with a decreased risk of allergic sensitisation, rhinitis and eczema, but not asthma. However, among adolescents (ie, those 16 to 20 years of age), being raised on a farm decreased the risk of asthma. Personality traits were associated with both beliefs of asthma medication and adherence to treatment. FUTURE PLANS: Follow-up of the cohort is being undertaken every 8 to 10 years. The repeated clinical examinations will take place in 2019 to 2022. The cohort data are currently being linked to routine Swedish healthcare registers for a continuous follow-up. Mechanistic, genomic, genetic and translational investigations are ongoing.

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