The aim of this study was to compare the estimation ability of a dental hygienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursing. Seventy-three persons, enrolled in a home nursing long-time care programme, were recruited. For the oral examination a newly developed protocol with comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency reliability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreement was estimated by calculating the kappa-values. Comparing the two examiners, good agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more changes. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing the dental hygienist's and the dentist's ability to estimate oral health status, treatment intention, and treatment need, some differences were observed, the dental hygienist tending to register "on the safe side", calling attention to the importance of inter-examiner calibration. However, for practical purpose the inter-examiner agreement was acceptable, constituting a promising basis for future out-reach activities.
A delicate duty for ambulance personnel is to care for patients who suffer from chest pain, caused by acute myocardial infarction (AMI-patient). In Sweden pain-relieving drugs may be administered, such as: oxygen, entonox, or morphine according to the skill of the ambulance personnel. The aim of this study was to find out if AMI-patients' expressions of pain were monitored and evaluated, in which way the AMI-patients received pain-relief, and to which degree they were relieved of pain. Examinations of the records of the ambulance personnel's observations during transport of AMI-patients revealed that nine tenths of those who complained about chest pain received pain-relieving drugs. The results of the treatments varied, however, from a good rate of response to morphine to less responses to oxygen and entonox. In order to treat AMI-patients who are in need of pain-relief during their transit to hospital the ambulance personnel must possess thorough knowledge of both pain theory and communication theory. Furthermore, they need tools for assessment of pain and for administering adequate pain-relieving drugs in clinical practice. In the future it may be necessary to differentiate between ambulance personnel in routine service and those in emergency service according to their levels of education.
Being affected by aphasia influences the total life experience. The aim of this study was to generate a theoretical model, from a nursing perspective, of what aphasic persons (n = 12) experience in encounters with other people. Data were collected through interviews which adopted a biophysical, socio-cultural and psychological approach and then analysed using grounded theory method. Two main categories emerged, namely: 'interaction' and 'support'. Encountered experiences led to: 'a feeling of having ability'; 'a feeling of being an outsider'; and 'a feeling of dejection or uncertainty'. The feeling state was dependent on whether the interaction was 'obstructed' or 'secure' and on whether the support resulted in 'strengthened' or 'impaired' self-esteem. Therefore nurses need to give support that enhances patients' self-esteem and which results in them gaining a positive and realistic view of their aphasia, as well as involving those around them in this perspective. This then will give the possibility for the patient to turn the interaction process from an obstructed into a secure one.
STUDY OBJECTIVE: The study objective was to determine, first, the association between men's and women's chest pain and their socio-economic status (occupation, smoking) and, secondly, the association between their socio-economic status and self-rated health, in a primary health care area. DESIGN AND SETTING: A population-based cross-sectional survey was made in a primary health care area of Sweden. Primarily based on occupation according to Swedish standards, 4,238 men and women were divided into two socio-economic groups; blue-collar and white-collar workers. METHODS: Odds ratios with 95% CI were calculated by multivariate logistic regression, controlling for the variable age as confounding factor. Student's t-test was used to compare self-rated health, and the chi 2-test to determine any difference in smoking habits between the two groups. MAIN RESULTS: Both male and female blue-collar workers showed significantly more chest pain when excited than white-collar workers. In six of eight health indices, they also reported significantly worse self-rated health than the white-collar workers. CONCLUSIONS: These findings show that there are socio-economic inequalities in self-reported chest pain. Furthermore, socio-economic status has a major influence on self-rated health, acting across the working life of both sexes.
Patients with head and neck cancer report several disease- and health-related problems before, during and a long time after completed treatment. Nurses have an important role in educating/supporting these patients about/through the disease and treatment so that they can attain well-being. This study describes the cancer patients' experiences of nurses' behaviour in terms of critical incidents after nurses had given them care to promote health. The study had a qualitative, descriptive design and the method used was the critical incident technique. Twenty-one informants from the Nordic countries diagnosed with head and neck cancer were strategically selected. It was explained to the informants what a critical incident implies before the interviews took place; this was defined as a major event of great importance, an incident, which the informants still remember, due to its great importance for the outcome of their health and well-being. The nurses' behaviour was examined, and critical incidents were involved in 208 cases-150 positive and 58 negative ones-the number of incidents varying between three and 20 per informant. The nurses' health promotion activities or lack of such activities based on the patients' disease, treatment and symptoms, consisted of informing and instructing the patients as well as enabling their participation. Personal consideration and the nurses' cognisance, knowledge, competence, solicitude, demeanour and statements of understanding were found to be important. Continuous health promotion nursing interventions were of considerable value for the majority of this group of cancer patients. Oncology nurses could reconfirm and update the care of head and neck cancer patients by including health promotion activities in individual care plans. By more frequent use of health promotion models, such as the empowerment model, the nurses could identify and focus on those individuals who needed to alter their life-style as well as tailor their approach towards these patient by setting goals for well-being and a healthy life-style.
The aim of the study was to investigate the relationship between mortality from cardiovascular diseases (CVD) and socio-economic status (SES) in Sweden and to estimate to what extent the difference between a province with low mortality and the rest of Sweden was dependent on socio-economic factors. A population-based retrospective study with a historical prospective approach was performed covering a 10-y period in the province of Halland, Sweden, as well as Sweden as a whole. Altogether 1,654,744 men and 1,592,467 women were included, of whom 45,394 men and 43,403 women were from Halland, distributed according to SES. Multivariate analysis with Poisson regression was used. Relative risks with 95% confidence intervals were calculated. Both men and women with a low SES showed a significantly higher risk of death from CVD in Sweden as a whole. The risk was 23% higher for male blue-collar workers and 44% higher for female blue-collar workers when compared to their white-collar counterparts. The level of mortality in Halland was 14% lower compared to the country as a whole when only age was taken into account. When the socio-economic variable was also included, this figure was 8%. The results show the substantial significance of social differences with respect to CVD mortality. The effect of SES seems to be more important than that of geographical conditions when the latter are isolated from socio-economic influence.
OBJECTIVE: The aim of this study was to describe decisive situations experienced by spouses of patients with heart failure that could potentially affect their ability to provide social support to the patient. METHODS: A qualitative descriptive design with a critical incident technique was used. Twenty-three informants, 15 women and 8 men, who were spouses of patients with severe heart failure were strategically chosen to ensure maximal variation in sociodemographic data and experiences as a spouse. RESULTS: Decisive situations influenced the experience of spouses of patients with heart failure in a manner that was either positive (involvement with others) or negative (feeling like an outsider). When spouses were given attention and treated like persons of value, they experienced involvement with others. In these cases, spouses had someone to turn to and were included in the physical care. In contrast, when spouses were kept at a distance by the patient, were socially isolated, and received insufficient support from children, friends, and health care professionals, they experienced feeling like an outsider. CONCLUSIONS: By identifying spouses' experiences, health care professionals can assess which kind of specific interventions should be used to improve the life situation of the patient with heart failure and his or her spouse.
A preliminary study of the relationship between a physically active versus a physically non-active life before a myocardial infarction and coping ability (e.g. psychosocial effects) after a myocardial infarction has been performed. In a mainly rural area in south-western Sweden all myocardial infarction sufferers (N = 49) during January 1984-August 1986, fulfilling certain criteria, were sent a questionnaire with special emphasis on their present and former exercise habits and psychosocial situation. The results indicate that there is a positive relation between a physically active as compared with a physically non-active life and coping ability in terms of fewer expressed depressions, better experienced relations in the family and higher degree of return to work, after a myocardial infarction among the physically active. However, further investigations are needed in order to explain the mechanisms involved. The results further imply that primary and secondary prevention must support the "risk-individual's" coping ability from a multifactorial view, built on holistic caring.
Avoiding patient's and doctor's delay is important for the detection of cancer. In order to study the possibilities for shortening the delay, without causing anxiety, an educational programme for early detection of cancer (EPEDC) was worked out, aimed to be evaluated at the community level. A community with 77,100 inhabitants, was informed about cancer symptoms in a letter. Participants who observed the cancer symptoms, described in the letter, were invited to visit the health centres, where they were interviewed and examined according to a specially designed schedule. Guidelines for taking care of these participants were also worked out. Fifteen previously unknown cancers were detected. By means of a telephone interview and a questionnaire the reactions to the EPEDC were studied. The results indicate that it is possible to inform and educate the population about cancer symptoms without causing anxiety on condition that there is an organisation which can be contacted without delay by subjects with potential cancer symptoms.