The purpose of the study is to analyse medicine behaviour seen from the user's point of view. The study intends to generate ideas to specify topics of problems and to try out a combination of qualitative research methods. The practitioners and four asthmatic patients attached to a health centre in Billund, Denmark, were interviewed. The patients kept a diary based on topics, the notes of which were elaborated by weekly telephone interviews. In a final interview all participants evaluated the course of the study. The combination of qualitative methods has been very suitable to provide the perspective of the user. The results of the study question the ideal picture of the patient as a passive user of medicine. The main trends show that: the users develop different strategies to evaluate medication therapy; it has negative consequences to the patient when medication is changed regardless of patient experience; the therapy improves when the doctor draws on the experience of the patient. The study contributes to the present, sparse knowledge about the consciously acting user of medicine and indicates the importance of incorporating the user's experience and life situation in the health care system's handling of health problems.
To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.
As in burns treatment, certain countries in Western Europe have also been able to achieve a lot in the field of Burns Prevention. In order to learn about the methods of prevention adopted by these countries and their effectiveness, a short study tour was sponsored by the Burns Association of India and the Sir Dorabji Tata Trust.
Head and neck (H&N) cancer patients and their families meet a large number of clinicians during their long treatment period and many of them find it difficult to understand all the information given concerning their illness, treatment, and care. We have developed a care diary for these patients and their families, used also by the clinicians involved, to improve communication and patient involvement. The present survey was an evaluation of the helpfulness of those diaries. Anonymous answered questionnaires were collected from 42 H&N cancer patients, 28 family members, and 47 clinicians of different categories. Altogether 85% of the respondents stated that the care diaries had a positive effect on information, in general, and communication. It is recommended that care diaries should be implemented in the standard care for H&N cancer patients and their families. To improve the clinical value, it is particularly important to inform the clinicians on how to use the care diaries. The content and layout of the care diaries needs to be developed according to suggestions given from the respondents in this survey.
Previous studies have demonstrated that intensified treatment can result in lower blood glucose concentrations and retard microvascular complications. In the Stockholm Diabetes Intervention Study, 96 patients were followed for 5 years; 44 patients received intensified, conventional treatment and 52 patients received regular treatment. Changes in conceptions and attitudes that accompanied intensified treatment were evaluated with questionnaires and semistructured interviews. After education and personal tutoring, HbAlc was significantly lower in patients in the intensified treatment group compared with patients in the regular treatment group. Self-rated well-being and perceived ability to control the diabetes increased more in the patients in the intensified treatment group. Blood glucose testing became more important to the patients in the intensified treatment group, who used the blood glucose tests more frequently whenever necessary, and who acted on the test results. Microvascular complications were retarded or halted.
OBJECTIVE: To compare women's reports of aspects of their care during pregnancy, labour and delivery following stillbirth and live birth. DESIGN: Data were collected by postal questionnaire in 1994. SETTING: A Swedish nation-wide population-based study of cohorts defined in 1991. PARTICIPANTS: Three hundred and fourteen women with stillbirth (subjects) and 322 women with live birth (controls). MEASUREMENTS AND FINDINGS: Labour and delivery were assessed as physically 'insufferably hard' by 52 (17%) of the subjects and 33 (10%) of the controls. The corresponding figures for emotional strains were 144 (47%) and 21 (7%). Obstetric analgesia was more frequently used during labour for stillbirth. One hundred and thirty-eight (44%) subjects, as compared to 44 (2%) of the controls, left hospital within 24 hours of birth. Almost all the women with stillbirth 296 (95%) stated that it was important to have an explanation of the baby's death. Adverse events related to bromocriptine given to inhibit postpartum lactation, were reported by 60 (22%) of the subjects. KEY CONCLUSIONS: It is possible to ease the distress of labour and delivery for stillbirth. Discussion of the aetiology of the baby's death with the mother should be a priority. The optimal length of stay in hospital after stillbirth remains to be defined. Non-pharmacological inhibition of lactation may be presented as an alternative to bromocriptine, breast binding is a concrete 'reality confrontation' for the woman and may aid her in her grieving process. Further studies concerning breast binding vs pharmacological inhibition of lactation and long-term psychological outcome are warranted.