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Sökning: hsv:(SAMHÄLLSVETENSKAP) > Sophiahemmet Högskola

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  • Hedegaard, Joel, et al. (författare)
  • Gendered communicative construction of patients in consultation settings
  • 2014
  • Ingår i: Women & health. - 0363-0242. ; 54:6, s. 513-529
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.
  • Amsberg, Susanne, et al. (författare)
  • A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients : a randomized controlled trial
  • 2009
  • Ingår i: Patient Education and Counseling. - 0738-3991. ; 77:1, s. 72-80
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.
  • Amsberg, Susanne, et al. (författare)
  • Experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients
  • 2009
  • Ingår i: Diabetes Research and Clinical Practice. - 0168-8227. ; 84:1, s. 76-83
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To describe experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, in terms of feasibility, predictors and associations of improved glycaemic control. Methods Data were collected on 94 poorly controlled adult type 1 diabetes patients who were randomised to a study evaluating the effects of a behavioural medicine intervention. Statistics covered descriptive and comparison analysis. Backward stepwise regression models were used for predictive and agreement analyses involving socio-demographic and medical factors, as well as measures of diabetes self-efficacy (DES), diabetes locus of control (DLOC), self-care activities (SDSCA), diabetes-related distress (Swe-PAID-20), fear of hypoglycaemia (HFS), well-being (WBQ), depression (HAD) and perceived stress (PSS). Results The participation rate in the study was 41% and attrition was 24%. Of those patients actually participating in the behavioural medicine intervention, 13% withdrew. From the regression models no predictors or associations of improvement in HbA1c were found. Conclusions The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors or associations of improved metabolic control as the response to the intervention. Further research in this area is called for.
  • Anderbro, Therese, et al. (författare)
  • A longitudinal study of fear of hypoglycemia in type 1 diabetes
  • 2015
  • Konferensbidrag (refereegranskat)abstract
    • AimThe aim of this study was to investigate fear of hypoglycemia (FoH) longitudinally in adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over four years either showed a significantly higher or significantly lower level of FoH in order to identify factors associated with changes in FoH.MethodThe Swedish version of the Hypoglycemia Fear Survey (HFS) along with a questionnaire to assess hypoglycemia history (mild, moderate, nocturnal and severe hypoglycaemia (SH), unawareness, and daytime/nocturnal self-monitoring of blood glucose (SMBG)) were sent by mail to 764 patients in 2010. The responders in 2010 (n=469) received another set of the same two questionnaires in 2014. A1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one-sample t-tests and chi-square.ResultsThe absolute difference in the HFS total score (n=359) between 2010 and 2014 was m=±7.6, SD ±6 (range -29 - +35). In the subgroup with increased FoH 2014 (n=45), more patients reported unawareness (76% vs 58%, Χ2= 5.05, p= 0.025) and a higher frequency of moderate hypoglycemia (52% v s 38%, Χ2= 3.93, p= 0.047) compared to 2010. In the group with decreased FoH (n=43), fewer patients reported going to the emergency department due to hypoglycemia in 2014 compared to 2010 (2% vs 14%, Χ2= 4.84, p= 0.028). There were no differences in the remaining hypoglycemia history variables or medical variables between 2010 and 2014. Between group analyzes show that in the decreased FoH group more patients have a high frequency of daily SMBG compared to the increased FoH group in 2010 (35% vs 17%, Χ2= 12.23, p= 0.00) and in 2014 (33% vs 13%, Χ2= 13.75, p= 0.00). In the increased FoH group more patients report a high level of mild (67% vs 49%,Χ2= 6.4, p= 0.011) and moderate (52% vs 23%,Χ2= 14.00, p= 0.00) hypoglycemic episodes as well as unawareness (76% vs 54%,Χ2= 11.37, p= 0.001) in 2014 compared with the decreased FoH group.DiscussionTo our knowledge, this is the first longitudinal study of FoH in patients with type 1 diabetes. Our study shows that FoH is stable across time for most patients although a number of patients show increased or decreased levels of FoH. The patients whose level of FoH increased experienced a higher frequency of moderate hypoglycemic episodes and more hypoglycemic unawareness in 2014.
  • Anderbro, Therese (författare)
  • Behavior change intervention and fear of hypoglycemia in type 1 diabetes
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions
  • Anderbro, Therese, et al. (författare)
  • Fear of hypoglycemia : relationship to hypoglycemic risk and psychological factors
  • 2015
  • Ingår i: Acta Diabetologica. - 0940-5429. ; 52:3, s. 581-589
  • Tidskriftsartikel (refereegranskat)abstract
    • The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A(1c)), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A(1c) measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control. There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.
  • Anderbro, Therese, et al. (författare)
  • Psychometric evaluation of the Swedish version of the Hypoglycaemia Fear Survey
  • 2008
  • Ingår i: Patient Education and Counseling. - 0738-3991. ; 73:1, s. 127-31
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The objective of this study was to evaluate the psychometric properties of the Swedish version of the Hypoglycaemia Fear Survey (Swe-HFS) for use among Swedish-speaking patients with type 1 diabetes. METHODS: The HFS was translated using the forward-backward translation method and was thereafter answered by 325 type 1 patients. The psychometric properties were investigated using exploratory factor analysis, Cronbach's alpha, content and convergent validity. RESULTS: The factor analysis showed that a three-factor solution was reasonable with the subscales Behaviour/Avoidance (10 items), Worry (6 items) and Aloneness (4 items). Cronbach's alpha coefficient for the total score was 0.85. The result also supports the instrument's content validity and convergent validity. CONCLUSION: The Swedish version of the HFS appears to be a reliable and valid instrument for measuring fear of hypoglycaemia (FoH) in type 1 patients. PRACTICE IMPLICATIONS: The results from this study suggest that the Swe-HFS, an instrument that is brief and easy to administer, may be valuable in clinically assessing FoH among patients with type 1 diabetes.
  • Avelin, Pernilla, et al. (författare)
  • Parental grief and relationships after the loss of a stillborn baby
  • 2013
  • Ingår i: Midwifery. - 0266-6138. ; 29:6, s. 668-673
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.
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