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  • 1.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. 1School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.; Faculty of Medicine and Health, Linköping University, Sweden.
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Jönsson, Birgitta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.; The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.
    Wallin, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.; University of Gothenburg, Göteborg, Sweden.
    Denti, Leif
    University of Gothenburg, Göteborg, Sweden.
    Elf, Marie
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.; School of Architecture, Chalmers University of Technology, Göteborg, Sweden.
    Supporting first-line managers in implementing oral care guidelines in nursing homes2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed)
    Abstract [en]

    This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

  • 2.
    Hägglund, Patricia
    et al.
    Umea Univ, Fac Med, Dept Odontol, Oral & Maxillofacial Radiol, SE-90187 Umea, Sweden..
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden..
    Ståhlnacke, Katri
    Publ Dent Hlth Serv, Orebro Cty Reg, Orebro, Sweden.;Orebro Univ, Fac Hlth & Med, Orebro, Sweden..
    Persenius, Mona
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden..
    Hägg, Mary
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Cty Council Gavleborg, Hudiksvall Hosp, Speech & Swallowing Ctr, Dept Otorhinolaryngol, Hudiksvall, Sweden..
    Andersson, Maria
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden..
    Koistinen, Susanne
    Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden.;Orebro Univ, Fac Hlth & Med, Sch Hlth Sci, Orebro, Sweden..
    Carlsson, Eva
    Rebro Univ, Fac Hlth & Med, Univ Hlth Care Res Ctr, Orebro, Sweden..
    Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 78Article in journal (Refereed)
    Abstract [en]

    Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia). Methods/Design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT < 10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups. Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

  • 3.
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Life After a Stroke Event: With Special Reference to Aspects on Prognosis, Health and Municipality Care Utilization, and Life Satisfaction Among Patients and Their Informal Caregivers2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. The aim of this thesis was to study the prognosis, health care utilization and health situation in stroke patients, and informal caregiver burden during the first post-stroke year.

    Material and methods. 390 patients, 65 years or older, discharged from hospital after a stroke, were followed with repeated patient interviews, patient record and register data, and hospital staff and informal caregiver questionnaires.

    Results. Prognosis assessments performed by hospital staff at discharge regarding the course of events during the following year were highly accurate and were mainly influenced by the patient’s pre- and post-morbid state. The risk of dying or having a new stroke decreased rapidly during the early post-morbid phase. Health care utilization, in hospitals as well as in primary health care, and municipal social service support was considerably higher after the stroke than before, but the utilization of services was lower than previously reported. Health problem prevalence according to interview and record scrutiny was modest, peaked early after discharge and then declined. Support from informal caregivers increased significantly after discharge and remained high during the first post-stroke year. The support given was mainly determined by patient functional ability, distance to patient, relation to patient, municipal social service support provided, and patient sex. The informal caregivers reported considerable strain and burden, with significantly higher levels of anxiety and depression than the stroke patients. Moreover, there was a parallel between the patient’s and the caregiver’s situation regarding anxiety, emotional and social situation, and home, social and outdoor activities.

    Conclusion. Hospital staff prognosis assessments of patient outcomes during the next year were highly accurate. Risk of recurrence and mortality, and health problem prevalence was high in the early post-stroke period, and than declined. Health care utilization and municipality social support increased over time. Informal caregivers reported considerable strain and burden.

    List of papers
    1. Prognosis assessment in stroke patients at discharge from hospital
    Open this publication in new window or tab >>Prognosis assessment in stroke patients at discharge from hospital
    2007 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 36, no 2, p. 184-189Article in journal (Refereed) Published
    Abstract [en]

    Background: Accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. Objective: To analyse factors affecting the accuracy of discharge prognosis assessments. Design: Prospective study of stroke patients discharged from hospital. Setting: two cities in central Sweden. Subjects: Three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. Methods: At discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. Results: The prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. Conclusions: Prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

    Keywords
    prognosis assessment, outcome, functional capacity, health situation, dwelling, stroke, elderly
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-10401 (URN)10.1093/ageing/afl146 (DOI)000244959500014 ()17178766 (PubMedID)
    Available from: 2007-03-22 Created: 2007-03-22 Last updated: 2017-12-11Bibliographically approved
    2. Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years
    Open this publication in new window or tab >>Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years
    2009 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 11, p. 3585-3590Article in journal (Refereed) Published
    Abstract [en]

    Background and Purpose — The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

    Methods — Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

    Results — The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

    Conclusions — The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.

    Keywords
    epidemiology, hazard function, health care utilization, municipal support, recurrence
    National Category
    Medical and Health Sciences
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112848 (URN)10.1161/STROKEAHA.109.556720 (DOI)000271160300030 ()
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2017-12-12Bibliographically approved
    3. Health problems in elderly patients during the first post-stroke year
    Open this publication in new window or tab >>Health problems in elderly patients during the first post-stroke year
    2012 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 3, p. 318-327Article in journal (Refereed) Published
    Abstract [en]

    Background. A wide range of health problems has been reported in elderly post-stroke patients. Aim. The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

    Methods. A total of 390 consecutive patients, >= 65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

    Results. More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

    Conclusions. Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.

    Keywords
    stroke, elderly, health problems, outcome
    National Category
    General Practice
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112871 (URN)10.3109/03009734.2012.674572 (DOI)000307186800009 ()
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2018-01-12Bibliographically approved
    4. Life situation among informal caregivers to stroke patients
    Open this publication in new window or tab >>Life situation among informal caregivers to stroke patients
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background and Purpose Stroke related problems may affect the life situation of not only stroke patients but also their informal caregivers. The objective of this study was to assess life situation aspects in stroke patients and their informal caregivers during the first post-stroke year.

    Methods 377 patients surviving a stroke event were followed during the first post stroke year with interviews 1 week after discharge from hospital and three and twelve months after the index stroke admission. Their informal caregivers answered questionnaires in connection to the interviews. In both groups information based on the Hospital Anxiety and Depression Scale (HAD), the Nottingham Health Profile (NHP), and GQL-Activity Scale was obtained. Additional information was sought among patients on their health situation and Mini Mental State Examination (MMSE) score, and among informal caregivers on the nature and amount of assistance provided, measured as support score and number of hours per week and perceived caregiver burden (CB) score.

    Results Before index admission 85% of informal caregivers provided on average five hours’ care per week and 8-10 support score. The corresponding numbers after discharge were 91%, 10 hours per week and 13-15 support score. Support determinants were patient’s functional ability, distance to patient’s home, relation to patient, municipality social service support given. CB score determinants were municipality support given, relation to patient, functional ability, and patient age. The caregivers had higher anxiety and depression scores than the patients. Significant associations between caregiver and patient responses were found for HAD anxiety, NHP emotional and social, and GQL activity score.

    Conclusions The informal caregivers reported a significant caregiver burden. There was a parallel situation between patients’ and caregivers’ situation.

    Keywords
    stroke, elderly, informal caregiver, life situation
    National Category
    General Practice
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112873 (URN)
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2018-01-12Bibliographically approved
  • 4.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Health problems in elderly patients during the first post-stroke year2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 3, p. 318-327Article in journal (Refereed)
    Abstract [en]

    Background. A wide range of health problems has been reported in elderly post-stroke patients. Aim. The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

    Methods. A total of 390 consecutive patients, >= 65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

    Results. More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

    Conclusions. Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.

  • 5.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Life situations and the care burden for stroke patients and their informal caregivers in a prospective cohort study2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 4, p. 290-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective.

    METHODS: A total of 377 Swedish stroke patients, aged ≥65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score.

    RESULTS: Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient's functional ability, low received municipal social service support, closeness of patient-caregiver relation, and short distance to patient's home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient's age, sex, functional ability, and patient-caregiver relationship. CB score increased with amount of informal caregiver support, patient's age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time.

    CONCLUSIONS: There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

  • 6.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Elf, M
    Eldh, AC
    Wallin, L
    Jönsson, B
    Implementing oral health-care guidelines in long-term-care: the role and support of managers2015Conference paper (Other academic)
  • 7.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hägg, M
    Ståhlnacke, K
    Carlsson, E
    Persenius, M
    Effects of swallowing training on eating, oral health and quality of care among elderly people in short-term care units: preliminary findings2015Conference paper (Other academic)
  • 8.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Omne-Pontén, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Prognosis assessment in stroke patients at discharge from hospital2007In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 36, no 2, p. 184-189Article in journal (Refereed)
    Abstract [en]

    Background: Accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. Objective: To analyse factors affecting the accuracy of discharge prognosis assessments. Design: Prospective study of stroke patients discharged from hospital. Setting: two cities in central Sweden. Subjects: Three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. Methods: At discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. Results: The prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. Conclusions: Prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

  • 9.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Omne-Pontén, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years2009In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 11, p. 3585-3590Article in journal (Refereed)
    Abstract [en]

    Background and Purpose — The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

    Methods — Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

    Results — The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

    Conclusions — The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.

  • 10. Stålnacke, K
    et al.
    Carlsson, E
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hägg, M
    Persenius, M
    OHRQoL, oral-health/care, eating and swallowing among elderly people in short-term accommodations in Sweden2015Conference paper (Other academic)
  • 11. Österlund Efraimsson, Eva
    et al.
    Klang, Birgitta
    Ehrenberg, Anna
    Larsson, Kjell
    Fossum, Björn
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care2015In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 2, article id 27915Article in journal (Refereed)
    Abstract [en]

    Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

    Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

    Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

    Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

    Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

    Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

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