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Aim: The aim of the study was to compare experienced painrelief of treatment with acupuncture and pelvic support (trocanter-belt) for pelvic pain. A second aim was to look for differences according to sick leave and consumption of analgesia. Metod: The population consisted of 61 pregnant women with pelvic pain. The women were included between 23+6 and 31+6 weeks of their pregnancy, and were allocated to either acupuncture or pelvic support. A midwife gave an average of 6.3 acupuncture treatments. A trocanter-belt and pain relief advice was given by physiotherapists. The treatment lasted for five weeks with a follow up two weeks later.

Results: Better pain relief in the acupuncture group than in the pelvic support group. In the acupuncture group the consumption of analgesia decreased significantly. The pelvic support group showed no significant decrease in consumption of analgesia but showed a significant increase in sick leave.

Conclusion: The study confirmed that acupuncture can relieve pelvic pain and thereby increase mobility. It also confirms other studies showing that back pain prior to pregnancy or back pain in a previous pregnancy increases the risk of pelvic pain during pregnancy. It is therefore important to give individual advice and preventive measures early in next pregnancy to avoid or minimise pelvic pain.

According to the National Board of Health and Welfare, women applying for an abortion should receive information concerning available methods of abortion. As of 1992, women pregnant fewer than 64 days can choose between a medical or a surgical abortion. Aim: To describe womens experience of information concerning abortion and their possibility to choose method and how they experienced the abortion. Method: A descriptive comparative questionnaire study. The sample consisted of women pregnant fewer than 64 days. Two questionnaires where used, the first where answered by 128 women before the abortion. The second where answered by 90 women one month after the abortion. Results: Before the visit to the doctor 66% had a wish to use the medical method, 23% surgical and the rest had no wishes. Among those who had a wish to use the medical method 98% received it, 52% received wished surgical method. Information about free choise of method received most of the women. A third of the women that had a medical abortion experienced the pain as unbearable or almost unbearable. The women who had a surgical abortion experienced no pain. Among the women who had received medical abortion 70% would select the method again and 90% would recommend it to others, compared with 48% and 52% among those who hadn´t received the method they wished. Conclusion: More women who used the method that they had wished from the beginning would select the same method and recommend to others than those who didn´t receive the method they wanted. Keywords: Medical abortion, surgical abortion, satisfaction, information

Introduction: During the last decades, the contribution of good nutrition to better results in health care has been emphasised.

Aim: To investigate if a nutritional drink, given seven days before a planned operation to patients undergoing intestinal surgery, can influence the degree of malnutrition and insulin resistance and thereby consequences in the pre and postoperative phases, as compared to when patients did not receive the nutritional drink.

Method: En randomised controlled trial. The data collected using two instruments, a diary together with protocols and a blood test. All together there were 24 patients in the intervention group and 22 patients in the control group.

Results: Pre and postoperative nausea were significantly lower in the intervention group. Nutrition status, assessed as transtyretin values, declined from the point of inclusion to the day of operation in both groups but twice as much in the control group, despite that the latter were more postoperatively more insulin resistance. In the intervention group, clinically postoperative effects could be seen in terms of mobilisation, feelings of well-being, complications and earlier gas releases. There were no clinically or statistically significant differences in length of care or nutrition.

Conclusions: A nutritional drink seven days prior to planned surgery had a positive effect on the pre and postoperative condition of the patients. The study can help the health care personal to realise the importance of patients being well nourished prior to intestinal surgery

which will in turn be of benefit to the patients.

Objective: The objective was to evaluate the short as well as the long-term effects of climate therapy, in a sunny and warm climate, on women with rheumatoid arthritis in terms of physical function, disease activity and pain. Methods: 19 female patients with rheumatoid arthritis who received rehabilitation during four weeks in Tenerife were followed for six months. Physical function was evaluated with shoulder movement impairment, index of muscle function (IMF), submaximal treadmill test and the Swedish version of Stanford health assessment questionnaire (HAQ). Disease activity and pain were evaluated with disease activity score (DAS28), C-reactive protein (CRP) and visual analogue scale (VAS). Results: Immediately after the treatment, there were significant improvements in shoulder function, IMF, HAQ, DAS 28 and pain, but not in submaximal aerobic fitness based on Vo2max or CRP. After three months, the effects were still in evidence in shoulder function, IMF, and HAQ, but not in pain or DAS28. At six months, the only improvement remaining was in IMF. Conclusion: Intensive rehabilitation improved physical function in women with RA for at least three months but the improved disease activity and pain were not maintained.

Objective: The aim of the study was to describe and compare self-reported physical function, disease activity, well-being and physical activity in patients with ankylosing spondylitis with or without regular follow-up by a physiotherapist. Methods: 68 patients answered self-administered questionnaires. Results: 25 patients were followed on a regular basis by a physiotherapist and 43 patients were not followed on a regular basis. The group followed by a physiotherapist reported lower disease activity and higher well-being but worse physical function than the other group did, but the differences between the groups were not significant. There were, however, significantly more patients in the group that was not followed by a physiotherapist who reported sedentary leisure time than in the other group. Background factors such as gender, age, disease duration, education and employment did not differ between the two groups. The group that was followed on a regular basis by a physiotherapist reported a greater amount of physiotherapy and information about physical activity the last year and used more NSAID than the group that was not followed by a physiotherapist. Conclusion: Patients with ankylosing spondylitis should have the possibility to consult a physiotherapist but regular follow-up should be based on a judgement of each individual case. Key words: ankylosing spondylitis, physiotherapy, physical function, disease activity, well-being, physical activity

The aim of this study was to investigate young people´s knowledge of and attitudes towards contraceptives and sexual risk-taking behaviour. The study was qualitative and utilised a focus group methodology. Twenty-seven young people participated. Four homogenous focus groups with 5 to 9 youths in each met and had discussions based upon a guided questionnaire. The participants were males and females in the ninth grade of secondary school and in the third year of high school. The discussions were taperecorded and later transcribed. The material was analysed using qualitative content analyses. The results indicated that the young people knew of several contraceptive methods however they lacked detailed knowledge of those methods. Condoms were considered to be a safe contraceptive method although use of condoms was low. A couple of obstacles to condom use were mentioned. Females took more responsibility for contraception than males. Knowledge about sexually transmitted infections and abortion was deficient. Young people engaged in sexual activity without knowing who their partner was and alcohol was often present in contexts where unprotected sex took place. After unprotected sexual intercourse most females tested themselves immediately for possible infection while males would do so after developing symptoms of infection. Young people were positive to the idea of sexual education in school but felt the information and message had to be engaging and often repeated. Keywords: contraceptive, condom, adolescence, risk-taking behavior, abortion, sexually transmitted infections, sex- education

Aims: To investigate mortality, re-admission, hospital days, and number of primary health care contacts of patients with congestive heart failure in relation to level of care. Methods: The records of 175 patients were reviewed and divided into groups depending on who was responsible for the follow up: a cardiologist, a general practitioner or a nurse-led heart failure clinic. Results: The mortality rate was substantial, 22% during 12 months, and in 13.7% of the cases due to a cardiovascular diagnosis. Mortality was 3.6 % in the nurse-led group, 20% in the cardiologist group, and 27% in the general practitioner group. The mean age of patients was higher in the general practitioner group compared with the other groups. Statistical significant differences between the cardiologists and the other groups occurred concerning the combination of ACE-inhibitors/beta-blockers and diagnosis with echocardiography. Nurses had significantly fewer patients that were treated with diuretics. Patients followed up by the nurse had fewer re-admissions and fewer hospital days than did patients in the other groups. Conclusions: The study indicates that a follow up by a nurse is of substantial value for patients with congestive heart failure. Keywords: Congestive heart failure, heart failure clinics, nursing intervention, primary health care

Syftet var att beskriva hur avdelningschefer och personal vid hematologenheter upplevde att arbeta enligt skyddsisoleringsrutiner samt deras uppfattningar av hur patienter och anhöriga upplever skyddsisolering samt deras behov av kompetens och utbildning inom området.

Sammanlagt 129 personer på 7 hematologiska enheter i Uppsala/Örebro regionen besvarade en enkät. En enkät riktades till avdelningschefer och en till sjuksköterskor och undersköterskor.

Resultatet visade att vårdprogram och riktlinjer finns och följdes helt av 70,5% och ansågs av 70% att det inte var svårt att följa. Majoriteten (82%) såg inte skyddsisoleringsrutiner som ett hinder i kontakten med patienten. Trots detta uppgav en mindre andel (22%) av personalen att de ofta talade med patienten eller dess anhörig (7%) om upplevelsen av att vara skyddsisolerad. Hälften av avdelningscheferna uppgav att de sällan talade med patienter eller anhöriga om deras upplevelse av att vara skyddsisolerad. Både personal och avdelningschefer ansåg att det förekom mer internutbildning i hematologisk vård än i skyddsisolering. Trots det kände sig personalen mer osäker och otrygg i sin hematologiska kompetens.

Research points to the importance of early treatment of acute heart infarction in order to

decrease the mortality and to improve the prognosis. In 1997 two hospitals from two closely

situated cities were consolidated into a common hospital, situated in the largest city. The aim

of this study was to investigate if the fusion of the hospitals influenced the delay times for the

patients in the catchments area, and to describe any differences between city and countryside.

Three data collections were made, one before the fusion, the second one year after and the last

one four years after the fusion. Each data collection included approximately 100 patients with

acute heart infarction who responded to a questionnaire. Data was also collected from the

journals of the respective patients. The second goal was to study if the delay time decreased,

when thrombolytic therapy was initiated pre-hospital compared to in-hospital. This was made

with a retrospective journal review.

The total delay time increased by 15 minutes between 1997 to 2001. In the smaller city, the

delay time increased by 30 minutes and in the surrounding countryside of the larger city the

increase was 52 minutes. The largest change in the patients contact pattern occurred in the

area where the hospital was closed. More people (38%) with chest pain visited the general

practitioner first, than before the fusion (17%) (p=0,042). This increased the time lapse before

they reached the hospital. In the same area transportation by ambulance to the hospital

increased from 68% to 94% (p=0,001), compared with unchanged 60% in that area where no

change of the hospital had occurred. The delay time increased with ascending age of the

patient and this trend was even more pronounced in 2001 compared with 1997 (p=0,040). The

hospital delay time increased in the emergency department from 30 minutes in 1997 to 40

minutes in 2001. The nearness to the hospital has an impact on the delay time, but no

significant differences could be shown, except between the larger city and its surrounding

countryside in 2001, where the difference was 155 minutes (p=0,003). Thrombolytic therapy

initiated pre-hospital decreased the delay by 45 minutes compared with therapy initiated

in-hospital, which showed a significant divergence (p=0,004).

Key words: acute myocardial infarction, pre-hospital delay, thrombolytic therapy

Stroke is the third largest cause of death in Sweden. A major aim of rehabilitation is that persons who have had a stroke should be able, despite reduction of functional abilities, to experience a good life satisfaction. In addition to traditional methods of rehabilitation, various complementary methods are being tested, including massage.

Aim: To investigate the importance of tactile massage for recovery and well being of stroke patients.

Method: A randomised controlled study carried out at a Swedish geriatric clinic, 1998-1999. A total of 35 patients diagnosed with a brain infarction were included, of those 5 were excluded in the first two weeks. Eighteen received tactile massage while 17 formed a control group. The patient’s ADL functions and quality of life according to the Nottingham Health Profile were measured. Medication for pain, lack of sleep, depression, and anxiety were registered up until four weeks after their discharge.

Results: The patients who received tactile massage experienced significantly higher quality of life and improved their ADL functions compared with the control group. The massage group made clear progress in terms of incontinence, movement mobility, and hygiene while the control group improved marginally. The massage group used less medication, in particular for the relieve of pain and depression

Key words: stroke, tactile massage, quality of life, ADL