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<p>En teoretisk kontroll av luftvärnsbataljonens sjukvårdsfunktion</p><p>Syftet med detta arbete är att inom ramen för funktionsmålsättning för Försvarsmaktens hälso- och sjukvård kontrollera om luftvärnsbataljonens sjukvårdsfunktion enligt org. 09 är korrekt dimensionerad.</p><p> Frågeställningen är: När, med hänsyn till grupperingsgeometri, medicinska tidskrav samt evakueringskapacitet blir sjukvårdsfunktionen en begränsande faktor för luftvärnsbataljonen.</p><p> För att svara på detta jämförs luftvärnsbataljonens TOEM med kraven ur funktionsmålsättning för Försvarsmaktens hälso- sjukvård i syfte att kontrollera om sjukvårdsfunktionen ges förutsättning att lösa ställda uppgifter. Vidare analyseras faktorerna, aktionsradie, förlustskadeberäkningar preventiv medicin, samt evakueringskapacitet och grupperingsgeometri.</p><p>Den viktigaste slutsatsen ur arbetet är: Det är inte sannolikt att samtliga enheter inom bataljonen kan åtnjuta möjligheten till adekvat sjukvård inom de tider som de medicinska kraven ställer.</p> / <p>The purpose of this essay is to investigate if the medical function in the Air Defence Battalion is enough.</p><p> The question to be answered in this essay is as follows: When, considering deployment geometry, medical time-demands and evacuation capacity does the medical function become a limiting factor for the AD Battalion?</p><p> A descriptive method is used in this essay. Material has been gathered and analysed to show the limitations of the battalion considering the medical function. A study has also been made. The material and the study are used as a base in the discussion and from the discussion and the results from the analysis, conclusions are drawn.</p><p>One of these conclusions is that: It is not probable that all units in the Air Defence Battalion will receive proper medical attention within the time-span established in the guiding medical documents.</p>

The overall aim of this thesis was to investigate psychosocial consequences of cancer during adolescence, using a longitudinal approach. An additional aim was to investigate if mode of administration has an influence on adolescents’ and young adults’ self-reported psychosocial function. In Study I participants, aged 13-23 years, were randomised according to two modes of administration, telephone interview and postal questionnaire, and asked to complete the Hospital Anxiety and Depression Scale (HADS) and Short Form 36 (SF-36). The telephone mode resulted in a higher response rate, better self-rated psychosocial function (except for the youngest age group), overall lower Cronbach’s alpha values, and a larger percentage of ceiling effects compared to the postal mode. A higher proportion of males than females chose not to participate in the postal mode. In Study II and III adolescents diagnosed with cancer completed the HADS and two sub-scales from the SF-36 (Mental Health and Vitality) 4-8 weeks, 6, 12, and 18 months after diagnosis. In Study II adolescents with cancer were compared to a reference group from the general population. Shortly after diagnosis the cancer group rated their psychosocial function as worse compared to the reference group. However, the differences gradually disappeared over time and were then reversed, resulting in the cancer group reporting better vitality and lower levels of anxiety and depression than the reference group eighteen months after diagnosis. In Study III five distinct psychosocial states were identified, characterised by: psychosocial dysfunction (state A), poor psychosocial function (state B), incomplete psychosocial function (state C), good psychosocial function (state D), and excellent psychosocial function (state E). Shortly after diagnosis more adolescents than expected by chance were found in states A and C and fewer were found in states D and E. Eighteen months after diagnosis a different pattern emerged, where more adolescents than expected were found in state E and fewer than expected in state C. In Study IV adolescents, two years after diagnosis, reported problems with physical impairment, intrusive thoughts, feelings of alienation, and problems catching up with school. However, a majority of the participants also reported positive consequences with regard to the cancer disease: a more positive view of life, good self-esteem, knowledge and experience with regard to disease and hospital care, good relations, broader perspectives, and material gains. Study V, a review of the literature, indicates that survivors of childhood/adolescent cancer do not differ from comparison groups with regard to relations to others and relation to self. However, some findings highlight that friendship and marital status are areas of concern, and parenthood and sexuality are areas of potential concern. In conclusion, mode of administration influences adolescents’ and young adults’ self-reported psychosocial function and is related to age. Psychosocial function increases with time from diagnosis for most adolescents diagnosed with cancer. However, some individuals remain in poor psychosocial states during the first eighteen months after diagnosis. Increased efforts should be taken to identify these individuals.

The general aim of this thesis was to study the transition process from dependency towards anatomy and psychological empowerment among teenagers with type 1 diabetes. Thirty-two teenagers (18 female/14 male) aged 13-17 took part in conversational interviews. The interviews followed a semi-structured question guide. Data comprised 31 tape recorded interviews (one informant did not want to be tape recorded). The research design was based on a phenomenological and life world perspective including two different analysis methods. The transition towards autonomy among teenagers with type 1 diabetes was elucidated in a phenomenological approach (paper I). Through the teenagers’ narratives about their daily life experiences with type 1 diabetes there emerged the over-riding theme “Hovering between individual actions and support of others”. This theme illustrates the main problem related to diabetes management - duality in dependence and independence. The themes “growth through individual self-reliance” and “growth through confirmation of others” seem to facilitate the transition process from dependency towards autonomy. Experiences of the Empowerment Education Programme (EEP) were studied by a qualitative content analysis (paper II). From the teenagers’ descriptions the over-riding theme was formulated as “Sense of community”, and this covered the categories of social fellow feeling, collaborative learning, and community of interests. A synthesis of the findings illustrates that individual self-reliance, confirmation of others, and sense of community are closely related to individual inner resources, trust in others, and the feeling of belonging, which are all suggested as specific goals of empowerment and fulfilment of psychological empowerment. A model was created to explain the relation between psychological empowerment and growth through individual self-reliance, confirmation of others, and sense of community. Professional nursing care might start from the unique situation and context the individual experiences and exists in. Social meetings with like-minded youth were highly appreciated among the teenagers. The teenagers showed their willingness to transform themselves towards becoming more independent in self-management, and the teenage years may be the right period to empower and coach the teenagers towards autonomy and prepare them for adulthood living with type 1 diabetes.

The general aim was to explore philosophy of life, expectations and optimism in patients and spouses in two different cancer situations, and to determine whether these aspects had relevance for psychological distress and quality of life. The first situation was being newly diagnosed with advanced cancer. Data on philosophy of life, optimism and psychological distress were gathered on one occasion (I). In addition, changes in life were described using a qualitative approach in a sub-sample (II). The second situation was having completed curative cancer treatment. Data on expectations for the recovery period, optimism, psychological distress and quality of life were gathered on three occasions (III). Moreover, expectations and how these turned out were described using a qualitative approach in a sub-sample (IV). The results show that being diagnosed with an advanced cancer influenced aspects of patients’ and spouses’ philosophy of life, including that existential questions were common and were related to higher psychological distress (I). All experienced substantial mental changes in life, often also physical, practical and sometimes positive changes. Patients more often seemed to accept their situation and prepared themselves for death, whereas spouses had more difficulties in handling the situation (II). Patients who had completed curative treatment generally had higher expectations for the recovery period than did their spouses, and patients expectations were fulfilled to a lesser degree, however, this generally had little importance for psychological distress or quality of life (III). Patients’ expectation for their recovery period was generally that they would get well. For those whose recovery period had been tough, expectations were often unfulfilled, but they were often satisfied with their current life anyway owing to positive changes (IV). Being optimistic was the most beneficial for decreased psychological distress in both samples, as well as for better quality of life in the recovery group (I, III).

The aim of this thesis was to investigate health-related quality of life (HRQoL) and coping strategies for individuals with ulcerative colitis (UC) or Crohn’s disease (CD), and to study the effect of a group-based patient information on anxiety/depression and HRQoL. HRQoL and anxiety/depression were investigated (n=492) (Study I). In Study II, anxiety/depression, HRQoL, satisfaction with information and evaluation of the patient information were studied (n=49). Coping with disease activity was investigated in 166 patients reporting current exacerbation (Study III). Fifteen patients were interviewed about disease-related stress, how this is managed and the need of support from the health care (Study IV). Patients with UC reported better HRQoL and less anxiety/depression than did patients with CD during both remission and exacerbation. Satisfaction with information had increased at follow-up 6 months after patient information. The information and the possibility to discuss with lecturers and group members were valued as most important. No change was found in anxiety/depression or HRQoL at follow-up. Both problem-focused and emotion-focused strategies were employed to cope with disease activity, with no difference between patients with UC or CD. The urgent need of toilet availability and stress associated to social situations were the major disease-related stressors. This stress was managed by finding out the location of toilets, bringing toilet paper and extra underwear and emptying bowel before an activity. The patients wanted information and possibilities to talk to experienced staff and to other patients about how to live with the disease. This thesis shows that HRQoL for some patients with UC, and primarily for patients with CD, is impaired. Thus medical staff should be observant of the psychosocial well-being of patients with CD and also of patients with relapse. Methods to identify and support patients with anxiety/depression and poor HRQoL need to be developed. Interventions should target the patient’s specific problems and at appropriate times.

The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.

This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment. The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n1 = 215 and n2 = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity. The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment. The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.

The aim of this thesis is to investigate attitudes to functional foods (here defined as foods with health claims) among Swedish consumers and health-care professionals. The aim is also to survey demographics and health interests associated with the consumption of functional foods among Swedish consumers. Finally, the aim is to investigate health-care professionals’ knowledge of and willingness to recommend functional foods to patients. Examples of functional foods used in the studies are probiotic fruit-drinks, probiotic milk-products, cholesterol-lowering spreads and fibre-rich bread with omega-3 fatty acids. Ten focus groups of consumers and three of health-care professionals were conducted. Two questionnaires were also used, one for consumers aged 17-75 years (n=2000) and one for health-care professionals (dieticians, n=100; registered nurses, n=200; physicians, n=200). Almost half of the consumers (48%) and exactly half (50%) of the health-care professionals responded. The consumers wondered whether the functional foods were normal foods or medicines. They considered functional foods unnecessary, unless you suffer from incurable diet-related problems. The consumers were worried that the foods could be used as a compensation for an unhealthy lifestyle. While the consumers in the focus groups were mainly sceptical towards functional foods, these foods are being consumed by those who perceive them as necessary, the health-conscious, the well-educated and people who have noticed effect of the foods. The registered nurses and physicians, in contrast to the dieticians, expressed doubts regarding the claimed effects of the functional foods. The dieticians rated higher knowledge and were more willing to recommend functional foods to patients than were the physicians and, to some extent, the registered nurses. The interviews with the health-care professionals revealed that the dieticians were more positive towards functional foods than the registered nurses and, primarily, the physicians. This was confirmed through the questionnaire. Those, who consumed functional foods, reported high knowledge, and perceived benefits of functional foods, were most likely to recommend these foods to patients.