The Baby-boom generation, a major contributor to an unprecedented increase in older-aged people, is known for its zest for life and autonomy. Boomers are predicted to enter nursing homes in record numbers with multiple chronic illnesses and person-centered health care expectations. The purpose of this work was to describe current chronic illness management practices in nursing homes focused on person-centered (resident-directed) care and involvement of residents in health-related decision-making and self-care activities. Four projects were undertaken to accomplish this objective: (1) a systematic review of the quantitative literature regarding the management of type 2 diabetes, an exemplar chronic illness; (2) a synthesis of the qualitative literature describing chronically ill, older-aged adults' perceptions of chronic illness care decision-making; (3) an ethnographic pilot study describing the meaning of having type 2 diabetes to nursing home residents; and (4) a qualitative descriptive study of secondary data describing nursing home stakeholder perceptions of opportunities for resident involvement in chronic illness decision-making and self-care activities. Wagner's Chronic Care Model, modified for the nursing home, was the sensitizing framework for this research. Twenty studies met criteria for the systematic review, which described a lack of adherence to clinical practice guidelines and rare inclusion of the resident and family in management practices. The synthesis of 7 qualitative studies revealed 4 themes: (1) Being recognized because I matter; (2) Awareness of importance; (3) Empower through connections and opportunities; and (4) Time is precious. Cognitively capable older-aged adults described benefits from involvement in health care decisions and harm from non-involvement. They perceived inadequate time spent with health care providers as a major determinant of involvement. The pilot ethnography included 3 residents. Findings revealed a perception of few diabetes management choices but many unspoken resident preferences. The qualitative descriptive secondary analysis study included 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Stakeholders perceived many opportunities for resident involvement in decision-making and self-care, but described as many limitations. Findings indicated a shortage of health care providers and differing stakeholder ideas of purpose and goals restricted resident involvement. Clinical, research, and policy implications were discussed. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Chronic myeloid leukaemia (CML) is a haematological malignant disease involving haematopoietic stem cells. It is caused by a known reciprocal chromosomal t(9;22)(q34;q11) translocation, or known as Philadelphia chromosome. The translocation results in the formation of a chimeric BCR-ABL fusion gene. In the most recent guidelines published by NCCN and European LeukemiaNet in 2013, tyrosine kinase inhibitors (TKI) specifically inhibiting the Bcr-Abl tyrosine kinase, are the first-line therapy for patients with chronic phase CML. Imatinib is the oldest among the 3 TKI, and is the most commonly prescribed. Despite its proven therapeutic role in CML, imatinib is a drug of extreme high cost. Estimated annual drug cost is HKD$223,380for a standard 400mg adult daily dose. Therefore, this study aims to survey on the prescribing pattern of imatinib in CML patients, its funding status, response; and estimate its economic burden on the Hong Kong population. Methodology: This is a retrospective patient chart review study. All patients who were diagnosed with CML from 2003 to 2012 and were managed in QMH or QEH were reviewed. Electronic records were retrieved to see whether imatinib was started as first-line treatment within 6 months of diagnosis. The reasons for not initiating imatinib were also investigated. Patients’ response to imatinib, and funding source for the drug, were documented. Annual drug cost of imatinib was estimated from all CML patients who attended all Hospital Authority institutions in 2012 who were prescribed with the drug. Results: Total 153 patients from the 2 institutions were reviewed. One hundred twenty four (81%) of them started imatinib as first-line therapy within 6 months of diagnosis. Nine patients started second generation TKI as first-line. Among those who did not start TKI, the most common reasons are patient preference (3.9%) and financial difficulties (3.3%). Twelve paediatric patients are identified, and all but one of them started imatinib. Seventy one% patients on imatinib experienced side effects. Most frequently reported adverse reactions are thrombocytopenia, oedema and neutropenia. Twenty eight% switched to second generation TKI due to suboptimal response or intoleranceto imatinib. During their course of treatment, 46.3% patients on imatinib require social subsidy from Samaritan Fund. From the dispensing records, the average drug cost per patient per year is HK$113,902. The estimated annual cost burden on the whole Hong Kong population is HK$43,425,878. Conclusion: The prescribing rate of imatinib in chronic phase CML patients in Hong Kong is comparable to overseas prescribing rate. The drug has become a significant financial burden to patients’ family and the society as a whole. / published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Medical Sciences

Introduktion: Sjuksköterskor idag står inför en växande patientgrupp med diabetes, som har svårläkta fotsår. Patienterna finns i alla vårdformer som primärvård, specialistvård och kommunal hälso- och sjukvård. För att patienten ska kunna upprätthålla en god livskvalitet och ett bra socialt liv krävs det en säker och snabb sårläkning. Syfte: Arbetets syfte var att beskriva vad som påverkar sårläkning hos patienter med diabetes och svårläkt fotsår, vid undertrycksbehandling. Metod: Denna litteraturstudie har utgått ifrån Polit och Becks (2012) niostegsmodell. Sökningarna har gjorts i CINAHL och PubMed. Kvalitetsgranskning gjordes som resulterade i tio kvantitativa vetenskapliga artiklar. Artiklarnas resultatdel analyserades och grupperades utifrån syftet och efter gemensamma områden.  Resultat: Resultatet i litteraturstudien delades in i två kategorier: sårstatus och behandlingstid. I resultatet framkom att undertrycksbehandling sågs som mer effektiv behandlingsmetod än konventionell fuktighetsbevarande sårbehandling. Volym och sårdjup minskade mer effektivt vid undertrycksbehandling än med konventionell fuktig sårbehandling. Slutsats: Litteraturstudien visar att undertrycksbehandling kan bidra till snabbare sårläkning hos diabetiker med svårläkt fotsår. Alla studier valde mätvärden som storlek, djup och typ av vävnad för att beskriva sårstatus. Behandlingstiden varierade i studierna. Det visade sig även att det vetenskapliga underlaget var begränsat.

The Obstructive Lung Disease in Northern Sweden study's (OLIN) overall aim is prevention of obstructive airways diseases; asthma, chronic bronchitis and chronic obstructive pulmonary disease (COPD). The first part of the OLIN study was a cross- sectional study in three phases, which aimed to estimate the prevalence obstructive lung diseases and to collect data on possible determinants of diseases. This thesis is based on the first part of the OLIN study, and on a postal survey mainly performed in order to evaluate the external validity of the first part of the project Aims: * To assess the prevalences of asthma, chronic bronchitis and respiratory symptoms in adults. * To compare the influence of various diagnostic criteria on prevalence. * To identify subjects with obstructive lung diseases, in particular asthma, for case-referent and prospective longitudinal studies. * To examine whether the trend towards an increase in the prevalence of asthma persists. * Study factors that may influence the development of obstructive lung diseases; age, gender, smoking habit, occupation, socio-economic group, population density and area of domicile. The first part of the OLIN study consisted of three phases. A postal questionnaire regarding respiratory symptoms and diseases, smoking habit and profession was sent to all subjects aged 35-36 y, 50-51 y and 65-66 y (n=6,610) living in eight representative areas of Sweden's northernmost province; 86% completed the questionnaire. Those reporting symptoms suspicious of asthma or chronic bronchitis (n=l,340), together with a stratified sample (n=315) of those not suspected of having the diseases according to the postal questionnaire, were invited to structured interviews and lung function tests. The prevalence of asthma, 5- 6% according to both the postal questionnaire and to the structured interview, prompted a validity study, which included bronchial provocation tests. While the prevalence remained unchanged, the validity study better identified the subjects with asthma and chronic bronchitis, thus improving the representativeness of the subjects with the diseases. In 1992, the study base was expanded by a postal questionnaire study which included 20/489 subjects 20-69 y in order to assess whether the prevalence had changed, to create possibilities to estimate the incidence, and to be better able to detect determinants of diseases. The results show that the prevalence of asthma in adults in 1992 was 7-8% according to postal questionnaire and was considerably higher, approximately 10%, in young adults. Further, the prevalence of asthma in 1986-1987 in subjects aged 35-36 y, 50-51 y and 65-66 y was 5% by using a combination of epidemiological and clinical methods. Various operational criteria yielded a prevalence of 4-7%. Between 1986 and 1992 the prevalence of asthma in these age groups increased with 1% according to the postal questionnaire. Chronic bronchitis in subjects aged 35-36 y was 3% in 1986-1987. The prevalence of chronic bronchitis increased with age, particularly in men. The mean prevalence in the three age groups 35-36 y, 50-51 y and 65-66 y was 12% in men and 8% in women. Chronic bronchitis was strongly associated with smoking, age and a family history of obstructive airways disease. Regarding socioeconomic group chronic bronchitis was related to manual workers in industry and to self- employed other than professionals, and it was particularly common in miners and in those employed in agriculture. The strongest risk factor for asthma was a family history of asthma, and asthma was more common in manual workers in service, in non-manual assistant employees as well as in farmers. The results also indicate the presence of an urban factor in asthma in northern Sweden, in spite of the fact that respiratory symptoms in general tended to be more common in the colder interior of the province compared with the coastal area. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 7 uppsatser</p> / digitalisering@umu

ABSTRACT Asthma exemplifies a major medical concern and is a considerable cause of morbidity and mortality in Western society. Controversy still exists regarding the most effective mode and intensity of exercise training for asthmatics. Thus, the purpose of the study was to determine whether walking or jogging at 60% of age-predicted heart rate maximum can increase effort-dependent pulmonary function parameters in moderate, persistent asthmatics. Forty-four sedentary asthmatics were randomly assigned to either a non-exercising control (NE) group (n = 22) or an eight-week moderate-intensity aerobic exercise (AE) group (n = 22). Results indicated that the subjects in the AE training group significantly (p = 0.05) increased their forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV) and inspiratory vital capacity (IVC). The NE group did not exhibit any significant changes in any of the measured variables. Therefore, walking or jogging at 60% heart rate maximum for 30 minutes three times a week for eight weeks can effectively improve the effort-dependent pulmonary parameters in moderate, persistent asthmatics. This represents a strong argument to support the inclusion of this mode of aerobic training in the treatment of moderate, persistent asthma due to its effectiveness, inexpensiveness and lowrisk.

Objectives: Theoretical models have helped conceptualise how individuals appraise and make sense of chronic illness and its psychological impact. Little attention has been given to the impact of uncertainty on this process. The objective was to investigate the relationship between levels of uncertainty, illness representations, coping, psychological and physical functioning in two chronic illnesses. The Self-Regulatory Model (SRM, Leventhal, Meyer & Nerenz, 1980) was used as a theoretical framework. Design: A cross-sectional design was used. It was hypothesised that a clear medical diagnosis would reduce levels of uncertainty and increase illness representations regarding control of symptoms. It was also hypothesised that high levels of uncertainty would independently predict increased psychological distress. Method: Patients suffering from chronic spinal pain and rheumatoid arthritis were recruited from local clinical departments. The levels of uncertainty, illness representations, coping strategies, mood and physical functioning of 85 participants were assessed using standardised questionnaires. Results: Chronic pain patients were found to have greater levels of uncertainty and psychological distress than rheumatoid arthritis patients. Rheumatoid arthritis patients had stronger beliefs about control of their condition. Uncertainty was not found to be a significant independent predictor of anxiety or depression. However, there appeared to be a degree of overlap between the variables of uncertainty and control beliefs. Conclusions: The findings highlight a complex relationship between the aspects of the SRM and uncertainty, with many components impacting on each other. Although levels of uncertainty were not found to be predictive of psychological distress, it is an area that warrants further investigation in order to understand how patients manage uncertainty. Within a clinical setting, issues of uncertainty should be addressed at all levels of care, maximising the patient's control beliefs, reducing the impact of uncertainty on their cognitive, emotional and physical functioning.

This paper explores chronic health issues as it relates to baby boomers and their use of digital technology. After considering how baby boomers use mobile devices and Internet technologies and what types of information they seek out within these platforms, further examination is done on health related topics such as healthcare, health literacy, and chronic health conditions. In recognition of baby boomers' likely development of one chronic condition or multiple occurring ones (known as comorbidity), three new health technologies are analyzed based on their ability to help individuals manage their chronic conditions. From these three technologies, smart pills, the Health Journal for Pain, and lx Conversations, individual marketing plans are recommended according to how they will benefit baby boomers in regards to better self health management in later adulthood years. / text

published_or_final_version / Medicine / Master / Doctor of Medicine

published_or_final_version / Statistics / Master / Master of Philosophy