Introduktion: Barncancer är ett samlingsnamn på en grupp av cancerformer som drabbar barn och ungdomar. Varje år drabbas ungefär 350 barn i Sverige. Att drabbas av cancer som barn är en traumatisk upplevelse som påverkar alla aspekter av livet. Sjukdomen påverkar inte bara barnet, utan familjen som helhet drabbas. För föräldrarna innebär det en omställning med emotionella och sociala anpassningar. Sjuksköterskan har en viktig roll i omhändertagandet av hela familjen. Syfte: Syftet är att undersöka föräldrars upplevelser av att ha ett barn med en cancersjukdom som genomgår behandling. Metod: En litteraturstudie med deskriptiv design användes. Tolv kvalitativa studier från PubMed eller CINAHL har granskats. Studierna analyserades med utgångspunkt i en artikel av Popenoe och medarbetare.   Resultat: Av analysen framkom tre kategorier: När världen vänds upp och ner, Obalans i vardagen och Någonting gott av det tillslut samt nio underkategorier. Föräldrarna beskrev en känslomässig påverkan som innefattade chock, rädsla, oro, ångest, skuld och hjälplöshet under barnets behandling. Då sjukdomen resulterade i ensamhet, oro för ekonomin och svåra påfrestningar upplevdes även en obalans i vardagen. Trots utmaningar och känslomässiga svårigheter beskrev föräldrarna även positiva upplevelser av sjukdomen. Detta beskrevs som trygghet i form av stöd, förbättrade relationer eller ny syn på livet. Slutsats: Föräldrarna till barn med en cancersjukdom upplever förändringar i livet, från chock och rädsla till obalans och påfrestningar i vardagen. Trots utmaningarna kan de uppleva trygghet, nya perspektiv eller förbättrade relationer. Examensarbetet belyser vikten av att arbeta familjefokuserat och att sjuksköterskans har en betydande roll gällande stöd till familjen. / Introduction: Childhood cancer is a collective name for a group of cancer forms that affect children and adolescents. Approximately 350 children in Sweden are diagnosed each year. Being diagnosed with cancer as a child is a traumatic experience that affects all aspects of life. The disease not only affects the child, but also has an impact on the entire family. For the parents, it means significant adjustments with emotional and social adaptations. The nurse has an important role in caring for the whole family.  Aim: The aim is to investigate parents' experiences of having a child with a cancer disease undergoing treatment. Method: A literature review with descriptive design was used. Twelve qualitative studies from PubMed or CINAHL have been reviewed for the results. The studies were analyzed based on an article by Popenoe and colleagues. Results: Three categories emerged from the analysis: when the world turns upside down, imbalance in everyday life and finding something good in it eventually, along with nine subcategories. The parents experienced a significant emotional impact such as shock, fear, worry, anxiety, guilt and helplessness during their child's treatment. An imbalance in everyday life was also experienced as the disease resulted in loneliness, financial worries and severe strains. Despite challenges and emotional difficulties, a number of parents also experienced positive aspects of the disease. This was described as security in form of support, improved relationships and a new outlook on life.  Conclusion: The parents of children with a cancer disease experienced a variety of changes in life, from shock and fear to imbalance and stress in everyday life. Despite many challenges, they experienced safety, new perspectives, and improved relationships. The thesis emphasizes the importance of working with a family-focused view and the nurse's significant role in supporting the family.

Yes / Purpose – The purpose of this paper is to perform a systematic review of articles that have used the unified theory of acceptance and use of technology (UTAUT). Design/methodology/approach – The results produced in this research are based on the literature analysis of 174 existing articles on the UTAUT model. This has been performed by collecting data including demographic details, methodological details, limitations, and significance of relationships between the constructs from the available articles based on the UTAUT. Findings – The findings indicated that general purpose systems and specialized business systems were examined in the majority of the articles using the UTAUT. The analysis also indicated that crosssectional approach, survey methods, and structural equation modelling analysis techniques were the most explored research methodologies whereas SPSS was found to be the largely used analysis tools. Moreover, the weight analysis of independent variables indicates that variables such as performance expectancy and behavioural intention qualified for the best predictor category. Moreover, the analysis also suggested that single subject or biased sample as the most explored limitation across all studies. Research limitations/implications – The search activities were centered on occurrences of keywords to avoid tracing a large number of publications where these keywords might have been used as casual words in the main text. However, we acknowledge that there may be a number of studies, which lack keywords in the title, but still focus upon UTAUT in some form. Originality/value – This is the first research of its type which has extensively examined the literature on the UTAUT and provided the researchers with the accumulative knowledge about the model.

Yes / The extended unified theory of acceptance and use of technology (UTAUT2) is less than ten years old and has already garnered more than 6,000 citations with extensive usage in information systems and beyond. This research employed cited reference search to systematically review studies that cited UTAUT2 originating article. Based on UTAUT2 usage, the downloaded articles were classified into four categories such as: 1) General citation, 2) UTAUT2 application, 3) UTAUT2 integration, and 4) UTAUT2 extensions. Weber's (2012) theory evaluation framework revealed UTAUT2 as a robust theory on most dimensions except for parsimony arising from the complex model. UTAUT2 extensions emerged as popular UTAUT2 utilization category as researchers extended the model with context specific variables. Finally, UTAUT2 extensions were mapped to Johns' (2006) context dimensions to identify various limitations of the existing technology adoption research and to provide multi-level framework for future researchers with libraries of context dimensions.

No / The objective of this article was to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies. The search strategy yielded 583 unique articles including 5 randomized controlled trials. Compared with control, meta-analysis showed that participants in the intervention group had: a 0.8-point reduction in pain intensity on a 0 to 10 numerical rating scale at 3 months [95% confidence interval (CI), -1.28 to -0.36] and a 0.7-point reduction (95% CI, -1.19 to -0.20) at 6 months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0- to 68-point function subscale of Western Ontario and McMaster Universities Osteoarthritis Index at 3 and 6 months, respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect." Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management.

Yes / People with dementia or mild cognitive impairment (MCI) and their family carers face challenges in managing medicines. How medicines self-management could be supported for this population is unclear. This review identifies interventions to improve medicines self-management for people with dementia, MCI and their family carers, and which core components of medicines self-management they address. Methods A database search was conducted for studies with all research designs and ongoing citation searches from inception to December 2021. Selection criteria included community dwelling people with dementia and MCI and their family carers, and interventions with a minimum of one medicine self-management component. Exclusion criteria were wrong population, not focusing on medicines management, incorrect medicines self-management components, not in English and wrong study design. Results are presented and analysed through narrative synthesis. The review is registered [PROSPERO (CRD42020213302)]. Quality assessment was carried out independently applying the QATSDD quality assessment tool. Results Thirteen interventions were identified. Interventions primarily addressed adherence. A limited number focused on a wider range of medicine self-management components. Complex psychosocial interventions with frequent visits considered the person’s knowledge and understanding, supply management, monitoring effects and side-effects and communicating with healthcare professionals; and addressed more resilience capabilities. However, these interventions were delivered to family carers alone. None of the interventions described patient and public involvement. Conclusion Interventions, and measures to assess self-management, need to be developed which address all components of medicines self-management, to better meet the needs for people with dementia and MCI and their family carers.

Reliability generalization (RG) is a method for meta-analysis of reliability coefficients to estimate average score reliability across studies, determine variation in reliability, and identify study-level moderator variables influencing score reliability. A total of 107 peer-reviewed RG studies published from 1998 to 2013 were systematically reviewed to characterize the meta-analytic methods employed and to evaluate quality of reporting practice against standards for transparency in meta-analysis reporting. Most commonly, RG studies meta-analyzed alpha coefficients, which were synthesized using an unweighted, fixed-effects model applied to untransformed coefficients. Moderator analyses most frequently included multiple regression and bivariate correlations employing a fixed-effects model on untransformed, unweighted coefficients. Based on a unit-weighted scoring system, mean reporting quality for RG studies was statistically less than that for a comparison study of 198 meta-analyses in the organizational sciences across 42 indicators; however, means were not statistically significantly different between the two studies when evaluating reporting quality on 18 indicators deemed essential to ethical reporting practice in meta-analyses. Since its inception a wide variety of statistical methods have been applied to RG, and meta-analysis of reliability coefficients has extended to fields outside of psychological measurement, such as medicine and business. A set of guidelines for conducting and reporting RG studies is provided.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13599号 / 論医博第2309号 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 西浦 博 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Flexion distraction chiropractic technique (FDCT) is a commonly used manual therapy technique which is purported to address various clinical pain syndromes. However, it lacks the credibility of appropriate evidence-based guidelines. An analysis of the literature would be able to inform the development of guidelines. Objectives: The aim of this systematic review was to determine the evidence to support the use of FDCT in clinical practice. Data sources: A systematic review of PubMed and Summons was conducted, using the following search terms: chiropractic, flexion distraction, protocol and / or technique. Study selection: All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction: Blinded review of the articles was conducted by three independent reviewers utilising the PEDro (for randomised controlled trials) and NOS for (non-randomised controlled trials). This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for FDCT. Data synthesis: 18 review outcomes were aggregated around four clinical categories; two articles each on neck pain, chronic pelvic pain, and physiological outcomes and the remaining twelve on low back pain. There was agreement that the evidence for pelvic pain and physiological function was limited to no evidence and limited respectively. Conflicting evidence existed for neck and low back pain (single and multimodal treatment) with limited and moderate evidence respectively. Conclusion: FDCT is clinically advocated for many conditions. The evidence provided in this review indicates that practitioners should be guarded in their use of FDCT, as the evidence to its widespread use is limited to only those conditions noted in this review. Therefore, further high quality and rigorous studies are required to develop appropriate treatment guidelines for use by practitioners to adequately provide evidence based care in clinical practice.

Background: Breast cancer is the most frequently diagnosed cancer and a leading cause of cancer death among females, both worldwide and in the UK. Although, UK incidence of breast cancer is rising, breast cancer mortality rates are falling, due largely to early detection and improved treatment. As a result there are more women living with a diagnosis of breast cancer than ever before. Due mainly to side-effects of adjuvant therapy, breast cancer patients may require diagnostic, therapeutic, supportive or palliative services many years post-diagnosis, which poses a major challenge to already stretched healthcare services. Accordingly, effective and inexpensive interventions that can alleviate treatment side-effects, improve health, quality of life and potentially reduce risk of early mortality are required for breast cancer patients. Awareness of the positive influence that physical activity can have on breast cancer development and outcome is an important determinant of physical activity levels. A higher level of physical activity before and after breast cancer diagnosis is related to a lower risk of all-cause and breast cancer-related mortality. Randomised controlled trials have reported beneficial effects of physical activity interventions on outcomes relating to health, quality of life and mortality risk among breast cancer survivors. Aims: The present project aimed to: 1) assess awareness of the role of physical activity on breast cancer risk and the sufficiency of physical activity undertaken in women attending the NHS breast screening programme (NHSBSP), 2) compare physical activity levels of women at different stages of breast cancer pathway, 3) investigate the effects of a low-cost six-month home-based physical activity intervention on physical activity, body mass, health-related quality of life (HRQoL), insulin resistance and blood lipid profiles of breast cancer survivors and 4) assess the effects of our home-based intervention on cardiorespiratory fitness in a subset of breast cancer survivors. Methods: A total of 309 volunteers (188 NHSBSP attendees, 41 breast cancer patients undergoing chemotherapy and 80 post-treatment breast cancer survivors) participated in the current project. Physical activity was assessed via the International Physical activity Questionnaires (IPAQ). In studies one and two, Body mass and body mass index (BMI) were assessed directly in chemotherapy patients and breast cancer survivors, and indirectly from self-reported values in NHSBSP attendees. While in study three, body fat percentage was measured via bioelectrical impedance analysis, HRQoL was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire and fasting blood samples were taken to measure lipid, glucose and insulin concentrations at baseline and post-six month home-based physical activity intervention. In study four, a random subsample of 32 breast cancer survivors undertook an exercise tolerance test to establish peak oxygen uptake values. Results: A high proportion (70%) of NHSBSP attendees engaged in low-moderate levels of physical activity and performed low amounts of recreational physical activity. Attendees demonstrated high awareness (75%) of the role of physical activity in reducing breast cancer risk but those categorised as “low activity” were significantly unaware of insufficiency of activity (p<0.05). Chemotherapy patients and breast cancer survivors had significantly lower levels of total physical activity than NHSBSP attendees (p<0.001 and p<0.05, respectively). The randomised controlled trial revealed significant improvements in total physical activity, body mass (p<0.05), BMI (p<0.05) HRQoL (breast cancer subscale, p<0.01; trial outcome index, p<0.05) and total (p<0.01) and low-density lipoprotein (p<0.05) cholesterol concentrations in the intervention group compared to usual care, and significant improvements in cardiorespiratory fitness (p<0.05) in a subsample of breast cancer survivors allocated to intervention. Conclusions: Physical activity interventions that incorporate strategies aimed at increasing awareness of recommended physical activity guidelines may be required in populations at risk of breast cancer. A relatively large proportion of women at risk of breast cancer may not be sufficiently exposed to the potential benefits of physical activity on breast cancer outcomes. Post-treatment breast cancer patients may be more receptive to physical activity interventions as the negative effects of chemotherapy begin to resolve, and therefore, may benefit from physical activity interventions. Results suggest that a low-cost home-based physical activity intervention with counselling and telephone support can improve the health and HRQoL of breast cancer survivors, which may in turn potentially reduce risk of breast cancer and cardiovascular disease-related mortality. Given the encouraging results and its highly portable and feasible nature, our intervention represents a promising tool for use in health and community settings to benefit large numbers of breast cancer survivors. The current project supports the inclusion of physical activity promotion as an integral component for the management and care of breast cancer survivors.