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Objectives: To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience., Methods: A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale., Results: Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'., Conclusion: The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement., Main Messages: • Assessing radiographers' clinical competencies is fundamental for ensuring professional standards. • Most competencies received high ratings both in the nursing and in the radiographic dimensions. • The highest rated competencies focussed on information and adaptability to the patients needs. • The lowest rated competencies focussed on encountering the patient in shock and image assessments. • Age, years in present position and work place only explained a relatively small part of competency.

The aim of this study was to investigate sleep, television and computer habits and enjoyment and feelings of tiredness in school of school-age children and adolescents in Sweden. An instrument found to be valid and reliable here was distributed to 3,011 children aged 6, 7, 10, 14, and 16 years. Those sleeping less than the median length of time reported a significantly lower degree of enjoyment of school. Short sleep was found to be associated with having a bedroom TV, spending more than 2 hr a day at the TV or the computer, being tired in school, and having difficulties both in waking up and in sleeping. Discussing sleep and media habits with schoolchildren and their parents regarding matters of optimal sleep and of how media habits affect sleep and learning is seen to be an important task of the school health service.

Background: While the work situation for nurse assistants in residential care is strenuous, they themselves often state that they are satisfied with their job. More knowledge is clearly needed of the interrelationship of variables associated with job satisfaction. This study aims to investigate job satisfaction and explore associated variables among nurse assistants working in residential care., Methods: A total of 225 respondents completed a questionnaire measuring general job satisfaction, satisfaction with nursing-care provision and measures concerning person-centered care, work climate, leadership, and health complaints. Job satisfaction was the outcome measure and comparisons were made among those reporting low, moderate, and high levels of job satisfaction; multiple regression analyses were used to explore associated variables., Results: The caring climate and personalized care provision were associated with general job satisfaction. High levels of satisfaction with nursing-care provision were also associated with the general work climate, organizational and environmental support, and leadership. Low job satisfaction was mainly associated with health complaints., Conclusions: Nurse assistants working in a positive work climate, caring climate, with a positive attitude to their leaders, who receive organizational and environmental support, provide person-centered care and experience a higher degree of job satisfaction. It seems essential, however, to include both general and context-specific measures when investigating job satisfaction in this field as they reveal different aspects of the nurse assistant's work situation.

Aim: With fast track surgery and shorter hospital stay, discharge from hospital after cancer surgery is becoming more challenging for the individual patient. The aim of this study was to explore how patients perceive information after surgery for colorectal cancer, what their information needs are and to determine factors affecting received information., Method: A hundred patients filled in the questionnaires QLQ-C30, CR38 and INFO25 created by the European Organization for Research and Treatment of Cancer, the Eastern Cooperative Oncology Group (ECOG) instrument and the SOC (sense of coherence) instrument and provided written comments within the first 2 weeks after discharge following surgery for colorectal cancer. The questionnaires were analysed using hierarchical cluster analysis and a multiple linear regression analysis. The written comments were analysed using content analysis., Results: In all, 49% of the patients expressed a need for more information. In the written comments they specified these areas of information: they lacked information concerning their surgery, how to handle symptoms and problems at home, someone to contact after discharge and prognostic information about their future. Patients reported most received information in areas of medical tests and disease but less on other services and support in outpatient care. The variation in INFO25 was best explained by gender (P = 0.045) and preoperative health status (American Society of Anesthesiologists score 3, P = 0.022)., Conclusion: The results from this study indicate that women and patients with a poorer preoperative health status scored less on information received and would need more time and support to prepare for discharge. The patients expressed a desire for more information about the surgery, how to handle symptoms at home and prognostic information about their future., (© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.)

The rotational band structure of the Z=104 nucleus (256)Rf has been observed up to a tentative spin of 20ℏ using state-of-the-art γ-ray spectroscopic techniques. This represents the first such measurement in a superheavy nucleus whose stability is entirely derived from the shell-correction energy. The observed rotational properties are compared to those of neighboring nuclei and it is shown that the kinematic and dynamic moments of inertia are sensitive to the underlying single-particle shell structure and the specific location of high-j orbitals. The moments of inertia therefore provide a sensitive test of shell structure and pairing in superheavy nuclei which is essential to ensure the validity of contemporary nuclear models in this mass region. The data obtained show that there is no deformed shell gap at Z=104, which is predicted in a number of current self-consistent mean-field models.

Objectives: The aim of the study was to further psychometrically evaluate the instrument "Pain Impact Inventory" (PII) in various subgroups., Methods: The sample comprised 384 persons (aged between 18 and 102 years) who reported chronic pain. The instrument PII was evaluated in terms of construct validity as well as reliability. The instrument's validity was investigated through corrected item-total correlation, floor and ceiling effects, and item response rate. Reliability was assessed by means of test-retest (with a 2-week interval) and Cronbach's alpha. All analyses were performed in various subgroups, men and women, as well as in 6 different age-groups and 5 primary pain location., Results: The result showed an item-total correlation above 0.30 for all items in all subgroups with exception for the 2 items in F5 in the age-group, 30 to 44. In the test-retest analysis, all kappa coefficients in the test-retest analysis were significant (P < 0.001) and varied between 0.482 and 0.879. The alpha values for factor 1 to 4 ranged between 0.80 and 0.94. Alpha values below 0.7 were only found for F5., Conclusion: The PII showed satisfactory psychometric properties in terms of construct validity and reliability with regard to gender, age-groups, and primary pain location., (© 2011 The Authors. Pain Practice © 2011 World Institute of Pain.)

Rationale, Aims and Objectives: Studies have challenged the validity and underlying measurement model of the physical and mental component summary scores of the 36-item Short-Form Health Survey in, for example the elderly and people with neurological disorders. However, it is unclear to what extent these observations translate to physical and mental component summary scores derived from the 12-item short form (SF-12) of the 36-item Short-Form Health Survey. This study evaluated the construct validity of the SF-12 in elderly people and people with Parkinson's disease (PD) and stroke., Methods: SF-12 data from a general elderly (aged 75+) population (n = 4278), people with PD (n = 159) and stroke survivors (n = 89) were analysed regarding data quality, reliability (coefficient alpha) and internal construct validity. The latter was assessed through item-total correlations, exploratory and confirmatory factor analyses., Results: Completeness of data was high (93-98.8%) and reliability was acceptable (0.78-0.85). Item-total correlations argued against the suggested items-to-summary scores structure in all three samples. Exploratory factor analyses failed to support a two-dimensional item structure among elderly and stroke survivors, and cross-loadings of items were seen in all three samples. Confirmatory factor analyses showed lack of fit between empirical data and the proposed items-to-summary measures structure in all samples., Conclusions: These observations challenge the validity and interpretability of SF-12 scores among the elderly, people with PD and stroke survivors. The standard orthogonally weighted SF-12 scoring algorithm is cautioned against. Instead, when the assumed two-dimensional structure is supported in the data, oblique scoring algorithms appear preferable. Failure to consider basic scoring assumptions may yield misleading results., (© 2011 Blackwell Publishing Ltd.)

The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.

The aim of this study was to investigate healthcare utilization patterns over a six-year period among older people (60+), classified as dependent/independent in Activities of Daily Living (ADL) and/or at/not at risk of depression and to identify healthcare utilization predictors. A sample (n=1402) comprising ten age cohorts aged between 60 and 96 years was drawn from the Swedish National study on Aging and Care (SNAC). Baseline data were collected between 2001 and 2003. Number and length of hospital stays were collected for six years after baseline year. Group differences and mean changes over time were investigated. Healthcare utilization predictors were explored using multiple linear regression analysis. The results revealed that 21-24% had at least one hospital stay in the six years after baseline, 29-37% among ADL dependent subjects and 24-33% among those at risk of depression. There was a significant increase of hospital stays in all groups over time. ADL-dependent subjects and those at risk of depression had significant more hospital stays, except for those at/not at risk of depression in years 2, 4 and 5. The healthcare utilization predictors 5-6 years after baseline were mainly age, previous healthcare utilization and various symptoms and, in 1-2 and 3-4 years after baseline, age, various diagnostic groups and various physical variables. Thus healthcare utilization patterns seem to be similar for the different groups, but it is difficult to find universal predictors. This suggests that different variables should be considered, including both ADL and psychosocial variables, when trying to identify future healthcare users., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The aim was to develop a new instrument for measuring length of sleep as well as television and computer habits in school-age children. A questionnaire was constructed for use when children visit the school health care unit. Three aspects of the validity of the questionnaire were examined: its face validity, content validity, and construct validity. Test-retest reliability was assessed by giving the questionnaire twice, 2 weeks apart, to the respondents. The questionnaire was assessed as being reasonably valid, the test-retest results (n = 138) showing 90.4% of the estimates regarding bedtime on weeknights on the two survey occasions to lie within ± 30 min of each other, the test-retest agreement also being rather close (κ > .600) regarding both sleep and media habits. The instrument can be a valuable tool in a clinical setting, both for measuring sleep habits in a class and for discussing sleep with individual school children and their families.

Aerosol samples have been studied under different background conditions using gamma-ray coincidence and low-background gamma-ray singles spectrometric techniques with High-Purity Germanium detectors. Conventional low-background gamma-ray singles counting is a competitive technique when compared to the gamma-gamma coincidence approach in elevated background conditions. However, measurement of gamma-gamma coincidences can clearly make the identification of different nuclides more reliable and efficient than using singles spectrometry alone. The optimum solution would be a low-background counting station capable of both singles and gamma-gamma coincidence spectrometry., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Few studies have investigated the subsequent rate of hospital and outpatient clinic utilization in those who receive continuing care and have documented frequent usage over one year. Such knowledge may be helpful in identifying those who would benefit from preventive interventions. The aim of this study was to investigate and compare the subsequent rate of hospital and outpatient clinic utilization among older people with 0, 1, 2, 3 or more hospital stays in the first year following the initiation of continuing care. A further aim was to compare these groups regarding demographic data, health complaints, functional and cognitive ability, informal care and mortality., Methods: A total of 1079 people, aged 65 years or older, who received a decision regarding the initiation of continuing care during the years 2001, 2002 or 2003 were investigated. Four groups were created based on whether they had 0, 1, 2 or ≥ 3 hospital stays in the first year following the initiation of continuing care and were investigated regarding the rate of hospital and outpatient clinic utilization in the subsequent 3-5 years., Results: Fifty seven percent of the sample had no hospital stay during the first year following the initiation of continuing care, 20% had 1 stay, 10% had 2 stays and 13% had three or more hospital stays (range: 3-13). Those with ≥ 3 hospital stays in the first year continued to have the significantly highest rate of hospital and outpatient care utilization in the subsequent years. This group accounted for 57% of hospital stays in the first year, 27% in the second year and 18% in the third year. In this group the risk of having ≥ 3 hospital stays in the second year was 27% and 12% in the third year., Conclusions: There is a clear need for interventions targeted on prevention of frequent hospital and outpatient clinic utilization among those who are high users of hospital care in the first year after the initiation of continuing care. Perhaps an increased availability of medically skilled staff in the day to day care of these people in the municipalities could prevent frequent hospital and outpatient clinic utilization, especially hospital readmissions.

The aim was to explore the relationship between health care utilization over 2 years and psychosocial variables measured at the end of this period in a sample of older people with high health care consumption. Sixty-three people aged 69-96 years were included in the study. Data were collected from two different registers covering health care utilization from 2004 to the end of 2008, and baseline data from an ongoing RCT. A cluster analysis (based on the health care utilization variables) was used to divide the sample into subgroups. The cluster analysis resulted in a two cluster and a three cluster solutions. The latter was found to be more appropriate because it more clearly discriminated between the groups regarding health care utilization and psychosocial variables. The three clusters were classified as "high consumers" (Cluster I), and "low consumers" (Clusters II and III). Cluster II seemed to be characterized by low outpatient but high inpatient care utilization, while the opposite utilization pattern can be seen in Cluster III, which also contained those with the largest social network, lowest risk of depression, highest life satisfaction and who felt least lonely. Cluster II contained those who felt the loneliest. Thus, older people whose health care consumption mainly comprises outpatient care appeared to have the least impact on the psychosocial variables (e.g., the highest life satisfaction, felt least lonely and were at the lowest risk of depression). Thus, measures taken to prevent health care utilization, especially among those with high utilization of inpatient care, will most likely have a positive effect on psychosocial variables and life satisfaction/quality of life (QoL)., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)., Design and Setting: Cross-sectional design, University hospital., Sample: Forty-four patients awaiting prolapse surgery., Methods: The dual-panel translation method followed by an evaluation of validity and reliability in prolapse patients., Main Outcome Measures: Construct, convergent and discriminant validity, reliability via test-retest and internal consistency., Results: Item response rates were high (range 95.5-100%) for PFIQ-7 and PFDI-20. The corrected item-total correlations showed acceptable construct validity for PFIQ-7 (r=0.338-0.826) but low for PFDI-20 (r=0.116-0.581) and PISQ-12 (r=0.024-0.735). Acceptable convergent validity was found in all three instruments, with a negative correlation with the SF-12. There were no floor or ceiling effects in the three instruments. In the test-retest analysis, intraclass correlation coefficients were significant (r=0.888-0.943). Cronbach's α varied between 0.57 and 0.94., Conclusion: This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties., (© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem sparse, for all known versions of the instrument., Aim: The aim was to psychometrically evaluate the Swedish version of the DREEM instrument., Method: A total of 503 students (undergraduate medicine), aged 19-46 years, in semesters 2, 6 and 10 were included in the study. Validity was evaluated through analysis of construct validity and reliability., Results: The instrument had in general both acceptable validity and reliability. Due to a rather poor model fit in the confirmatory factor analysis, an explorative factor analysis was also employed which suggested a new five-factor solution for the instrument., Conclusions: The Swedish version of the DREEM instrument is shown to be valid and reliable, except for the factor structure. The new five-factor solution found in this study is not proven to be a superior measurement model compared with the original, but could be seen as an alternative model to the original, where the strong and weak areas are somewhat more easily identified.

Aim: The aim was to test sampling and explore sample characteristics in a pilot study using a case management intervention for older people with functional dependency and repeated contact with the healthcare services as well as to investigate the effects of the intervention on perceived health and depressed mood after 3 months. The aim was also to explore internal consistency in the life satisfaction index Z, activities of daily living-staircase and Geriatric Depression Scale-20., Method: This pilot study was carried out in a randomised controlled design with repeated follow-ups. In all, 46 people were consecutively and randomly assigned to either an intervention (n = 23) or a control (n = 23) group. Two nurses worked as case managers and carried out the intervention, which consisted of four parts., Result: No differences were found between the groups at baseline. The results showed the participants had low life satisfaction (median 14 vs. 12), several health complaints (median 11) and a high score on the Geriatric Depression Scale (median 6) at baseline, indicating the risk of depression. No significant effects were observed regarding depressed mood or perceived health between or within groups at follow-up after 3 months. Cronbach's alpha showed satisfactory internal consistency for group comparisons., Conclusions: The sampling procedure led to similar groups. The life satisfaction, functional dependency and symptoms of depression measures were reliable to use. No changes in perceived health and symptoms of depression were found after 3 months, indicating that it may be too early to expect effects. The low depression score is noteworthy and requires further research., (© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.)

This study aimed to investigate medical healthcare utilization 3-5 years following the decision about long-term care at home vs. in special accommodation in older people. A total of 1079 people who were granted long-term care the years 2001, 2002 or 2003 were studied regarding the number of hospital stays and the number of contacts with physicians in outpatient care in the 3-5 subsequent years. Those living at home and those in special accommodation were compared regarding medical healthcare utilization during the 3-5 subsequent years. Data were collected through the study Good Aging in Skåne (GAS) and through the registers, Patient Administrative Support in Skåne (PASiS) and PrivaStat. Utilization of medical healthcare decreased slightly in the years following the decision about long-term care. Despite younger age and less dependency in activities of daily living (ADL), those living at home utilized hospital and outpatient care to a greater extent than those in special accommodation; these differences remained over time. Thus, it seems as long-term care needs to become more effective in the prevention of medical healthcare utilization among those cared for at home. More, older people who are granted long-term care at home may otherwise imply increased utilization of medical healthcare., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Purpose: The aim of this study was to explore healthcare consumption in relation to more versus less knowledge concerning prescribed drugs among older people with functional dependency and repeated healthcare contacts, and to explore the determinants of more versus less knowledge, Methods: The sample comprised 63 persons (mean age 82.8 years). Data concerning use and knowledge about drugs, demographics, health complaints and self-reported diseases were collected from the baseline measure in an ongoing randomised controlled trial (RCT) and merged with data from two public registers about healthcare consumption 2 years prior to baseline measurement. Data were analysed descriptively and using regression analysis., Results: Fifty-two percent of the sample (n = 33) had less knowledge (defined as not knowing the indications for 50% or less of their prescribed drugs) and these had more acute hospitals stays (median 2 vs 0), more total hospital stays (median 2 vs 1) and more bed days in hospital (median 18 vs 3) than those with more knowledge. Bed days and visits to other outpatient staff groups were associated with less knowledge; visits to physicians were associated with more knowledge., Conclusions: The healthcare consumption pattern of those with less knowledge differed from that of those with more knowledge in terms of more acute inpatient care. The results indicate that there is a need for the health system to create mechanisms to ensure that patients do not lose their knowledge about their drugs when admitted in an acute situation; there is also an apparent need for educational intervention with patients, starting at the time of admission.

Aim: To investigate the utilization of medical healthcare, hospital care and outpatient care, during a 1-year period in relation to informal care, multimorbidity, functional status and health complaints and to long-term care at home or in special accommodation among people aged 65+, with one or more hospital admissions and receiving long-term care., Method: A total of 694 people receiving long-term care during the year 2001 were studied. Data were collected by means of the administrative registers Patient Administrative Support in Skåne and PrivaStat and through the study Good Ageing in Skåne. Those at home and those in special accommodation were compared regarding utilization of medical healthcare, informal care, multimorbidity, functional status and health complaints. Multiple logistic regression analysis was performed using at home vs. in special accommodation as the dependent variable and also two multiple linear regression analyses using the number of hospital stays and the number of contacts with the physician in outpatient care separately as dependent variables., Findings: Those at home were significantly younger (mean age: 81 vs. 84 years) and less dependent in personal and instrumental activities of daily living (PADL/IADL) than those in special accommodation. A larger proportion of those at home was admitted to hospital three times or more (21 vs. 14%) and they had significantly more contacts with physicians in outpatient care (md: 10 vs. md: 7). Informal care was associated with care at home (OR = 0.074) and with utilization of outpatient care (B = 2.045). Dependency in PADL was associated with care in special accommodation (OR = 1.375) and with utilization of hospital care (B = -0.060) and outpatient care (B = -0.581)., Conclusion: Medical healthcare seems more accessible to those who live at home are younger, less dependent and who have access to informal caregivers.

The frequency of fatigue among older people (both with and without chronic pain) and its major impact on daily life indicate the urgent need for further research about fatigue, the mechanisms behind it, as well as interventions to alleviate it. Such interventions are necessary to promote health, improve quality of life, and provide opportunities for successful aging.

Background: The medical programme at Lund University, Sweden, has undergone curricular reform over several stages, which is still ongoing. Students have been somewhat negative in their evaluations of the education during this time., Aim: To find out how the students perceived the educational climate using the Dundee Ready Education Environment Measure (DREEM), and to compare the findings taken at two given points in time., Method: The DREEM instrument was distributed in semesters 2, 6 and 10 in 2003 and 2005, to a total of 503 students., Results: The students rated their climate as positive. The total DREEM score (145) was somewhat higher than other published results and in the same range as for other reformed curricula. There was hardly any difference between the genders in their perceptions of the climate. Certain items were rated low and became subject of development between the measurements. These items concerned a perceived lack of a support system for stressed students and a lack of feedback and constructive criticism from teachers. Some improvement was detected in 2005., Conclusion: The educational climate was high in a reformed curriculum and could be maintained high during on-going curricular reform. Educational development resulted in better results on some items.

Objectives: The aim was to investigate the prevalence of chronic pain in different age groups and pain locations, as well as to identify variables associated with chronic pain., Methods: This cross-sectional survey had a randomized age-stratified sample comprising 826 respondents aged 18–102 years. Comparisons were made across age groups and pain locations. Multiple logistic regression analysis was used to identify variables associated with chronic pain., Results: The overall pain prevalence rate was 46%, with a variance of 27–55% across age groups. The prevalence increased up to the 60–74-year age group, after which it remained more or less constant. The pain sites differed across age groups. Forty-six per cent of the respondents had not received any diagnosis or did not know the reason for their pain, while 21% had no pain management. Several complaints (e.g. appetite loss, constipation, fatigue, depressed mood) were both more prevalent and more severe among those in pain than those with no pain. The regression analysis showed that body mass index (BMI), fatigue, sleep, and mobility problems were significantly associated with chronic pain., Conclusions: Chronic pain is common and constitutes a major public health problem. Interventions should not only be focused on the pain per se but should also include coexisting factors.

Objectives: The aim of this study was to develop and psychometrically evaluate an instrument for measuring the impact of chronic pain on daily life., Methods: The study comprised 384 respondents (aged between 18-102 years) who reported chronic pain. The instrument "Pain Impact Inventory" (PII) was evaluated in terms of face, content, construct and criterion validity, as well as two reliability measures. Reliability was measured by means of test-retest (with a 2-week interval) while Cronbach's alpha was used to measure internal consistency., Results: The results showed that the PII had acceptable validity and reliability. The PII contains 20 items and was found to have a nested design with five sub-scales (Physical impact, Psychological impact, Impact on social life, Social support, and Control) and two overarching dimensions ("Impact" and "Support")., Conclusions: The initial tests showed that the PII seems to be a psychometrically sound instrument for measuring the impact of pain on daily life from a multidimensional perspective.

The rotational band structure of 255Lr has been investigated using advanced in-beam gamma-ray spectroscopic techniques. To date, 255Lr is the heaviest nucleus to be studied in this manner. One rotational band has been unambiguously observed and strong evidence for a second rotational structure was found. The structures are tentatively assigned to be based on the 1/2-[521] and 7/2-[514] Nilsson states, consistent with assignments from recently obtained alpha decay data. The experimental rotational band dynamic moment of inertia is used to test self-consistent mean-field calculations using the Skyrme SLy4 interaction and a density-dependent pairing force.

Background: The brief screening version of the Multidimensional Pain inventory (MPI) is a shorter version of the West Haven-Yale Multidimensional Pain Inventory that measures pain in a multidimensional way and is theoretically linked to a cognitive-behavioural perspective on chronic pain., Objectives: The aim of this study was to psychometrically evaluate the 'brief screening version' of the Multidimensional Pain inventory Swedish version (MPI-S)., Methods: An age-stratified cross-sectional study, comprising 384 people aged 18-102 years, was carried out in southern Sweden in 2005. Factor analyses were performed to investigate the factor structure of the instrument and inter-correlation between the sub-scales as well as external measures were used to assess convergent and discriminant validity. Reliability was assessed by internal consistency (Cronbach's alpha)., Results: Mean scores and standard deviations are presented for the total sample as well as for each stratum. The inter-correlations revealed that discriminant validity was not satisfactory in the total sample, although the correlation analysis in each stratum showed acceptable discriminant validity in most age groups. The factor structure was the same as in the MPI-S in all age groups, except for those aged >or=90 years. Reliability tests (Cronbach's alpha) showed alpha values ranging between 0.68 and 0.93., Conclusion: The result showed that the instrument had acceptable validity and reliability in all age groups except for those aged >or=90 years. Thus, the instrument can be seen as a useful (multidimensional) form of screening for chronic pain.

Objective: To study the relationship between tobacco use and pain intensity., Design: An age-stratified cross-sectional study was carried out in southern Sweden in 2005., Sample: The population study consists of 384 people, aged 18-102 years, with chronic pain., Measurement: Data collection took place by means of a postal questionnaire. Comparisons of pain intensity were made between smokers and nonsmokers, and between users and nonusers of moist snuff. A multiple linear regression analysis was carried out in order to identify the determinants of pain intensity., Results: Among respondents with chronic pain, smokers experienced a higher pain intensity than nonsmokers, although there was no evidence of such a difference among snuff users. The regression analysis revealed that gender (i.e., women) and smoking significantly increased pain intensity., Conclusions: Pain intensity was highest among daily smokers and those who had quit. Thus, interventions to prevent smoking (to stop smoking and in particular not to start smoking) among people with chronic pain may not only be considered a method to improve health but also to reduce pain.

The aim was to psychometrically evaluate the activities of daily living (ADL)-staircase in various age groups. This age stratified, cross-sectional study comprised 826 individuals aged 18-102 years. The factor structure was assessed by means of hierarchical cluster analyses, plots and analyses of nonclassifiable responses. Reliability was assessed in terms of internal consistency. In general, the cluster analysis revealed two main clusters, which followed the intended factor structure (i.e. grouping the items according to personal ADL and instrumental ADL) and which were found in four of the six age groups (18-29, 30-44, 45-59 and 75-89 years). Plots confirmed that, in general, the instrument followed the hierarchical structure. Acceptable Cronbach's alpha was found in the total sample, the 18-29 age group and those aged 60 years and older. The ADL-staircase showed a varying degree of acceptable construct validity and reliability. The instrument, however, seems to be more suitable for older people.

This study aimed at examine the number of planned and acute hospital admissions during 1 year among people 65+ and its relation to municipal care, outpatient care, multimorbidity, age and sex. Four thousand nine hundred and seven individuals having one or more admissions during 2001 were studied. Data were collected from two registers and comparisons were made between those having one, two and three or more hospital stays and between those with and without municipal care and services. Linear regression was used to examine factors predicting number of acute and planned admissions. Fifteen percent of the sample had three or more hospital stays (range 3-15) accounting for 35% of all admissions. This group had significantly more contacts in outpatient care with physician (median number of contacts (md)=15), compared to those with one (md: 8), or two admissions (md: 11). Main predictors for number of admissions were number of diagnosis groups and number of contacts with physician in outpatient care. Those who are frequently admitted to hospital constitute a small group that consume a great deal of inpatient care and also tend to have frequent contacts in outpatient care. Thus interventions focusing on frequent admissions are needed, and this requires collaboration between outpatient and hospital care.

Aims: To present descriptive data, study psychometric abilities, and investigate the characteristics of non-respondents to SF-12., Method: The study had a randomized sample (n=4278; age: 75-105) stratified in four age groups. Factor analyses were performed to investigate the factor structure of the instrument, and convergent and discriminant validity was assessed by correlation between summary scores and by means of various measures (such as symptoms and ADL). Mean scores and Cronbach's alpha were computed for the total sample and for each stratum. Respondents and non-respondents to SF-12 were compared regarding various measures. A multiple logistic regression analysis was conducted to identify determinants for respondents/non-respondents., Results: Mean scores in the total sample were 37.5 SD 11.9 for the physical component summary score (PCS) and 50.3 SD 11.5 for the mental component summary score (MCS). Both PCS and MCS decreased significantly with higher age. The instrument showed acceptable convergent/discriminant validity and Cronbach's alpha, but the factor solution did not follow the intended structure of the instrument. Completion rate for all 12 items was 85.5% in the total sample, and the characteristics of non-respondents to SF-12 were higher age, being female, living alone, living in special accommodation, being worried about health, being in need of help with activities of daily living, reporting fewer symptoms, and having a smaller social network than respondents., Conclusions: The instrument generally showed acceptable validity and reliability, except for its factor structure. Furthermore, new determinants for non-respondents of SF-12 were found, such as type of living conditions, being worried about health, and social network.

The aim was to investigate healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care at home or in special accommodation and to investigate determinants for healthcare consumption. The study comprised 362 people (aged 65 or over), all subject to a decision about municipal care and/or services during 2002-2003, drawn from the Swedish National Study on Aging and Care (SNAC). Data were collected from three existing registers, the SNAC data covered age, gender, marital status, functional ability, informal care and living conditions and were merged with the Skåne County Council's patient administration system PASiS and PrivaStat covering healthcare consumption from the year 2000 and forward. About 50% of the acute hospital stays (n = 392) occurred within 5 months prior to municipal care. The men (n = 115, mean age 80.8) had significantly longer stays in hospital (P = 0.025), more diagnoses (P = 0.004) and contacts with other staff groups beside physicians in outpatient care (P < 0.001) compared to the women (n = 247, mean age 83.8). The regression analysis showed heart conditions, cancer, musculoskeletal problems, genitourinary diseases, injuries and unspecified symptoms to be significantly associated with various kinds of healthcare consumption. The findings indicated a breakpoint in terms of hospital admissions about 5 months prior to municipal care and service and a share of 15% having several admissions to hospital. Early detection and preventive interventions to these people in a transitional stage of becoming increasingly dependent on continuous care and services seems urgent to prevent escalating acute healthcare consumption.

Aims and Objectives: The aim of the study was to investigate the quality of life and related factors among older people who are in pain and in need of help to manage daily living., Background: To intervene against the low quality of life in nursing care knowledge about factors affecting it is needed and this is especially important for vulnerable people such as those who suffer from pain and who are in need of help to manage daily living., Methods: Five hundred and twenty-six people, aged 75-102 years participated in this study., Results: Those in pain reported a significantly higher degree of all complaints and lower quality of life in all measures compared with those not in pain. Overall quality of life was associated with mobility problems, sleeping problems and depressed mood, while health-related quality of life was associated with living in special accommodations, walking problems, mobility problems and fatigue., Conclusions: Those in need of help to manage daily living and in pain seem to be at higher risk of lowered quality of life than those not in pain and the lower quality of life among those in pain is probably caused by the complex of complaints rather than pain per se., Relevance to Clinical Practice: Daily nursing care should identify and treat the complex of complaints related to pain as well as pain itself, to improve everyday life and quality of life for older people in pain.

Background and Aims: To investigate mortality, determinants of mortality, and time until death among elderly subjects receiving public long-term care., Methods: This study comprises 626 respondents (age: 65-98 years). Data were collected for two cohorts (2001 and 2002). Cox regression analysis was used to identify determinants of mortality. Those who died and those who did not die were compared by, for example, demographic data and activities of daily living (ADL)., Results: The crude mortality rate was 9% in cohort 2001 and 14% in cohort 2002 in the first year, and 23% in cohort 2001 and 18% in cohort 2002 in the second year after decisions about care and service. Determinants of death were gender (men), severe cognitive impairment, co-morbidity, and high ADL scores. Regression analysis also showed that malignant tumors, respiratory, urinary and genito-urinary diseases were found to be significant predictors for mortality., Conclusions: The mortality rate was quite high, several diseases were common, and the need for help with ADL was wide-ranging. Results also showed that ADL scores, together with a measure of cognitive impairment, may be useful in identifying elderly subjects at high risk of mortality.

Objectives: The aim was to psychometrically evaluate the Swedish version of the Multidimensional Pain Inventory (MPI-S) and the "brief screening version of MPI-S" for use in an elderly sample., Methods: This study comprised 175 people aged 76-99 years reporting pain and in need of help to manage daily living. The instrument's factor structures were investigated through factor analyses, convergent and discriminant validity were assessed through inter-scale correlations and correlations with items from SF-12. Reliability was assessed by Cronbach's alpha., Results: The full-length version of MPI-S did not, in general, show any satisfactory validity and reliability when used among elderly. It had acceptable convergent and discriminant validity, but the factor analysis did not show a good model fit. Low alpha values were found for most of the sub-scales. However, the brief screening version of MPI showed acceptable validity and reliability, except for rather low alpha values in sections 3 and 4., Conclusion: The MPI-S instrument may not be very useful for measuring pain among frail elderly. The brief screening version may instead be a better alternative to the full version of the MPI-S. However, the small number of observations may be the reason to the lack of fit, and further studies are warranted.

Factors that explain the variance in quality of life among older adults with osteoarthritis were investigated. Individuals with osteoarthritis (n = 168) had more pain, functional limitations, and lower quality of life (physical component) than those without osteoarthritis (n = 246). No significant differences between the groups were found related to depressed mood and mental components of quality of life. Quality of life was associated with pain, functional limitations, and depressed mood in both groups. It is important to identify these problems when caring for older adults, and special attention should be given to individuals with osteoarthritis because of their higher degree of pain and functional limitations.

Objective.  The aim of the study was to survey existing research about fatigue among older people with chronic non-malignant pain. Method.  A structured literature review was carried out using the Medline database. The terms 'fatigue' and 'tiredness' were used synonymously. These subject headings were combined with pain. A literature search was made in 2004 and included articles back to 1995. Results.  The review of studies from the last decade resulted in 11 articles of relevance. The result showed that fatigue was common among older people and even more common among those in pain. However, there was discordance regarding the prevalence, and the figures ranged from 30% to 98%. Fatigue was found to be associated above all with pain, functional limitations/functioning, and low quality of life. No articles were found focusing on interventions against fatigue. Conclusions.  Fatigue is common in old age and even more common when people are in pain. However, knowledge seems to be sparse especially regarding interventions in daily care. Thus, more studies are needed that focus on fatigue to get firm evidence about the prevalence among older people in pain. In addition, studies about interventions against fatigue are urgently needed so that the care of older people can include actions against fatigue and to improve quality of life. Relevance to clinical practice.  It is of importance that fatigue is not ignored in the care of older people. By intervening against symptoms such as fatigue it will most likely ease the pain and improve quality of life.

Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. However, knowledge about what may characterise those seemingly 'healthy' older people is sparse. The aim of the study was to investigate the characteristics of a sample of people (75+) reporting various degrees of Quality of Life (QoL) with respect to QoL in different areas, as well as self-rated health, health problems, social support, everyday activities and sense of coherence. A postal questionnaire was sent out in spring 2001 to a randomly selected population-based sample (n= 600) in the southern parts of Sweden. A two-step cluster analysis was performed (n= 385, mean age 84.6, SD = 5.7) with 'present QoL' as clustering attribute. Three groups were disclosed, classified as high, intermediate and low present QoL, of which 33.8% could be regarded being at risk of low QoL. Those with low present QoL (18.4%) were the oldest and most vulnerable, a majority were women with 'poor or bad' self-rated health, high frequencies of health problems, low total QoL, low social support and sense of coherence and less physically active. Those with high present QoL (47.8%) reported more 'excellent or good' self-rated health, physical activity, satisfactory social support and higher sense of coherence and total QoL than the other two groups. Those with intermediate present QoL (33.8%) had more of 'poor or bad' self-rated health, more health problems were less physically active, had lower total QoL and sense of coherence, and less social support than those with high present QoL. The sample seemed to reflect the ageing process in that the respondents were at different stages of ageing. However, the fact that the level of social support, sense of coherence and self-rated health followed the same curve as QoL may indicate that some are more vulnerable to low present QoL given the same health and these should be targeted in preventive programmes since they report low QoL.

Evaluation of various methods in clinical practice is often based on interpretations by two or more observers. Such data need to be analysed with correct statistics, or the results and conclusions may be misleading. In this study, the use of measures of agreement for ordinal data in five international nursing journals is reviewed and various methods for measuring agreement are presented and discussed. Analyses of agreement did not seem to be very common in nursing research, but a great variation was found regarding the choice of method for analysing agreement. Both acceptable and unacceptable methods were found in the articles reviewed. When choosing among various methods for agreement the weighted kappa-coefficient is probably the most useful for ordinal data, but several issues of concern arise and need to be taken into consideration when using these types of analyses.

Background and Aims: The aim of this work was to study feelings of loneliness and fear among elderly people (75+) in a gender perspective, and to explore their causes., Methods: A cross-sectional study (postal questionnaire) with a randomised and age-stratified sample (n = 4277) was used to study the variables of interest. Because the variables were compared between men and women, weighted values for means, standard deviations, and ratios were used. Multiple logistic regression analysis was used to identify the causes of loneliness and fear., Results: Findings showed that loneliness and fear were both more frequently reported by women than men. Loneliness was significantly associated with gender, marital status, living in special accommodation, fear, and need of help with activities of daily living (IADL). Fear was significantly associated with gender, number of children, having someone to trust, loneliness, and being in need of help with IADL. Those who reported loneliness and/or fear had significantly lower health-related quality of life than those who did not. Many of the elderly feared violence/crime, but only a few had been exposed to violence/crime., Conclusions: Loneliness and fear are common among elderly people. Both variables seem to be related to each other and were both found to be "threats" to a good life in old age. However, to minimize these "threats" and perhaps improve these people's quality of life, action can be taken in the care for elderly people such as involving the social network and reducing the need of help with IADL.

Objective: To describe and compare self-reported health complaints, overall and health-related quality of life and to investigate how health complaints, age, gender, marital status, living and dwelling conditions and socio-economy predicted overall and health-related quality of life., Data and Method: A sample of 469 persons (aged 75-99) responded to a postal questionnaire. Multiple linear regression analysis was used to examine possible predictors., Result: Self-reported health complaints such as pain, fatigue and mobility impairment significantly predicted low overall and health-related quality life. Women had significantly lower overall and health-related quality of life than men, and a significantly higher degree of self-reported health complaints. The regression models had more similarities than differences, implying that the overall quality of life instrument were sensitive to physical influences only supposed to be detected by health-related quality of life instruments. Several of the health complaints predicting low quality of life are amenable for being relieved by nursing care. In the care of older people nurses need to assess for several health complaints simultaneously and be aware of their possible interaction when outlining interventions. Nurses are able to facilitate early detection of health complaints negatively affecting quality of life by implementing more pro-active preventive work as well as a higher degree of thorough and systematic assessments. It also seems important to consider that older woman's and men's needs for high quality of life may differ.

Objectives: The aim of this study was to review the presentation and analysis of ordinal data in three international nursing journals in 2003., Method: In total, 166 full-length articles from the 2003 editions of Cancer Nursing, Scandinavian Journal of Caring Sciences and Nursing Research were reviewed for their use of ordinal data., Results: This review showed that ordinal scales were used in about a third of the articles. However, only about half of the articles that used ordinal data had appropriate data presentation and only about half of the analyses of the ordinal data were performed properly., Conclusions: Ordinal data are rather common in nursing research, but a large share of the studies do not present/analyse the result properly. Incorrect presentation and analysis of the data may lead to bias and reduced ability to detect statistical differences or effects, resulting in misleading information. This highlights the importance of knowledge about data level, and underlying assumptions for the statistical tests must be considered to ensure correct presentation and analyses of data.

The aim of this study was to investigate the use of various pain relief methods among older people in chronic pain and in need of help to manage activities of daily living. People who reported pain and were in need of help to manage activities of daily living were included in the study. The Multidimensional Pain Inventory-Swedish version and a modified version of the Pain Management Inventory were used to study pain and methods of pain relief. The respondents used a variety of methods (median = 3) to relieve their pain; pharmacologic methods, rest, and distraction were the predominant strategies employed. A cluster analysis identified 2 main groups of people: people who used a few well-known methods and were significantly older and people who used a larger repertoire of methods to relieve their pain and reported higher pain severity and interference with daily life. About a third of older people reported inadequate pain relief. These findings stress the need for nurses to inform older people about available methods for pain relief and to do systematic pain assessments to evaluate the effectiveness of various pain relief methods.

Objectives: To describe and compare the methods of pain management used by elderly individuals with chronic pain and requiring assistance with activities of daily living, depending on whether they live alone, with someone, at home or in special accommodations., Methods: This study comprised 294 people aged 76-100 years, identified as having chronic pain and requiring assistance with activities of daily living. Pain and pain management methods were compared using the Multidimensional Pain Inventory, Swedish version, and the Pain Management Inventory., Results: Those living in special accommodations reported more pain than those living at home. Those living with someone reported more pain and interference in daily life than those living alone, despite using more pain-relief methods and having greater social support. The median number of pain-relieving methods used was 3.0 (75th-25th percentile: 5-2). Some (3.8%) did not use any method to relieve their pain. The most frequently used methods were prescribed medicine (20%), rest (20%) and distraction (15%). The methods rated most effective were using cold, exercise, hot bath/shower and consuming alcohol., Conclusion: Participants had only a small repertoire of pain management methods and these were mostly conventional in nature. Few non-pharmacological methods were used. The findings suggest the importance of thorough assessment, and the need to fully discuss pain management options with the elderly.

Objectives: To compare the oldest old (85 years and above) in pain with those with no pain across gender, regarding demographic data, living conditions, social network/support, walking/mobility problems, fatigue, sleeping problems, depressed mood and quality of life (QoL). The aim was also to test how these variables were related to QoL among the oldest old in pain., Methods: The study comprised 1622 people aged 85-105 years, of whom 47% reported pain. SF-12 and the LGC questionnaire were used to measure QoL. Multiple linear regression analysis was used to identify factors associated with QoL., Results: Functional limitations, fatigue, sleeping problem and depressed mood were significantly more prevalent and QoL was significantly lower among those in pain than those not in pain, and among women compared to men. These complaints, along with financial problems, living in sheltered housing and living alone, were associated with low QoL among those in pain., Conclusion: Pain is common among the oldest old and coexists with several other complaints that together negatively affect QoL. By identifying those in pain and coexisting factors, actions can be taken to contribute to QoL, also in late life.

To investigate the prevalence of pain in older people (75+), compare those in pain to those without regarding demographics, social network, functional limitations, fatigue, sleeping problems, depressed mood and quality of life (QOL), and identify variables associated with pain, a cross-sectional, prospective survey was conducted in an age-stratified sample of 4,093 people aged 75-105 years old. Those reporting pain (n=1,654) were compared with those who did not (n=2,439). Pain was more common with higher age, as were all complaints among those in pain and among those without, except sleeping problems. Lower QOL was found with higher age, as well as with pain. Pain was found to be associated with functional limitations, fatigue, sleeping problems, depressed mood, and QOL. These data highlight the importance of identifying old people in pain. Those who are older and those affected by pain are at greater risk of also being troubled by other problems, such as functional limitations and lowered QOL.

The aim of this study was to review the research literature on pain and quality of life (QoL) and the relationship between these variables among people aged 75 years and above with rheumatoid arthritis and/or osteoarthritis. A Medline and CINAHL search was carried out using MeSH terms rheumatoid arthritis, osteoarthritis, QoL and pain in various combinations. Seventeen articles were identified that met the requirements for methodological quality and inclusion criteria. No study focused only on respondents aged 75 years or over. The studies had varying representation of this age group. Pain was common in both groups and was found to increase with age and disease duration among those with rheumatoid arthritis but not among those with osteoarthritis. Increased pain could lead to depression. Pain, functional limitation and increased age were found to decrease QoL among those with rheumatoid arthritis and osteoarthritis alike. Social support was found to buffer against negative effects on QoL among those with osteoarthritis while no moderating effects were found in rheumatoid arthritis. Increased age was found to relate to pain (rheumatoid arthritis) and decrease QoL (both rheumatoid arthritis and osteoarthritis). It is, however, hard to draw any firm conclusions about older people's pain and QoL because of the lack of studies including respondents aged 75 years or over. Thus, research about pain and QoL, especially focusing on the old and the very elderly with rheumatoid arthritis/osteoarthritis, is needed. It also seems justified to say that nursing care should especially focus on older people and that these people should be assessed for their level of pain, functional limitations and QoL especially in the case of having rheumatoid arthritis and/or osteoarthritis.

Water suppressed proton nuclear magnetic resonance (1H NMR) spectroscopy of human plasma has been described as successful in detection of malignancy. We designed a prospective study to test the hypothesis that in vitro NMR spectroscopy has a high sensitivity for detecting early breast cancer. One hundred and thirty-five women were referred for breast biopsy due to abnormal mammograms. One hundred of these were recruited through a population-based mammography screening project. Sixty-nine of 135 women were found to have breast cancer and their average line width of the methyl and methylene resonance in the plasma were compared to those women who had a benign or normal histopathology in the biopsy and to the line width for 100 healthy subjects from the same population. The mean line width at a half-height of the methyl and methylene resonances of the serum lipoprotein lipids in the NMR spectrum did not differ appreciably between the groups. The line width correlated highly with the serum triglycerides, but correction for the level of triglycerides did not improve the diagnostic accuracy of the line width. Receiver-operating characteristic analysis revealed a sensitivity of 61% and a false positive rate of 43% at the most beneficial cut-off of line width (39.7 Hz). In vitro NMR spectroscopy in our hands was thus not a useful diagnostic tool in patients with early breast cancer.