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The aim was to explore the patients experiences to get insights into their living habits prior to gastrointestinal cancer surgery. An interpretative phenomenological analysis (IPA) approach was used. Six in-depth interviews with participants recruited from a hospital in southeast Sweden. The IPA analysis identified 3 themes: The influence of the cancer diagnosis on awareness and motivation, Life circumstances affecting living habits, and Activities bringing mental strength. The participants expressed their motivation level and circumstances in life. Various types of activities and support promoted physical and mental health. Motivation level and circumstances in life both influence living habits. Various kinds of activities and support promote patients physical and mental health. Nurses need to investigate patients experiences when developing person-centered support to achieve health-promoting behavior prior to cancer surgery., Funding Agencies|Health, Medicine and Caring Science, Linkoping University; County Council of Ostergoetland

AimThis study investigated healthcare professionals attitudes and perceptions towards the familys participation in surgical cancer care. DesignA prospective mixed method study. MethodsThe study was conducted at three hospitals in Sweden with registered nurses, assistant nurses and surgeons. Data included 43 completed Families Importance in Nursing Care (FINC-NA) questionnaires answered by registered nurses and qualitative data from 14 interviews with surgeons and assistant nurses. Data analysis was performed according to the Creswell convergent parallel mixed method. ResultsBoth quantitative and qualitative data demonstrated that the family was an important resource in nursing care, was highly valued as a conversational partner and had resources that should be considered. Each family should be supported in determining their role and as implements for maintaining a functioning family constellation and increasing their participation. Patient or Public ContributionNo patient or public contribution.

The study aimed to explore the experiences of participation among the next of kin of patients who had surgery for upper abdominal tumours. This study had a qualitative research design and data were analysed by thematic analysis. Eleven qualitative interviews were conducted with next of kin to patients who had surgery for liver, bile duct or pancreatic malignancy. The following themes emerged:from the shadows to an important roleandan inviting and inhibiting environment for participation.Next of kin were a central part of their loved ones care but often in the shadows. The next of kin described how they were not always invited and often they had to struggle to get involved. Next of kin often have a major psychosocial role to supporting the patient during and after discharge, and therefore need to be invited and involved in the whole care process.

A decade ago, major public health differences between two neighboring, equal sized large Swedish cities, Norrköping and Linköping (»the Twin cities«) were revealed. These differences were considerable for cardiovascular mortality and life expectancy. An important finding was that cardiovascular mortality rates for men and women in the city of Norrköping were highest compared to other major Swedish cities. In this follow-up, a decade later, cardiovascular mortality rates are still highest for the Norrköping population in comparison to the largest Swedish cities. There are also still profound and major public health differences between these twin cities. The differences seem to persist over time. These differences could not be explained by differences in health care, but are rather reflecting different social history and socioeconomic and life style differences in these two cities., Hjärt–kärldödligheten minskar totalt sett i landet, men betydande skillnader i hjärt–kärldödlighet framkommer mellan de största svenska städerna. Norrköping har den högsta hjärt–kärldödligheten både hos kvinnor och män, av de största svenska städerna, liksom för 10 år sedan. Skillnaderna i hjärt–kärlmortalitet och förväntad medellivslängd mellan »tvillingstäderna« Norrköping och Linköping verkar inte minska i ett 10-årsperspektiv. Folkhälsoskillnaderna mellan tvillingstäderna kan inte förklaras av skillnader i hälso- och sjukvård utan snarare av socioekonomiska och livsstilsrelaterade skillnader liksom städernas olika socialhistoria.

Background: The importance of the social environment and human life conditions for public health was early recognized in community medicine. Despite major reductions in recent decades, cardiovascular diseases (CVD) is one of the leading causes of mortality and morbidity for both genders in all European countries. Aim: The overall aim of this thesis was to increase our knowledge of factors in the social environment and of individual psychosocial factors that could explain why some women in working ages are affected by cardiovascular diseases. Methods: The Swedish sample comes from the urban population in two major cities in a region in the south-east of Sweden, the Twin cities. According to their social history they could be labelled a “blue-collar” and a “white-collar” city. Cardiovascular morbidity data in all papers for the Twin cities was derived from a computerized population-based administrative Health Care Register (HCR). In Paper IV, we made a comparative study between Sweden and Scotland, the Scottish data comes from the Scottish Health Survey. Results: In Paper I, the cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women were significantly higher in the population of the blue collar city in all ages and for both sexes. The qualitative interviews of women after an MI, in Paper II, the findings revealed a broad picture of social factors, life circumstances, personalities and, not least, psychosocial factors that are important to middle-aged women who have suffered an MI. Paper III demonstrated that women with a high level of the personality trait “being a Good Girl” reported significantly more psychosocial risk factors for CVD and more commonly report chest pain without seeking medical care, no increased incidence for various CVD-diagnoses were found. The comparative study (Paper IV) clearly showed that Scottish middle-aged women are – relative to Swedish women - particularly affected by a worse profile of CVD

Background: Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. Methods: We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. Results: The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. Conclusions: This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city., Original Publication: Carina Wennerholm, Björn Grip, AnnaKarin Johansson, Hans Nilsson, Marja-Liisa Honkasalo and Tomas Faresjö, Cardiovascular disease occurrence in two close but different social environments, 2011, INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, (10), 5. http://dx.doi.org/10.1186/1476-072X-10-5 Licensee: BioMed Central http://www.biomedcentral.com

Background: The leading cause of death and loss of disability-adjusted life years globally are cardiovascular diseases. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The aim of this study was to estimate the occurrence of common cardiovascular diseases and cardiovascular mortality in defined populations in two geographical close but socially different cities, a white-collar and a blue-collar twin city - “The Twincities”. Methods: We focused on the total population in these two neighbouring and equally sized cities with a population of around 135 000 inhabitants respectively, representing two close but different social environments in the same Swedish county. Data about morbidity for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care and calculated as cumulative incidence rates. Mortality for ischemic heart diseases is based on official Swedish national statistics. Results: The cumulative incidence of cardiovascular diagnoses for younger as well as elderly men and women revealed significant differences between these two cities. The relative risks for both sexes were highest for all cardiovascular diagnosis studied and cardiovascular mortality in the population of the blue-collar twin city. Conclusions: There are major differences in cardiovascular morbidity and mortality between the studied twin cities representing two close but different social environments. Since these differences seem to be profound and stable over time preventive measures is warranted in the blue-collar city.

Background: A recently published study by us shows interesting incidence numbers of myocardial infarction (MI) in two close cities. One of the cities has the highest incidence of MI in Sweden. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. MI among women of working age is a relatively rare event. It can be an indicator of the current health situation in a city. The purpose of this study was to analyze lay perceptions and believes regarding the disease among affected women in their social context. Knowledge about this can give us a better understanding about how they think, act and choose in life. Methods: We focused on younger women under 65 years of age affected by MI. Qualitative interviews was made with 12 women in the defined region. Results: The majority of the women mentioned inner stress as a cause for, and specific life events adjacent to the MI. All women in the study point out conventional risk factors (smoking, obesity, lack of exercise, diet, and heredity) as an explanation for their MI. Finally, most of these women had high demands on themselves, put other people's needs above their own and some testified about very traumatic life experiences. Conclusions: Knowledge about young women affected by MI and their lay perceptions is an important prerequisite for preventive measures for this special group.