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The aim of this study was to conduct a validation and assess the test-retest reliability of the health questionnaire based on Nordenfelt's Welfare Theory of Health (WTH). The study used a questionnaire on health together with the Short Form 12-Item Health Survey (SF-12) questionnaire, and 490 pupils at colleges for adult education participated. The results of the study are in accordance with Nordenfelt's WTH. Three hypotheses were stated, and the first was confirmed: People who were satisfied with life rated higher levels than those who were dissatisfied with life concerning both mental and physical health, measured with the SF-12. The second hypothesis was partially confirmed: People with high education were more often satisfied with life than those with low education, but they were not healthier. The third hypothesis, that women are unhealthy more often than men, was not confirmed. The questionnaire on health showed acceptable stability.

The aim of this study was to test the psychometric properties of the instrument 'Check your health' in teenagers with type 1 diabetes. The instrument measures 'self-reported health' and 'burden of diabetes'. A convenience sample of 199 teenagers, 12-17 years of age, completed the questionnaires 'Check your health' and DisabKids when visiting the diabetes clinic. Forty-seven patients completed the questionnaires at home a second time. In the reliability test, the correlation between test and retest was found to be satisfactory, (0.94-0.62, except for social burden, 0.41). Convergent validity was moderate (0.62-0.38), while the instrument showed good discriminant validity. Self-reported health and burden of diabetes were different in boys and girls, in patients with good or poor metabolic control or who reported high and low disease severity. The domain burden of diabetes turned out to be very sensitive. Conclusion: The instrument 'Check your health' showed clinical utility in teenagers with diabetes. Reliability and validity tests of the measure showed promising results in Swedish teenagers, and it can probably be used in clinical settings. To further strengthen the convergent validity, it should be compared with other QoL instruments, and to obtain normative values, it has to be used in a larger context.

Objective To describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients’ possibilities of reaching national treatment targets. Design A Swedish national survey. Setting Swedish PHC. Subjects Data from 485 primary healthcare centres (PHCCs) and 91 637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006. Main outcome measures Description of how patient education is arranged, HbA1c, body mass index, cholesterol, blood pressure, and physical activity. Results Of the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients’ needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients’ needs. The majority of PHCCs (96%) reported that they set individual goals (HbA1c, blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients’ possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1–5.7%. Neither individual counselling (checklist-driven or individualized to patients’ needs) nor group education had an impact on patients’ possibilities of reaching the targets. Conclusion The current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients’ possibilities of reaching national treatment targets.

Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

Background: Becoming autonomous is an important aspect of teenagers' psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support. Objective: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes. Design and method: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis. Participants: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes. Findings: The lived experiences of the transition towards autonomy in self-management were characterized by the overriding theme "hovering between individual actions and support of others". The findings indicate that individual selfreliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme "confirmation of others" showed that parental encouragement increased the certainty of teenagers' standpoints; peers! acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers' self-esteem. Conclusion: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients’ confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients’ confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.

The aims of this study are to evaluate whether diabetic teenagers participating in a group educational programme, 'the schooner programme', differ from non-participants in attitudes towards diabetes and self-care, and to evaluate the impact on the attitudes, HbA1c and treatment of the programme. Ninety teenagers aged 14–18 years attended the programme. Attitudes towards diabetes and self-care were measured with a validated questionnaire. Medical data were collected from the medical records. The participants reported more positive attitudes towards diabetes and self-care and more frequent contacts with others with diabetes monitored blood glucose more often and felt less disturbed by diabetes than non-participants. The programme had positive impact on attitudes towards diabetes. There was no change in HbA1c, but the use of insulin pumps was more frequent among participants after the programme. To get teenagers attracted to group education, the diabetes care team needs to influence them towards more positive attitudes.

Aims: To determine the effects of an empowerment programme on glycaemic control and empowerment, and to study the role of parental involvement. Methods: The wait-list design is a randomized controlled trial lasting for 6 months, after which the control group participate in the same education programme as the intervention group. After 6 months, data from the two groups are analysed together (pre/post). Thirty-two teenagers with Type 1 diabetes (12-17 years) completed an empowerment group education programme, meeting weekly for 6 weeks. They were also offered an extra meeting together with their parents, which resulted in three groups: together with parents, only parents and no parent involvement at all. HbA1c was measured before intervention and after 6, 12, 18 and 24 months, and empowerment before, and 6 and 12 months after. Results: HbA1c and empowerment were similar in the intervention group and the control group 6 months after intervention. In pre/post analysis, HbA1c was significantly higher 6 and 12 months after intervention in teenagers > 14 years (from 8.4% to 9.3%; P < 0.05 to 9.6%; P < 0.01), but returned to baseline 18 months after the programme. In teenagers ≤ 14 years of age, HbA1c did not change during the study. The teenagers felt more ready for changes after the programme than before (3.9 sd = 0.5 to 4.1 sd = 0.5; P < 0.05). In the teenagers in the group that involved their parents, there was a significant decrease in HbA1c 12 and 24 months after intervention, from 8.9% (sd = 1.1) to 7.6% (sd = 1.3; P < 0.05, confidence interval 0.37, 2.26). Conclusion: This empowerment programme for teenagers with diabetes showed no positive glycaemic or empowerment effects. Empowerment programmes for diabetic teenagers in early and middle adolescence should include parental involvement.

The aim was to describe patients' experiences of being delirious. Background. Delirium is a serious psychiatric disorder that is frequently reported from hospital care settings, particularly among older patients undergoing hip surgery. It involves disturbances of consciousness and changes in cognition, a state which develops over a short period of time and tends to fluctuate during the course of the day. It is a certified fact that delirium is poorly diagnosed and recognized although the state often is described as terrifying. To be able to give professional care, it is of the utmost importance to know more about patients' experience of delirium. Method. Included in the interviews were patients who had undergone hip-related surgery and during the hospital stay experienced delirium. Fifteen patients participated in the interviews. Of these, six had experienced episodes of nightly delirium (sundown syndrome) and nine experienced delirium during at least one day. The interviews were analysed by qualitative content analysis. Results. The entry of delirium was experienced as a sudden change of reality that, in some cases, could be connected to basic unfulfilled physiological needs. The delirium experiences were like dramatic scenes that gave rise to strong emotional feelings of fear, panic and anger. The experiences were also characterized by opposite pairs; they took place in the hospital but at the same time somewhere else; it was like dreaming but still being awake. The exit from the delirium was associated with disparate feelings. Relevance to clinical practice. It is necessary to understand patients' thoughts and experiences during the delirious phase to be able to give professional care, both during the delirium phase and after the recovery.

Objectives. A previous study that assessed an empowerment programme for teenagers with diabetes showed no effects on metabolic control or empowerment outcomes. In pre/post measures teenagers >14 years of age significantly increased their HbA1c, and the hole group their readiness for changes. To balance the teenagers’ decision-making competence with parent involvement seems to be important when planning empowerment programmes for teenagers. The aim was to get a deeper understanding of teenagers view on decision-making competence and parent involvement. Methods The study is a descriptive, qualitative interview study. Thirty one out of 32 teenagers (19 girls, 13 boys, mean age= 14.2) attending an empowerment programme was interviewed after completing the programme. The interviews were transcribed, and analyzed with qualitative content analysis. Results Decision-making competence: We found seven categories that influence decision-making competence: Cognitive maturity: Make abstractions and priorities, understand consequences Personal qualities: Flexibility, intuition and having courage. Self-strength: Strong wishes to own decisions and control. Experiencw: Own experiences or experiences from others. Social network can be both promoting and hindering. Safe environment and emotional factors. Parent involvement: We defined three categories of parent involvement: Constructive involvement: Creating safety and teamwork. Parents being there when needed, having trust, sharing responsibility, listening and coaching. Active destructive involvement: Misbelieves, blaming and making too hard demands. Passive destructive involvement: Lack of understanding and engagement, need of control and conflicts. Conclusions We have elucidated factors that seem to be important when planning empowerment group education programmes for teenagers with diabetes. To facilitate parent involvement the results can be used in discussing efficient coping strategies with teenagers and parents.

Background:Individuals with blindness caused by diabetes face problems in their daily life that are related to both conditions. Hopefully some of these problems can be solved and simplified through a suitable educational programme. Aims: The aim of this study was to evaluate whether the educational programme 'I'm the boss' is suitable for blind individuals with diabetes, and to discover whether and how the programme inspired the participants in developing self-management skills. Methods: An ophthalmologic centre and two medical centres in a well-defined geographic area were screened for blind individuals with diabetes, resulting in the participation of nine individuals in the educational programme. The programme consisted of six three-hour-long weekly sessions based on empowerment and problem-based learning. Empowerment was measured using the Swedish version of the diabetes empowerment scale (Swe-DES-23). After completion of the programme, the participants were interviewed (focus group and individual interviews). The interviews were analysed using qualitative content analysis. Findings: The evaluation of the educational programme showed that almost half the participants improved their diabetes empowerment in the subscales ‘self-awareness’ and ‘ability to manage stress’. The qualitative data corresponded well with the quantitative data in terms of increasing participants' self-efficacy and knowledge. The learning process was experienced as flexible and the content as stimulating and creative. Conclusion: It is concluded that the programme seems suitable for blind individuals with diabetes, and in collaboration with others allows space for innovation and self-realisation

BACKGROUND: It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. AIM: The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. METHOD: The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. FINDINGS: Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. CONCLUSIONS AND IMPLICATIONS: These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of

Background The aims of present study were to study sickness absence among Swedish parents of children with Down's syndrome (DS) and to compare their rates of absence with those of control parents. Sickness absence data for 165 DS parents were compared with those for 174 control parents; all data were for the period 1997-2000. Sickness absence rates were also related to parental self-perceived health, stress and sense of coherence. Methods The self-administrated measures of parental self-perceived health, stress and sense of coherence were compared with the number of days of sickness absence. Results In about two-thirds of the parents in both the study and the control group, no days of sickness absence were registered. Six of the DS parents had remarkably large numbers of days of sickness absence (more than 100 per year). None of the control parents had such high sickness absence rates. It is speculated that there is a small group (less than 5%) of parents who are more vulnerable to the birth of a child with DS. Apart from these six DS parents, sickness absence was not more frequent among the DS parents than among the control parents. DS parents stayed at home to care for their sick DS child three times more often than control parents did for their non-disabled child. DS fathers took greater responsibility in the care of their temporarily sick child and stayed at home to care for the child even more often than control mothers did. DS parents with sickness periods experienced small deterioration in self-perceived health, significantly higher stress and decreased sense of coherence in comparison with parents without sickness periods. Conclusion There was a great similarity in sick leave rates due to one's own sickness between DS and control parents, but a small group of DS parents (< 5%) may be more vulnerable. DS fathers stayed at home to care for their sick DS child remarkably often.