Aims and objectives: To investigate changes in self-reported fatigue and depression from four months to two years following a myocardial infarction, as well as to explore gender differences, identify the incidence of fatigue without coexisting depression and finally predict health-related quality of life at a two-year follow-up. Background: Depression and fatigue are associated with decreased health-related quality of life after myocardial infarction. Although there is a close relationship between fatigue and depression, it has been shown that symptoms of fatigue can occur without coexisting depression. Design: Quantitative and longitudinal design. Methods: Participants (n = 155) were asked to complete the following questionnaires: the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory-20 (MFI-20) and the Short Form Survey (SF-36) following myocardial infarction (after four months and two years). Descriptive statistics, paired t-tests and multiple regressions were carried out. Results: In the entire group, self-reported fatigue had decreased from four months to two years after myocardial infarction. After two years, 18% of respondents reported depression together with fatigue and 30% reported fatigued without depression. Women scored higher than men on the fatigue dimensions reduced activity, reduced motivation and mental fatigue. Moreover, the physical dimension of health-related quality of life two years after myocardial infarction was predicted by experienced general fatigue at four months. Conclusion: Fatigue with or without coexisting possible/probable depression remains as a significant symptom two years after myocardial infarction in nearly half of the entire group. Relevance to clinical practice: Fatigue is a problem following myocardial infarction. Therefore, systematic screening and early identification of patients experiencing symptoms of depression and fatigue after myocardial infarction are important for suitable care planning. In contemporary coronary care, strategies aimed at relieving fatigue should be developed. ￜ 2013 Blackwell Publishing Ltd.

Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.

Background and RESEARCH Objective: Health-related quality of life (HRQoL) is impaired in patients after a myocardial infarction (MI), and fatigue and depression are common health complaints among these patients. Patients' own beliefs about their illness (illness perceptions) influence health behavior and health outcomes. The aim of the present study was to examine illness perception and its association with self-reported HRQoL, fatigue, and emotional distress among patients with MI. Subjects and Methods: The sample consisted of 204 patients who had had MI and who completed the questionnaires during the first week in the hospital and 4 months after the MI. The questionnaires used were the Illness Perception Questionnaire, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and the Short Form Health Survey (SF-36). Results: Patient's illness perception changed over time from a more acute to a more chronic perception of illness, and beliefs in personal and treatment control of MI had decreased. Furthermore, these negative beliefs were associated with worse experiences of fatigue and lowered HRQoL. Conclusions: Patients' illness perceptions influence health outcomes after an MI. Supporting MI patients in increasing their perception of personal control could be a primary nursing strategy in rehabilitation programs aimed at facilitating health behavior, decreasing experiences of fatigue, and increasing HRQoL. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

AIMS AND OBJECTIVES: The aim of this study was to explore patients' illness perception of myocardial infarction four months after a myocardial infarction. BACKGROUND: An important task for research on recovery from myocardial infarction is to understand the factors that influence an individual's adherence to secondary preventive strategies. Perceptual, cognitive and motivational factors have been found to influence adherence to a secondary preventive regimen. METHOD: Twenty-five patients were interviewed four months after a myocardial infarction. In accordance with grounded theory methodology, data collection and analysis were carried out simultaneously. RESULTS: The findings can be understood in light of two core categories: 'trust in oneself ' vs. 'trust in others'; belief in one's own efforts to control the illness; and 'illness reasoning', lines of thought about illness identity. In searching for relationships, six categories describing variation in illness perceptions of a myocardial infarction emerged: (i) 'sign of a chronic condition - feasible to influence'; (ii) 'sign of a chronic condition - uncontrollable'; (iii) 'acute event that can recur - feasible to influence'; (iv) 'acute event that can recur - uncontrollable'; (v) 'unthinkable acute event'; and (vi) 'non-recurring acute event'. CONCLUSION: The more reflective patients perceived the heart attack as a sign of a chronic condition; they also devoted time for reasoning about the possible causes of their illness. This is in contrast to patients who were less reflective and viewed their myocardial infarction as an acute event, which they avoided thinking about. The findings contribute to our understanding of variation in illness perceptions. RELEVANCE TO CLINICAL PRACTICE: The examination of how individuals perceive myocardial infarction may help health-care professionals individualize secondary preventive strategies, thereby improving adherence to health-care regimens. Nurse-patient discussions could begin with identification of the patient's variations of reflectiveness concerning his/her illness.

Abstract

Working in primary care with chronic leg ulcers is both time-consuming and difficult. There is a large category of patients with leg ulcers, that is expected to increase in a number of years, and many of them will probably come to a district nurse for help.

Aim

Method

The approach was qualitative. The study was done with a phenomenological life-world approach. Seven district nurses working in primary care were interviewed. The phenomenological perspective focuses on the respondents’ own life-world and has openness to the interviewee's own experiences. The phenomenon we wanted to study was the district nurses’ experiences of caring for patients with chronic leg ulcers.

Results

Aim To describe the development and evaluation of a model for a national clinical final examination in the bachelor nursing education.

Background After the transfer of nursing education to the academy, concerns have been raised among nurses, nurse leaders, lecturers and researchers about the nursing students clinical competence at the entrance to professional life.

Methods During 2003 to 2005, a collaborative project was carried out between four universities and adjunctive health-care areas supplying clinical placements in Sweden. A two-part examination was agreed upon comprising a written theoretical test and a bedside test. An assessment tool for the bedside test was created. Nursing students, nurses and clinical lecturers participated voluntarily in the evaluation.

Results The model was highly appreciated, and its relevance, usability, and validity were considered quite good for the assessment of nursing students clinical competence at the final stage of their education. Several deficiencies were revealed, which led to further development of the model.

Conclusions and implications for nursing management The development and first evaluation of the model proved encouraging for further use, but it needs further evaluation. Involvement of nursing managers is necessary in order to satisfy new demands on competence and staffing of clinical nurses.

Background One of the main demands on Swedish and global health care in general is to meet the patient’s need for safety. By general health care law this also comprises district nurses’ field of responsibility. Although there are numerous studies describing the concept of safety and its different shapes, no research could be found exploring how safety is, or supposed to be, mediated by district nurses’ in a Swedish context. Research about this is therefore needed. Aim The aim of this qualitative study was to explore how district nurses’ mediate safety to their patients. Method Qualitative data were collected from seven district nurses’ by means of semi structured interviews. Thereafter, a concept analysis was carried out. Results Responses revealed that district nurses’ consider themselves mediate safety through a variety of ways. Five major categories emerged: (1) complaisance’s; (2) competence; (3) patient participation; (4) same caregiver; (5) personal characteristics. Conclusion District nurses’ mediate safety through a combination of general attitudes and concrete acts. Preconditions are bound to each district nurse’s individual ability to give a good complaisance, his/her competence and ability to involve patients in treatment and care. Other, less pronounced, are bound to the district nurse’s ability to create continuity in contact with patients’ and his/her personal characteristics.

Objectives: To identify young adults' stated reasons for not taking asthma medication and to determine the significance of personality, asthma control and health-related quality of life in relation to these stated reasons. Background: Reasons for non-adherence to asthma medication treatment have previously been studied, but research on the significance of personality in relation to stated reasons for not taking asthma medication is limited. Methods: Young adults with asthma (age 22years; n=216) stated their most common reasons for not taking asthma medication and completed postal questionnaires on personality, asthma control and health-related quality of life (HRQL). Results: The most common reason for non-adherence was ". No perceived need" (n=141). Participants giving this reason for not taking asthma medication scored lower on the personality trait Negative Affectivity and reported both higher asthma control and higher mental HRQL. "Insufficient routines" was the second most common reason (n=66), and participants stating it scored higher on Negative Affectivity and reported lower asthma control. An increase in asthma control increased the odds of stating ". No perceived need" as the reason for not taking asthma medication. An increase in Negative Affectivity was associated with an increase in the odds of giving ". Insufficient routines" as a reason. Conclusions: The personality trait Negative Affectivity and perceived asthma control played a role in the young adults' stated reasons for not taking asthma medication, which indicates that these parameters are of importance to young adults' medication management. © 2013 Elsevier Inc.

BACKGROUND:Antimicrobial resistance results from inappropriate use of antibiotics and makes common or life-threatening infections more difficult or sometimes impossible to treat. Proper adherence to antibiotic therapy is one among several measures required to prevent antimicrobial resistance. Knowledge of personality traits could help in identifying patients who need support with their adherence behaviour. Previous research has presented associations between personality traits and adherence to long-term medication treatment in individuals with different chronic diseases. However, there is limited knowledge about associations between personality traits and adherence to both antibiotic therapy and to shorter treatment periods. The aim was to explore the relation between personality and adherence behaviour in people prescribed antibiotics for common infections.METHODS:In a population-based study, 445 respondents reported on their prescribed antibiotic therapy and completed the Neuroticism, Extraversion, and Openness to experience Five-factor Inventory and the Medication Adherence Report Scale. Data were statistically analysed using descriptive statistics, t-tests, bivariate correlations, multiple and logistic regressions.RESULTS:Non-adherence was estimated to be 9.4%. The most common reasons for stopping therapy prematurely was that the respondent was now healthy and that the respondents experienced side-effects. Non-adherent respondents scored lower on the personality traits Agreeableness and Conscientiousness. A logistic regression showed that higher scores on Agreeableness decreased the risk for non-adherence to antibiotic therapy. In a multiple regression, Neuroticism was identified as a negative predictor, and both Agreeableness and Conscientiousness were identified as positive predictors of adherence behaviour.CONCLUSIONS:Preventive measures to decrease non-adherence may be to inform patients not to interrupt the antibiotic therapy when they start to feel healthy and to inform them about how to prevent and handle common side-effects. As associations between personality and adherence mainly have been described in relation to long-term treatments in chronic diseases, the current study add to the literature by showing that personality traits also seem to be reflected in adherence to shorter treatment periods with antibiotics for common infections. More studies in this specific area of adherence research are recommended.

Background: Limited research exists exploring the influence of personality on adherence behaviour. Since non-adherence is a major obstacle in treating prevalent chronic diseases the aim was to determine whether personality traits are related to reported adherence to medication in individuals with chronic disease. Methodology/Principal Findings: Individuals with chronic disease (n = 749) were identified in a random population sample of 5000 inhabitants aged 30-70 in two municipalities in West Sweden. Data on five personality traits, Neuroticism, Extraversion, Openness to experiences, Agreeableness, and Conscientiousness, and medication adherence behaviour was collected by questionnaires. Statistical analyses resulted in a negative relationship between Neuroticism and medication adherence (P<0.001), while both Agreeableness (P<0.001) and Conscientiousness (P<0.001) were positively related to adherence. At high levels of Conscientiousness, low adherence was related to higher scores in Neuroticism. At high levels of Agreeableness, low adherence was related to low scores in Conscientiousness and high scores in Openness to experiences. Conclusions: This study demonstrated that multiple personality traits are of significant importance for adherence behaviour in individuals with chronic disease. The findings suggest that several personality traits may interact in influencing adherence behaviour. Personality traits could putatively be used to focus efforts to educate and support patients with high risk of low medical adherence. © 2011 Axelsson et al.

PURPOSE: Poor adherence to medication treatment for asthma and allergic rhinitis could challenge a positive health outcome. Health-related quality of life (HRQL) is an important measure of health outcome. Both personality and gender could influence adherence and perceptions of HRQL. The purpose was to clarify the role of personality and gender in relation to adherence and HRQL in people with asthma and/or rhinitis.

DATA SOURCES: Participants (n = 180) with asthma and allergic rhinitis, selected from a population-based study, filled out questionnaires on the five-factor model personality traits-neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness-HRQL, and adherence to medication treatment. Data were statistically analyzed using t-tests, Mann-Whitney tests, bivariate correlations, and multiple regressions.

CONCLUSIONS: Personality traits were associated with adherence to medication treatment in men. The influence of personality traits on HRQL also differed between men and women. These differences suggest that both a personality and gender perspective should be considered when planning care support aimed at improving adherence and HRQL in people living with asthma and/or allergic rhinitis.

IMPLICATIONS FOR PRACTICE: It is suggested that both a personality and gender perspective be taken into account in care support aimed at improving adherence and HRQL in people with asthma and allergic rhinitis.

Background:

There is evidence that both personality traits and personal beliefs about medications affect adherence behavior. However, limited research exists on how personality and beliefs about asthma medication interact in influencing adherence behavior in people with asthma. To extend our knowledge in this area of adherence research, we aimed to determine the mediating effects of beliefs about asthma medication between personality traits and adherence behavior.

Methods:

Asthmatics (n=516) selected from a population-based study called West Sweden Asthma Study completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory, the Medication Adherence Report Scale, and the Beliefs about Medicines Questionnaire. Data were analyzed using confirmatory factor analysis and structural equation modeling.

Results:

Three of the five investigated personality traits – agreeableness, conscientiousness, and neuroticism – were associated with both concerns about asthma medication and adherence behavior. Concerns functioned as a partial mediator for the influencing effects of agreeableness, conscientiousness, and neuroticism on adherence behavior.

Conclusion:

The findings suggest that personality traits could be used to identify individuals with asthma who need support with their adherence behavior. Additionally, targeting concerns about asthma medication in asthmatics with low levels of agreeableness or conscientiousness or high levels of neuroticism could have a favorable effect on their adherence behavior.

Purpose Personality traits are rather stable dispositions inadulthood, while self-efficacy and adherence may bemodified through targeted interventions. Health-relatedquality of life (HRQL) serves as a vital outcome measure.The present aim was to explore the function of self-efficacyand adherence as mediators for the influencing effect ofpersonality traits on HRQL in people with chronic disease.Methods An epidemiological sample of 786 personscompleted questionnaires on personality, general self-efficacy,adherence behaviour and HRQL. Data were statisticallyanalysed using descriptive statistics, correlationanalyses and path models.Results Self-efficacy mediated the effect of Extraversionand Conscientiousness on mental HRQL. Neuroticism hada direct effect on both physical and mental HRQL.Adherence partially mediated the effect of both Agreeablenessand Conscientiousness on mental HRQL.Conclusions The mental HRQL in people scoring low onExtraversion or low on Conscientiousness could beimproved by strengthening general self-efficacy. Increasingadherence in people scoring low on Agreeableness orConscientiousness could improve their mental HRQL, butthe improvement was small and may be of lesser clinicalrelevance. These results argue for personalized interventionsintended to positively affect health outcomes inpeople with chronic disease.

Diabetes self-management is a challenge for both clients and health-care professionals. Empowerment plays a vital role in helping clients to achieve successful self-management. This study adopted a meta-ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines-of-argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors.

Background Single ventricle defects are among the most complex congenital heart defects and the development of advanced surgical procedures in recent decades has created the first generation of adolescents and young adults living with this condition. Yet little is known about how these individuals experience life and what impact the heart defect has on their life in general. Objective The aim was to illuminate and gain a deeper understanding of adolescents’ and young adults’ experiences of living with a surgically palliated univentricular heart. Design Seven open-ended in-depth interviews were conducted, transcribed, and analyzed according to the henomenological hermeneutical method. All adolescents and young adults operated before 1995 according to the Fontan procedure or the total cavo-pulmonary connection procedure at one pediatric cardiology unit were included in the study. They were 17–32 years of age (median age 22 years). Results The interpretation of the interview transcripts showed that the participants experienced living with a surgically palliated univentricular heart in terms of feeling exceptional, strong, and healthy. This was supported by two structural analyses, where three themes emerged: happiness over being me, focusing on possibilities, and being committed to life. Conclusion Living with a Fontan circulation included negative experiences but the analyses clearly demonstrated a feeling of being strong and healthy. An appreciation of having survived and being committed to life was found to be an integral part of the development of the interviewees’ existential growth. This probably strengthens them further in their ability to balance expectations and hurdles in life. This study provides valuable insights into the experience of patients after the Fontan procedure and the importance of a positive health care environment throughout their lives.

Etiska aspekter vid screening av bukaortaaneurysm - en delutvärdering vid införandet i Västra Götaland

Regionstyrelsen har beslutat om införande av screening av 65-åriga män för buk-aortaaneurysm (fortsättningsvis benämnt AAA) i Västra Götalandsregionen. Syftet är, i likhet med andra screeningundersökningar, att ställa diagnos i ett tidigt skede, redan innan sjukdomen har börjat ge symtom. Utvärderarna, liksom den helt övervägande delen av de kallade och intervjuade medarbetarna, anser att detta är en riktig satsning. Utvärderingsgruppen ställer sig således bakom införandet och huvuddragen i genomförandet av AAA screening i Västra Götalandsregionen. De kunskaper vi har om screening i allmänhet och AAA i synnerhet indikerar helt enkelt att det vore oetiskt att inte screena denna grupp personer. Det finns dock en risk för oro och ångest i samband med förfarandet. Det är därför viktigt att minimera negativa upplevelser hos de kallade. Utvärderingen är gjord med detta som utgångspunkt och har således ansatsen att finna förbättringsmöjligheter i det framväxande förfarandet.

Under 2009 kallades 10 361 män och av dessa avstod 14,5 % . Till SU/Östra och SU/Mölndal avstod ca 20 % att komma medan de som kallades till SÄS, SKAS och NU avstod i mindre utsträckning (ca 11 %).

Förbättringsförslagen i rapporten bygger på enkätsvar, telefonintervjuer från såväl de som kom som de som uteblev. Det genomfördes också fokusgruppsintervjuer med den personalen som undersökte de kallade (ST-läkare, sjuksköterskor och biomedicinska analytiker) på de kliniskt fysiologiska mottagningarna vid Sahlgrenska universitetssjukhuset Mölndal och Östra, Kungälvs sjukhus (röntgen), Södra Älvsborgs sjukhus (SÄS), Norra Älvsborgs sjukhus (NÄL) och Skaraborgs sjukhus (SkaS).

Kort om resultaten

De kallade och personalen var i allmänhet positiva till att sjukvården gjorde screeningundersökning av 65-åriga män. Kallelse och informationsbrev upplevdes av de flesta som bra. Avståndet till screeningorten påverkade inte deltagandet i screeningen negativt trots kommentarer om lång resväg. De som hade längst resväg undersöktes på NÄL och SkaS. Att få ett påminnelsebrev gjorde att flera som glömt eller var bortresta kunde undersökas. Egenavgiften (100 kr) hade inte betydelse för deltagandet. Undersökningen medförde inga obehag och gick snabbt (5 min). Undersökningens korta tid kunde dock vara ett besvär för den som behövde mer omfattande information eller omhändertagande. Informationen om undersökningen var bra men besked om hur vanligt tillståndet var och normalgränserna saknades av de undersökta.

Av dem som avstod från undersökning förekom fysisk psykisk sjukdom eller handikapp som orsak till att det var svårt eller omöjligt att undersökas. Flera hade negativa attityder till massundersökningar och som exempel angavs svininfluensa-vaccinationen för inställningen. Andra orsaker till att man avstod var inställningen ”det drabbar inte mig”. Några hade dålig erfarenhet av sjukvård eller läkarskräck. Det förekom också transportproblem, som att man inte hade egen bil. Den största andel som avstod bodde i Göteborgsregionen (22 %).

Screeningpersonalen upplevde att de flesta var positiva och nöjda med informationen i kallelsen, förutom att man trodde att hela bukaortaavsnittet skulle undersökas. Personalen fick påpekanden från män att egenavgiften (100 kr) utgjorde ett problem för dem som inte hade internet då en betalningsavgift tillkommer. Speciell tid var avsatt för undersökningarna, på två ställen på kvällstid för att det skulle vara lättare med parkering. Ofta räckte undersökningstiden till (5 min) men ibland, om undersökningen var mer komplicerad eller om någon hade svårt att röra sig eller behövde prata, upplevdes tiden för kort.  Principen var att det skulle ges besked om bukaorta var normal eller förstorad, men beskedet gavs på olika sätt, en del fick muntligt besked, andra också skriftligt. Några fick reda på måttet när det var normalt men inte om det var förstorat. Vid upptäckt av vidgad aorta skulle personalen faxa uppgifter till kärlkirurgen i Göteborg. Personalen upplevde att de inte hade klara besked på hur informationen till patienten skulle ges om vidgad aorta upptäcktes. Det var även osäkert om och när patienten skulle bli omhändertagen både beroende på tillgång till mottagningstid till kärlkirurg och beroende på hur stor vidgning aorta hade.

Utvärderingsgruppen har reflekterat över de etiska aspekterna av screeningen. Gruppen anser att tillvägagångssättet visat sig vara hållbart och föreslår endast förbättringar av förfarandet och rekommendationer om alternativa förhållningssätt.

Sammanfattning av etiska reflektioner vid bukaortascreeningen i Västra    Götaland

• Information och undersökning byggde på ett rationalistiskt perspektiv där 65-åriga män ansågs vara friska, svensktalande och utan hjälpbehov.
• Vid komplicerad undersökning eller vidgad aorta var det brist på tidsmarginal vilket innebar att kravet på ett fullgott omhändertagande riskerade att inte kunna uppfyllas.
• Förfarandet vid beskedet av mätresultat, både skriftligt och muntligt, var inte samstämmiga mellan screeningorterna.
• Yrkeskategori som inte var utbildad för eller hade erfarenhet av omhändertagande vid besked kunde skapa oro och ångest.
• Beskeden till männen om och när läkarkontakt skulle fås varierade.
• Osäkerhet och frustration över att inte ha tillgång till läkare/psykolog fanns bland screeningpersonalen.

OBJECTIVE: To assess physical activity and energy expenditure and to identify their correlates during adolescence and early adulthood. DESIGN: In a cohort study, total energy expenditure (TEE) and physical activity level (PAL) were assessed at 15 and 21 y from a 7-day activity diary and predicted BMR. The influences on TEE and PAL of body size, gender, sexual maturity, physical activity habits, sitting time, region, social conditions, employment, food habits, smoking and alcohol intake were examined in multivariate analyses.Subjects:71 male and 89 female subjects, living in two socioeconomically different regions of Sweden, a university region and an industrial region. SETTING: The university city of Uppsala and the industrial town of Trollhättan. RESULTS: At both 15 and 21 y, PAL and TEE were high, with gender, sitting time and physical activity habits as main correlates. At age 21 y, employment and the mother's educational level also appeared as significant correlates. The relations between the main variables and their correlates were more complex than at age 15 y, and the sitting time was reduced and the activity habits were changed. CONCLUSIONS: A reduction of daily sitting appears to be a major reason why high levels of physical activity and energy expenditure were maintained from 15 to 21 y of age in spite of changed and less frequent activity habits during this interval.

Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.

AIM: This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction. BACKGROUND: Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood. METHOD: Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis. FINDINGS: Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping. CONCLUSION: Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

Coping with myocardial infarction: evaluation of a coping questionnaire The negative effects of emotional distress on the recovery following myocardial infarction make it important to study coping strategies in this situation. The present study aimed to evaluate the psychometric properties and the validity of a 10 dimensions questionnaire labelled The General Coping Questionnaire (GCQ). The structure of the questionnaire was based on a previous interview study with 26 persons with different diseases. The 10 dimensions are called self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation and intrusion. The present study comprised 114 first-time myocardial infarction patients (37 women, 77 men). Five months after myocardial infarction, they answered questions about health-related quality of life, health complaints, sense of coherence and the GCQ. A multi-trait/multi-item analysis showed good item-scale convergent and discriminatory validity when the GCQ was reduced from 47 to 40 items. In conclusion, the results showed that the 40-item GCQ is a well-structured and reliable questionnaire for measuring coping strategies in myocardial infarction patients.

In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged

BACKGROUND: Various studies have demonstrated that nursing is stressful and that the incidence of occupational stress-related burnout in the profession is high. AIM: This descriptive-correlational study examined nurses' satisfaction with their psychosocial work environment, their moral sensitivity and differences in outcomes of clinical nursing supervision in relation to nurses' well-being by systematically comparing supervised and unsupervised nurses. METHODS: Nurses were selected from two hospitals (n = 71). Data collection was by means of questionnaires and analysed by descriptive and inferential statistics. RESULTS: The nurses' satisfaction with their psychosocial work environment was reflected in six factors: 'job stress and anxiety', 'relationship with colleagues', 'collaboration and good communication', 'job motivation', 'work demands' and 'professional development'. The nurses' perceptions of moral sensitivity comprised seven factors: 'grounds for actions', 'ethical conflicts', 'values in care', 'independence patient-oriented care', 'the desire to provide high-quality care' and 'the desire to provide high-quality care creates ethical dilemmas'. Nurses well-being were reflected in four factors 'physical symptom and anxiety', 'feelings of not being in control', 'engagement and motivation' and 'eye strain sleep disturbance'. The moral sensitivity 'ethical conflicts' were found to have mild negative correlations with psychosocial work environment 'job stress and anxiety professional development' and with 'total score' psychosocial work, moral sensitivity factor 'independence were correlated with psychosocial work factor 'relationships with colleagues' and 'total score', moral sensitivity were mildly correlated with 'collaboration and good communication and had a negative correlation to psychosocial work factor 'work demands'. In addition, significant correlations were found between the nurses' well-being profile and demographic variables, between 'engagement and motivation' and 'absence due to illness' and between 'time allocation for tasks', 'physical symptoms and anxiety' and 'age'. Mild significant differences were found between nurses attending and not attending group supervision and between 'physical symptoms and anxiety' and 'feelings of not being in control'. CONCLUSIONS: We conclude that ethical conflicts in nursing are a source of job-related stress and anxiety. The outcome of supporting nurses by clinical nursing supervision may have a positive influence on their perceptions of well-being. clinical nursing supervision have a positive effect on nurses physical symptoms and their feeling of anxiety as well as having a sense of being in control of the situation. We also conclude that psychosocial work have an influence on nurses experience of having or not having control and their engagement and motivation.

Aim: The aim of this study was to make a synthesis of three studies that deal with the following research question: 'How does clinical nursing supervision enhance nurses' experiences of well-being in relation to their psychosocial work environment?' Background: Clinical nursing supervision is one way to support nurses in coping with their stressful work situation. Method: A hermeneutic approach was used to reflect and interpret nurses' experiences of well-being in relation to clinical nursing supervision and psychosocial work environment. Results: The findings suggest that clinical nursing supervision has an influence on nurses' experiences of well-being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment. Conclusions: The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well-being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self-recognition. © 2006 The Authors.

Att tveksamheter framförts angående mål- och kunskapsrelate-rade betyg liksom till möjligheten att betygskomplettera är väl känt. Likaså att betygsmedelvärdet har ökat sedan införandet av det nya målrelaterade betygssyste-met. Däremot har det varit oklart vad dessa höjningar av betygen representerar; mer kunskaper eller betygsinflation. Då betygen ska signalera kunskaper, och de kunska-per som eleverna tillägnar sig i gymnasieskolan ska ligga till grund för fortsatt utbildning, är det rimligt att förvänta att ju bättre gymnasiebetyg desto bättre studie-resultat vid fortsatt utbildning. Syftet med föreliggande studie är att undersöka gymnasiebetygens egenskaper och innebörden av betygskomplettering genom att relatera betygens jämförelsetal till studieframgång på civilingenjörs- och läkarpro-grammen. Resultaten visar att gymnasieskolans betygssättning är utsatt för en betydande inflation och att detsamma gäller för betygsförändringar som resultat av komplettering. Hela den genomsnittliga betygsökningen, oavsett om det gäller betygsutveckling eller komplettering, utgörs av »tomma» betygsenheter som inte svarar mot bättre resultat inom högskoleutbildningarna. 

A sample of 221 11th grade students and their parents were asked to complete the Interpersonal Reactivity Index (IRI; M. H. Davis, 1980), which is comprised of 4 subscales: empathic concern, perspective taking, fantasy, and personal distress; and a global-item measure containing 4 items, 1 for each subscale. The factorial structure that emerged in a previous study (C. Cliffordson, 2000) involving the students was tested on ratings provided by their parents. The results from the IRI scale were also compared to results from the global-item measure. Structural equation modeling was used to examine the structure of empathy and the agreement of self/other judgments. The results support the conclusions from the previous study that the concept of empathy can be considered to be identical to empathic concern, which also explains a great deal of perspective taking and fantasy. The agreement between the students' and their parents' judgments was substantial, and there are several reasons to believe that the interjudge agreement obtained is accurate.

The purpose of this study is to examine step‐wise admission to two medical programs with regard to selection effects. By using data from a large‐scale longitudinal project, the influence of background variables on regular and step‐wise admission is estimated. Characteristics of both applicants and those admitted are investigated using descriptive statistics and the probabilities of admission and application are examined using logistic regression analysis. The results indicate that self‐selections were generally greater for the step‐wise groups compared to the regular groups. However, the selections resulting from the procedure were generally lower for the step‐wise groups. The results vary between different step‐wise designs, indicating self‐selections to be dependent upon the type of instrument used in the first step, and selections resulting from the procedure to be dependent on the number of steps and/or, more probably, the type of instruments used and the number of those selected in each step.

The purpose of the present study was to examine the structure of empathy using a hierarchical approach, and to compare the dimensions of empathy with measures of social functioning, in order to contribute to the understanding of the nature of empathy. The dimensionality of the Interpersonal Reactivity Index, which comprises four subscales (empathic concern, perspective taking, fantasy and personal distress) was examined using confirmatory factor analysis. Relations with the Social Skills Inventory were also investigated. A sample of 127 applicants for places on nursing and social work undergraduate programs participated in the study. The study findings indicate that empathy is hierarchi-cally organized, with one general dimension at the apex. The general factor is identical to empathic concern and this dimension overlaps to a great extent with perspective taking and fantasy. The findings also indicate that the general dimension constitutes an integrated entirety, with its main emphasis on emotional reactivity by also involving cognitive processes.

The purpose of this study is to examine effects of the admission system to higher education on background diversity of students and study efficiency. By using data from a longitudinal project, the students admitted to medical education on different admission grounds are compared. The results indicate that admissions based on upper secondary grades best promote the goal of diversity. In addition, those students perform nearly as well as those admitted via step-wise procedures. The step-wise procedures promote study efficiency, but tend to favour applicants with upper-middle-class and Swedish backgrounds compared to those admitted via grades. Those admitted on the basis of SweSAT scores perform more poorly than those admitted via grades and step-wise procedures. Furthermore, the results indicate that admission via SweSAT scores contradict rather than promote the goals of increasing social, educational, and national diversity in higher education. © 2006 Scandinavian Journal of Educational Research.