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  • 1.
    Andreae, C
    et al.
    Mälardalen University.
    Ekstedt, Mirjam
    Department of Health Care Sciences, Ersta Sköndal University.
    Snellman, I
    Mälardalen University.
    Patients' participation as it appears in the nursing documentation, when care is ruled by standardized care plans2011In: ISRN nursing, ISSN 2090-5491, Vol. 2011, p. 707601-Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe inpatients with myocardial infarction and their participation in care as documented in the nursing records when standardized care plans are used in care. The use of standardized care plans not only has increased the quality of medical treatment but has also overlooked patients' opportunities to participate in their own care. There is a lack of knowledge about how standardized care plans influence patients' participation in nursing care. Data were collected from thirteen patients' records with diagnoses of myocardial infarction. Participation in the decision-making process and participation associated with "sharing with others" were searched for in the analysis. The analytical process was guided by content analysis. The findings were grouped into two categories: patients' intermediary participation and patients' active participation. The main results indicated that patients' intermediary participation depended on healthcare professionals' power to rule the nursing care situation.

  • 2. Borosund, Elin
    et al.
    Cvancarova, Milada
    Moore, Shirley M.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Ruland, Cornelia M.
    Preliminary Results Of Two Web-Based Interventions On Symptom Distress, Anxiety And Depression Among Breast Cancer Patients2014In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 47, p. S188-S188Article in journal (Other academic)
  • 3. Börösund, E
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    Patient-centered care challenges nurses´professional role: Experiences of using an interactive tailored patient assessment tool in clinical practice2013In: The 10th Nordic Conference on Advances in Health Care Sciences Research, 2013Conference paper (Refereed)
  • 4. Børøsund, E.
    et al.
    Cvancarova, M.
    Moore, S. M.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Ruland, C. M.
    Comparing effects in regular practice of e-communication and web-based self-management support among breast cancer patients: Preliminary results from a randomized controlled trial2014In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 16, no 12, article id e295Article in journal (Refereed)
    Abstract [en]

    Background: While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care. Objective: Our aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months' follow-up data in a 12-month trial. Methods: We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time. Results: Patients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e-messages. Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress (mean difference 0.16, 95% CI 0.06-0.25, P=.001), anxiety (mean difference 0.79, 95% CI 0.09-1.49, P=.03), and depression (mean difference 0.79, 95% CI 0.09-1.49, P=.03) compared with the usual care group. The IPPC group reported significant lower depression scores compared with the usual care group (mean difference 0.69, 95% CI 0.05-1.32, P=.03), but no differences were observed for symptom distress or anxiety. No significant differences in self-efficacy were found among the study groups. Conclusions: In spite of practice variations and moderate use of the interventions, our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness. Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising. However, the multicomponent intervention WebChoice had additional positive effects.

  • 5.
    Børøsund, Elin
    et al.
    Oslo University Hospital.
    Cvancarova, Milada
    Oslo University Hospital.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Moore, Shirley M
    Ruland, Cornelia
    Oslo University Hospital.
    How user characteristics affect use patterns in web-based illness management support for patients with breast and prostate cancer.2013In: Journal of medical Internet research, ISSN 1438-8871, Vol. 15, no 3, p. e34-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Frequently eHealth applications are not used as intended and they have high attrition rates; therefore, a better understanding of patients' need for support is warranted. Specifically, more research is needed to identify which system components target different patient groups and under what conditions.

    OBJECTIVE: To explore user characteristics associated with the use of different system components of a Web-based illness management support system for cancer patients (WebChoice).

    METHODS: For this secondary post hoc analysis of a large randomized controlled trial (RCT), in which WebChoice was tested among 325 breast cancer and prostate cancer patients who were followed with repeated measures for 1 year, usage patterns of 162 cancer patients in the intervention arm with access to WebChoice were extracted from the user log. Logistic regression was performed to identify patterns of associations between system use and patient characteristics. Latent class analyses (LCA) were performed to identify associations among the use of different system components and levels of social support, symptom distress, depression, self-efficacy, and health-related quality of life.

    RESULTS: Approximately two-thirds (103/162, 63.6%) of the patients logged on to WebChoice more than once, and were defined as users. A high level of computer experience (odds ratio [OR] 3.77, 95% CI 1.20-11.91) and not having other illnesses in addition to cancer (OR 2.10, 95% CI 1.02-4.34) increased the overall probability of using WebChoice. LCA showed that both men with prostate cancer and women with breast cancer who had low scores on social support accompanied with high levels of symptom distress and high levels of depression were more likely to use the e-message component. For men with prostate cancer, these variables were also associated with high use of the self-management advice component. We found important differences between men with prostate cancer and women with breast cancer when associations between WebChoice use and each user characteristic were analyzed separately. High use of all components was associated with low levels of social support among women with breast cancer, but not among men with prostate cancer. High use of e-messages, advice, and the discussion forum were associated with high levels of depression among women with breast cancer, but not among men with prostate cancer. For men with prostate cancer (but not women with breast cancer), high use of symptom assessments, advice, and the discussion forum were associated with high levels of symptom distress. However, it is unclear whether these findings can be attributed to differences related to diagnosis, gender, or both.

    CONCLUSIONS: This study provides evidence that different user characteristics are associated with different use patterns. Such information is crucial to target Web-based support systems to different patient groups. LCA is a useful technique to identify subgroups of users. In our study, e-messages and self-management advice were highly used components for patients who had low levels of social support and high illness burden, suggesting that patients with these characteristics may find such tools particularly useful.

  • 6. Børøsund, Elin
    et al.
    Ruland, Cornelia M
    Moore, Shirley
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation2013In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 83, no 7, p. E23-E34Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.

    OBJECTIVE: To explore nurses' experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.

    METHODS: This investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.

    RESULTS: Three themes and nine sub-themes emerged: (1) "Choice as facilitator for shared understanding and engagement in patients' own care," with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) "enhancing the patients' strengths," with two sub-themes: releasing patient's internal strengths and confirming "normalcy" for the patient; and (3) "new challenges for the nurse," with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.

    CONCLUSIONS: Findings suggest that, from nurses' perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses' professional roles and created dilemmas such as nurses' ambivalence regarding patients' levels of disclosure of sensitive issues and the nurses' ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.

  • 7. Cecilie, V
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    Challenges related to the Implementation of an Informatics Intervention into Regular Clinical Practice: A leadership Perspective2012In: 33rd Annual Meeting, Society of Behavioral Medicine, 2012, 2012Conference paper (Refereed)
  • 8.
    Ekstedt, M
    et al.
    Karolinska Institutet.
    Söderström, M
    Karolinska Institutet.
    Åkerstedt, T
    Karolinska Institutet.
    Nilsson, J
    Karolinska Institutet.
    Søndergaard, H-P
    Karolinska Institutet.
    Aleksander, Perski
    Karolinska Institutet.
    Disturbed sleep and fatigue in occupational burnout2006In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 32, no 2, p. 121-31Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this study was to investigate sleep with polysomnography and self-ratings and the diurnal pattern of sleepiness and fatigue in a group suffering from severe occupational burnout.

    METHOD: Twelve white-collar workers on long-term sick leave (>3 months) and 12 healthy controls with high and low scores on the Shirom Melamed Burnout Questionnaire (SMBQ) were included. A 1-night polysomnographic recording (after habituation) was carried out at home, and sleepiness and mental fatigue were rated at different times of the day for weekdays and the weekend. Precipitating factors at the time of the illness at work and real life were considered, and different dimensions of occupational fatigue were described. A repeated-measures analysis of variance using two or three within group factors was used to analyze the data.

    RESULTS: The main polysomnographic findings were more arousals and sleep fragmentation, more wake time and stage-1 sleep, lower sleep efficiency, less slow wave sleep and rapid eye movement sleep, and a lower delta power density in non-rapid eye movement sleep in the burnout group. The burnout patients showed pronounced sleepiness and mental fatigue at most times of the day for weekdays without reduction during weekends. The precipitating factor was occupational stress (psychiatric interview), and work stress indicators were increased.

    CONCLUSIONS: Occupational burnout is characterized by impaired sleep. It is suggested that impaired sleep may play a role in the development of fatigue or exhaustion in burnout.

  • 9.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Burnout and Sleep2005Doctoral thesis, comprehensive summary (Other academic)
  • 10.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    Børøsund, E.
    Svenningsen, I. K.
    Ruland, C. M.
    Reducing Errors through a Web-Based Self-Management Support System2014In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 201, p. 328-334Article in journal (Refereed)
    Abstract [en]

    Web-based self-management support systems SMSS, can successfully assist a wide range of patients with information and self-management support. O or as a stand-alone service, are e-messages. This study describes how one component of a multi component SMSS, an e-message service, in which patients with breast cancer could direct questions to nurses, physicians or social workers at the hospital where they were being treated, had an influence on safety and continuity of care. Ninety-one dialogues consisting of 284 messages were analysed. The communications between patients and the healthcare team revealed that the e-messages service served as a means for quality assurance of information, for double-checking and for coordination of care. We give examples of how an e-mail service may improve patients' knowledge in a process of taking control over their own care - increasingly important in a time of growing complexity and specialization in healthcare. It remains to be tested whether an e-message service can improve continuity of care and prevent or mitigate medical mishaps.

  • 11.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Cook, Richard
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Expressions of resilience are dependent on investments in systemic degrees of freedom: A case from specialized in-home care2014In: 3rd Nordic Conference on Research in Patient Safety and Quality in Healthcare, 2014Conference paper (Refereed)
  • 12.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Cook, Richard
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    The Stockholm Blizzard 20122014In: Resilience in Health care / [ed] Hollnagel,E.,Braithwaite,J.,Woods,DD, Ashgate, 2014Chapter in book (Other academic)
  • 13.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Dahlgren, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Karolinska institutet, Sweden.
    Säker vård även i hemmet en framtida utmaning2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 22, p. 1-2Article in journal (Refereed)
  • 14.
    Ekstedt, Mirjam
    et al.
    Karolinska Institutet.
    Fagerberg, Ingegerd
    Malardalen University College.
    Lived experiences of the time preceding burnout2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 49, no 1, p. 59-67Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period.

    BACKGROUND: Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non-client work. Role conflict and role ambiguity, or long-term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout.

    METHOD: Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method.

    FINDINGS: The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self-nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self-image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line.

    CONCLUSIONS: The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self-image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of 'cutting off' and thus help to open up for consolation and self-acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals' ability to shelter their need for recovery and restitution.

  • 15.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH).
    Kenttä, Göran
    The Swedish School of Sport and Health Sciences, Sweden.
    Återhämtning självklart för elitidrottare …men inte för yrkesarbetare2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 36, p. 1684-1687Article in journal (Refereed)
  • 16.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Nyberg, Gisela
    Karolinska Institutet.
    Ingre, Michael
    Stockholm University.
    Ekblom, Örjan
    Karolinska Institutet.
    Marcus, Claude
    Karolinska Institutet.
    Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study2013In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 10, no 82Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described. Method: We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds. Results: Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -. 23, P < .01). A negative association between BMIsds and sleep duration was found (-. 10, p < .01). Conclusions: Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.

  • 17.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Stenberg, Una
    Olsson, Mariann
    Ruland, Cornelia M.
    Health Care Professionals' Perspectives of the Experiences of Family Caregivers During In-Patient Cancer Care2014In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 20, no 4, p. 462-486Article in journal (Refereed)
    Abstract [en]

    Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals' perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients' in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals' perceptions of FCs during the patient's in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC's needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient.

  • 18.
    Ekstedt, Mirjam
    et al.
    Karolinska Institutet.
    Söderström, Marie
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Karolinska Institutet.
    Sleep physiology in recovery from burnout2009In: Biological Psychology, ISSN 0301-0511, E-ISSN 1873-6246, Vol. 82, no 3, p. 267-273Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the role of sleep physiology in recovery from burnout, in particular the relation between sleep and changes in fatigue and whether those changes would be related to return to work. 23 white-collar workers on long-term sick leave (>3 months) due to a burnout related diagnosis and 16 healthy controls were subjected to polysomnographic recordings at baseline and after 6-12 months' rehabilitation. Occupational status, subjective sleep quality, fatigue, anxiety and depression were assessed. Recovery from burnout was accompanied by improved sleep continuity. Significant interaction effects were seen for number of arousals, sleep fragmentation, sleep latency, sleep efficiency and time of rising. The burnout group improved significantly on all symptom variables although the post-treatment levels did not reach the levels of the controls. Recovery from fatigue was related to a reduction of the arousal from sleep and was the best predictor of return to work.

  • 19.
    Ekstedt, Mirjam
    et al.
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Karolinska Institutet.
    Söderström, Marie
    Karolinska Institutet.
    Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure2004In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 66, no 6, p. 925-931Article in journal (Refereed)
    Abstract [en]

    Objective: Previous work has demonstrated a link between restricted sleep and risk indicators for cardiovascular and metabolic disease, such as levels of cortisol, lipids, and glucose. The present study sought to identify relations between polysomnographic measures of disturbed sleep (frequency of arousals from sleep, total sleep time, and sleep efficiency) and a number of such indicators. A second purpose was to relate the number of arousals to mood, stress, work characteristics, and other possible predictors in daily life. Methods: Twenty-four people (10 men, 14 women; mean age 30 years), high vs. low on burnout, were recruited from a Swedish IT company. Polysomnographically recorded sleep was measured at home before a workday. Blood pressure, heart rate, morning blood sample, and saliva samples of cortisol were measured the subsequent working day. They were also recorded for diary ratings of sleep and stress, and a questionnaire with ratings of sleep, stress, work conditions, and mood was completed. Results: A stepwise regression analysis using sleep parameters as predictors brought out number of arousals as the best predictor of morning cortisol (serum and saliva), heart rate, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL)-, low-density lipoprotein (LDL)-cholesterol, and LDL/HDL-ratio. Work stress/unclear boundaries between work and leisure time was the best predictor of arousals among the stress variables. Conclusion: Consistent with sleep restriction experiments, sleep fragmentation was associated with elevated levels of metabolic and cardiovascular risk indicators of stress-related disorders. Number of arousals also seems to be related to workload/stress.

  • 20.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Ödegård, Synnöve
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Exploring Gaps in Cancer Care Using a Systems Safety Perspective2015In: Cognition, Technology & Work, ISSN 1435-5558, E-ISSN 1435-5566, Vol. 17, no 1, p. 5-13Article in journal (Refereed)
    Abstract [en]

    Gaps in the continuity of care may appear as losses of information or momentum or as interruptions in the delivery of care. To systematically improve patient safety, we need to know more about how gaps in the continuity of health care are identified and mitigated. This study seeks to describe healthcare professionals’ understanding of how they anticipate, detect and handle gaps in cancer care. Ten focus-group interviews and two individual interviews were conducted with a total of 34 cancer-care professionals (physicians, nurses, managers and administrators)from three counties in mid-Sweden. Various specialties in cancer care were covered: primary care, inhospital care, palliative care, advanced home are, and children’s care. Interviews were analyzed inductively using qualitative content analysis. The results show that patient safety in cancer care is dependent on a resilient organization that is capable of anticipation, monitoring, adapting and learning at all levels of care. The professionals anticipated gaps in situations where contacts between healthcare providers were limited and when they were faced by time or resource constraints. The extent to which aps could be managed by professionals at the sharp end was largely determined by their bility to adapt to complex and unexpected situations in their daily work. The management of gaps was perceived differently by managers and clinicians, however. The study also indicates hat the continuity of care could be improved by patients’ participation in decisions about reatments and care plans, and by a mutual responsibility for the transfer of information and knowledge across professional boundaries. These results are discussed from a resilience ngineering perspective, and they emphasize the management’s responsibility to address gaps identified in the system. Designing resilient healthcare organizations enables professionals at  the sharp end to prevent human error or mitigate its consequences.

  • 21.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Ödegård, Synnöve
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Patients Safety in cancer care from a systems perspective2012In: : The 2nd Nordic Conference in Patient Safety and Healthcare, 2012Conference paper (Refereed)
  • 22. Flink, M.
    et al.
    Lindblad, Marlene
    KTH, School of Technology and Health (STH).
    Frykholm, O.
    Kneck, A.
    Nilsen, P.
    Årestedt, K.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH). Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, School of Health and Caring Sciences, Faculty of Health and Life Sciences Linnaeus University, Kalmar, .
    The Supporting Patient Activation in Transition to Home (sPATH) intervention: A study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e014178Article in journal (Refereed)
    Abstract [en]

    Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management. Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. Trial registration number NCT02823795; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.

  • 23. Frykholm, Oscar
    et al.
    Flink, Maria
    Lindblad, Marlene
    KTH.
    Ekstedt, Mirjam
    KTH. Karolinska Inst, Sweden.
    User-centered design of integrated eHealth to improve patients' activation in transitional care2016In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 16, article id UNSP A338Article in journal (Refereed)
  • 24.
    Grossi, G
    et al.
    Karolinska Institutet.
    Perski, A
    Karolinska Institutet.
    Ekstedt, M
    Karolinska Institutet.
    Johansson, T
    Karolinska Institutet.
    Lindström, M
    Karolinska Institutet.
    Holm, K
    Karolinska Institutet.
    The morning salivary cortisol response in burnout2005In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 59, no 2, p. 103-111Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the present study was to examine the free salivary cortisol response to awakening in men and women reporting low, moderate, and high levels of burnout.

    METHODS: Twenty-two patients on sick leave due to burnout were compared with 22 working participants with low and 20 working participants with intermediate scores on the Shirom-Melamed Burnout Questionnaire (SMBQ), with regard to the free salivary cortisol response to awakening. Saliva samples were collected upon awakening and at +15, +30, and +60 min thereafter.

    RESULTS: Female burnout patients had higher cortisol levels than did the females with low burnout at awakening and at +15, +30, and +60 min after awakening. They also had a greater area under the curve (AUC) for salivary cortisol than did the female participants with low burnout. Male participants with moderate levels of burnout had higher cortisol levels at +60 min after awakening compared with males with low burnout.

    CONCLUSIONS: The results of the present study indicate a dysregulation in hypothalamic-pituitary-adrenocortical axis (HPA axis) activity, characterised by elevated morning salivary cortisol levels, among female burnout patients. Among males, increased cortisol levels were observed among participants with moderate levels of burnout, but not among patients or healthy controls.

  • 25. Gustafson, P.
    et al.
    Ahlberg, J.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Karolinska Institutet, Sweden.
    Lindh, M.
    Härenstam, K. P.
    Rutberg, H.
    Säkrare svensk sjukvård kräver sammanhållet och uthålligt arbete2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 25-26Article in journal (Refereed)
    Abstract [en]

    Despite a development in Swedish patient safety work in recent years, unambiguous results are missing. Here we propose some activities that will result in improved patient safety. Patients and employees are a strong driving force, and should be given a more important role. The level of education in patient safety must be raised in all levels in the system. Efective systems for learning, sharing and follow-up need to be reinforced. The understanding on how the health-care system adapts to varying circumstances, resilience, needs development. The knowledge basis of what constitutes and creates safety in psychiatry, paediatric care, primary care, and in care of the elderly must be developed.

  • 26. Hakanson, Cecilia
    et al.
    Sandberg, Jonas
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Sarenmalm, Elisabeth Kenne
    Christiansen, Mats
    Ohlen, Joakim
    Providing Palliative Care in a Swedish Support Home for People Who Are Homeless2016In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 26, no 9, p. 1252-1262Article in journal (Refereed)
    Abstract [en]

    Despite high frequencies of multiple, life-limiting conditions relating to palliative care needs, people who are homeless are one of the most underserved and rarely encountered groups in palliative care settings. Instead, they often die in care places where palliative competence is not available. In this qualitative single-case study, we explored the conditions and practices of palliative care from the perspective of staff at a Swedish support home for homeless people. Interpretive description guided the research process, and data were generated from repeated reflective conversations with staff in groups, individually, and in pairs. The findings disclose a person-centered approach to palliative care, grounded in the understanding of the person's health/illness and health literacy, and how this is related to and determinant on life as a homeless individual. Four patterns shape this approach: building trustful and family-like relationships, re-dignifying the person, re-considering communication about illness and dying, and re-defining flexible and pragmatic care solutions.

  • 27.
    Heijkenskjöld Bredenhof, K
    et al.
    Mälardalen University.
    Ekstedt, Mirjam
    Mälardalen University.
    Lindwall, Lillemor
    Karlstad University.
    The patient's dignity from the nurse's perspective.2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 3, p. 313-24Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to understand how nurses experience patients' dignity in Swedish medical wards. A hermeneutic approach and Flanagan's critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients' dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, friends, and unique persons with their own history, and have the courage to see when patients' dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients' dignity.

  • 28.
    Ingre, M
    et al.
    Stockholm University, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Sweden.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH). Malardalen University, Sweden.
    Kecklund, G
    Stockholm University, Sweden.
    Periodic self-rostering in shift work: correspondence between objective work hours, work hour preferences (personal fit), and work schedule satisfaction2012In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 38, no 4, p. 327-336Article in journal (Refereed)
    Abstract [en]

    Objectives The main objective of the present study was to investigate relative personal fit as the association between rated needs and preferences for work hours, on the one hand, and actual work hours, on the other hand, in three groups (hospital, call-center, and police) working with periodic self-rostering. We also examined the association between personal fit and satisfaction with the work schedule and preference for a fixed and regular shift schedule, respectively. Methods We collected questionnaire data and objective work hour data over 6-12 months from the computerized self-rostering system. The response rate of the questionnaire was 69% at the hospital and call-center and 98% among the police. In total, 29 433 shifts for 285 shift workers were included in the study. Data was analyzed by means of mixed ANOVA, Kendal tau correlations and ordinal (proportional odds) logistic regression. Results The results show that evening types worked relatively more hours during the evening and night hours compared to morning types as an indication of relative personal fit. Relative personal fit was also found for long shift, short rest, and morning-, evening- and night-shift frequency, but only personal fit related to morning, evening and night-shift was associated with satisfaction with work hours. Reported conflicts at the workplace about work hours and problems with lack of predictability of time for family/leisure activities, was associated with poor satisfaction and a preference for a fixed shift schedule. Conclusions The present study shows that periodic self-rostering is associated with relative personal fit, in particular with respect to night, evening, and morning work. Personal fit seems to be associated with satisfaction with work hours and may be a moderator of tolerance to shift work exposure.

  • 29.
    Kecklund, G
    et al.
    Karolinska Institutet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Akerstedt, T
    Karolinska Institutet.
    Dahlgren, A
    Karolinska Institutet.
    Samuelson, B
    The effects of double-shifts (15.5 hours) on sleep, fatigue and health.2001In: Journal of human ergology, ISSN 0300-8134, Vol. 30, no 1-2, p. 53-8Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate how "double-shifts" (15.5 hours) affects sleep, fatigue and self-rated health. The study was carried out on male construction workers of which 80% were long-distance commuters. The schedule involved two work periods and each work period involved two double shifts in a row. The subjects filled in a sleep/wake diary at 8 times across a year and a questionnaire at 3 times. They also wore an actigraph during one shift cycle. The results showed that sleepiness, and to a certain extent, mental fatigue increased during double shifts and accumulated across days. The short rest time (8.5 hours) between days caused insufficient sleep and approximately 5.5 hours of sleep was obtained between double shifts. Questionnaire data showed that complaints of insufficient sleep, exhaustion on awakening and pain symptoms increased across the year. It was concluded that a shift system involving double shifts has a negative effect on fatigue, recovery and health-related well-being.

  • 30.
    Liljeroos, M.
    et al.
    Mälardalen University, Sweden.
    Snellman, I.
    Mälardalen University, Sweden.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH).
    A Qualitative Study on The Role of Patient–Nurse Communication in Acute Cardiac Care2011In: Journal of Nursing Education and Practice, ISSN 1925-4040, Vol. 1, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to illuminate the meaning of the patient–nurse communication during a hospital stay as narrated by patients after a myocardial infarction, MI.

    Methods: Narrative interviews from 10 patients were analyzed, using a phenomenological-hermeneutic method.

    Results: The nursing dialogue meant a safe mooring point on the trajectory from initial chaos after a MI to a reoriented life. Nurses’ presence and availability for non-verbal and verbal communication created a trustful relationship where new knowledge was acquired and motivational strength for life-style changes was mobilized. A person-centered perspective was preferred, where relatives were invited into the conversation.

    Conclusions: These results highlight that patient–nurse communication based on the patient’s view is possible in acute care after MI, and is an issue of attitude rather than time. Trust lays the foundation for a person-centered communication and is developed through the nurse’s presence and availability not only in the emergency phase, but throughout hospitalization. Discussions focused on personal action plans with emphasis on the patient’s health assets may facilitate a successful rehabilitation.

  • 31. Lindblad, M
    et al.
    Cook, Richard
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Creating Safe Care in the Private Homes of People with Complex Care Needs: A systems perspective2014Conference paper (Refereed)
  • 32. Näverlo, S.
    et al.
    Carson, D. B.
    Edin-Liljegren, A.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Patient perceptions of a Virtual Health Room installation in rural Sweden2016In: Rural and remote health, ISSN 1445-6354, Vol. 16, no 4, article id 3823Article in journal (Refereed)
    Abstract [en]

    Introduction: The Virtual Health Room (VHR) is an ehealth initiative in the village of Slussfors in northern Sweden. Construction of VHRs in other locations is taking place, and the Centre for Rural Medicine in the Västerbotten County Council primary care department has implemented a VHR evaluation framework. This research focuses on evaluation of patient perceptions of the usability of the VHR and its contribution to their health care. Methods: Nineteen of the 25 unique users of the VHR during 2014/15 completed a survey asking about their attitudes to their own health (using the 13-question version of the Patient Activation Measure (PAM)), their demographic attributes, and their satisfaction with their visit to the VHR. Results: Respondents with lower PAM scores were less satisfied with the technical performance of the VHR, but equally likely to think the VHR made a good contribution to access to health care. In contrast, older patients were less likely to value the contribution of the VHR, but no less likely to be satisfied with its technical performance. There were no relationships between level of education and distance travelled and perceptions of the VHR. Conclusions: The research clearly demonstrated the distinction between technical performance of an ehealth initiative and its overall contribution to health care and access. Evaluation frameworks need to consider both aspects of performance. Transferability of these findings to other settings may depend at least in part on the nature of the catchment area for the VHR, with the Slussfors catchment being quite small and the impact of distance on access consequently limited.

  • 33. Oksholm, T.
    et al.
    Röstuen, T.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    It is risky to be in "the gap"2011Conference paper (Refereed)
  • 34. Oxholm, T.
    et al.
    Rustöen, T.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    Post-surgical transfer between hospitals is a risk situation for lung cancer patients2014Conference paper (Refereed)
  • 35.
    Sobko, Tanja
    et al.
    Karolinska Institutet.
    Svensson, Viktoria
    Karolinska Institutet.
    Ek, Anna
    Karolinska Institutet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Karlsson, Håkan
    Karolinska Institutet.
    Johansson, Elin
    Karolinska Institutet.
    Cao, Yingting
    Karolinska Institutet.
    Hagströmer, Maria
    Karolinksa Institutet.
    Marcus, Claude
    Karolinska Institutet.
    A randomised controlled trial for overweight and obese parents to prevent childhood obesity: Early STOPP (STockholm Obesity Prevention Program)2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overweight and obesity have a dramatic negative impact on children's health not only during the childhood but also throughout the adult life. Preventing the development of obesity in children is therefore a world-wide health priority. There is an obvious urge for sustainable and evidenced-based interventions that are suitable for families with young children, especially for families with overweight or obese parents. We have developed a prevention program, Early STOPP, combating multiple obesity-promoting behaviors such unbalanced diet, physical inactivity and disturbed sleeping patterns. We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents. This protocol outlines methods for the recruitment phase of the study.

    DESIGN AND METHODS: This randomized controlled trial (RCT) targets overweight and/or obese parents with infants, recruited from the Child Health Care Centers (CHCC) within the Stockholm area. The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach (dietitian, physiotherapist or a nurse). The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC, which include advices on healthy food choices and eating patterns, increasing physical activity/reducing sedentary behavior and regulating sleeping patterns.

    DISCUSSION: The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population, defining a feasible, theory-based intervention and assessing multiple measurements to validate and interpret the program effectiveness. The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge, this longitudinal RCT is the first attempt to demonstrate whether an early, long-term, targeted health promotion program focusing on healthy eating, physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective. If proven so, Early STOPP may protect children from the development of overweight and obesity.

    TRIAL REGISTRATION: The protocol for this study is registered with the clinical trials registry clinicaltrials.gov, ID: ES-2010).

  • 36. Stenberg, U.
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Oslo University Hospital, Norway.
    Olsson, Mariann
    Ruland, Cornelia
    Living Close to a Person With Cancer: A Review of the International Literature and Implications for Social Work Practice2014In: Journal of gerontological social work, ISSN 0163-4372, E-ISSN 1540-4048, Vol. 57, no 6-7, p. 531-555Article, review/survey (Refereed)
    Abstract [en]

    To help family caregivers (FCs), social workers need to understand the complexity of FC's experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC's own health risk, caregiver burden, and experiences over time can enhance a social worker's awareness of an FC's challenging situation and the potential impact this has on the FC's ability to provide care to the patient.

  • 37. Stenberg, U.
    et al.
    Ruland, C.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering.
    Olsson, M.
    Kreftsykepleie2013In: Pårörendes utfordringer / [ed] Stenberg, U, 2013, p. 12-17Chapter in book (Other academic)
  • 38. Stenberg, Una
    et al.
    Cvancarova, Milada
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Olsson, Mariann
    Ruland, Cornelia
    Family Caregivers of Cancer Patients: Perceived Burden and Symptoms During the Early Phases of Cancer Treatment2014In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 53, no 3, p. 289-309Article in journal (Refereed)
    Abstract [en]

    This study investigated levels of symptoms, caregiver burden, and changes over time in 278 family caregivers (FC) of cancer patients. FCs experienced high levels of depressive symptoms and sleep disturbance, low levels of fatigue, and low to moderate levels of caregiver burden, yet these symptoms remained relatively stable over time. Being female and not being employed were factors associated with an increased risk of symptoms and caregiver burden. The understanding evolving from this study can enhance social- and health care professionals' awareness of FCs' challenging situation and the potential impact this has on the FCs' ability to provide care to the patient.

  • 39.
    Stenberg, Una
    et al.
    Oslo University Hospital, Norway; University of Oslo, Norway.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH). Oslo University Hospital, Norway.
    Ruland, Cornelia
    Oslo University Hospital, Norway; University of Oslo, Norway.
    Olsson, Mariann
    Karolinska Institutet, Sweden.
    To Live Close To A Person With Cancer - Experiences Of Family Caregivers2012Conference paper (Refereed)
  • 40.
    Stenberg, Una
    et al.
    Oslo University Hospital, Norway.
    Ruland, Cornelia
    Oslo University Hospital, Norway; University of Oslo, Norway.
    Olsson, Mariann
    Karolinska Institutet, Sweden.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH). Oslo University Hospital, Norway.
    To Live Close to a Person With Cancer-Experiences of Family Caregivers2012In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 51, no 10, p. 909-926Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to obtain a deeper understanding of the experiences of Family Caregivers (FC) living close to a patient with cancer. This article reports on the findings from individual interviews with 15 FCs of patients with cancer. The interview transcripts were analyzed using qualitative hermeneutic analysis. This study revealed that living close to a cancer patient over the course of his or her illness affected many aspects of FCs lives in significant ways. Their experiences can be summarized with two major themes: (1) living in an ever changing life world and (2) balancing between conflicting interests and dilemmas. This study contributed to deeper insights into FC's experiences than previously reported in the literature.

  • 41. Svensson, V.
    et al.
    Ek, A.
    Forssén, M.
    Ekbom, K.
    Cao, Y.
    Ebrahim, M.
    Johansson, E.
    Nero, H.
    Hagströmer, M.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Nowicka, P.
    Marcus, C.
    Infant growth is associated with parental education but not with parental adiposity - Early Stockholm Obesity Prevention Project2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 4, p. 418-425Article in journal (Refereed)
    Abstract [en]

    AimTo explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12months, adjusting for known early-life risk factors for subsequent childhood obesity. MethodsBaseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n=144/53) and parental education (n=57/139). Observational data on infant growth between 0 and 12months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12months and rapid weight gain 0-6months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking. ResultsRelative weight at 3, 6 and 12months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education. ConclusionLow parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year.

  • 42.
    Söderström, M.
    et al.
    Karolinska Institutet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Åkerstedt, T.
    Karolinska Institutet.
    Nilsson, Jens
    Karolinska Institutet.
    Axelsson, John
    Karolinska Institutet.
    Sleep and sleepiness in young individuals with high burnout scores2004In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 27, no 7, p. 1369-1377Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Burnout is a growing health problem in Western society. This study aimed to investigate sleep in subjects scoring high on burnout but still at work. The purpose was also to study the diurnal pattern of sleepiness, as well as ratings of work stress and mood in groups with different burnout scores. Design: Sleep was recorded in 2 groups (high vs low on burnout) during 2 nights; 1 before a workday and 1 before a day off, in a balanced order. Sleepiness ratings as well as daytime diary ratings were analyzed for the workday and the day off after the sleep recordings. Setting: The polysomnographic recordings were made in the subjects' home. Participants: Twenty-four healthy individuals (14 women and 10 men) between the ages of 24 and 43 years participated. Interventions: N/A. Measurements and Results: A higher frequency of arousals during sleep (Workday: high burnout = 12 +/- 1 per hour, low burnout = 8 +/- 1 per hour; Day off: high burnout = 12 2 per hour, low burnout = 8 +/- 1 per hour), and more subjective awakening problems were found in the high-burnout group. The diurnal pattern of sleepiness indicated that the high-burnout group did not recover in the same way as did the low-burnout group on the day off. Indicators of impaired recovery were also seen within the high-burnout group as a higher degree of bringing work home and working on weekends, as well as more complaints of work interfering with leisure time. Conclusions: Young subjects with high burnout scores, but who are still working, show more arousals during sleep and an absence of reduced sleepiness during days off.

  • 43.
    Söderström, Marie
    et al.
    Karolinska Institutet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Akerstedt, Torbjörn
    Karolinska Institutet.
    Weekday and weekend patterns of diurnal cortisol, activation and fatigue among people scoring high for burnout2006In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, ISSN 0355-3140, no 2, p. 35-40Article in journal (Refereed)
    Abstract [en]

    Objectives The present pilot study attempted to investigate the diurnal pattern of cortisol, subjective activation, and mental fatigue among workers scoring high for burnout. The purpose was also to relate the cortisol data to objective sleep data. Methods One group with high (N=9) burnout scores and one with low (N=11) such scores were compared during a workday and a day off. Results The high-burnout group showed higher awakening cortisol during the workday than during the weekend. They also showed higher ratings for activation and mental fatigue during the weekend than the low-burnout group. A higher frequency of arousals during the prior sleep was associated with a higher diurnal amplitude and an earlier diurnal peak of cortisol during the workday. Conclusions The present results, which, due to the small sample size, should be interpreted with caution, may indicate that stress-induced frequency of arousal during sleep could contribute to the diurnal amplitude of cortisol. Furthermore, increased activation and mental fatigue during the weekend may reflect impaired recovery, which is of possible importance in the burnout process.

  • 44.
    Söderström, Marie
    et al.
    Karolinska Institutet, Sweden.
    Jeding, Kerstin
    Stockholm University, Sweden.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH).
    Perski, Aleksander
    Stockholm University, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Sweden; Karolinska Institutet, Sweden.
    Insufficient sleep predicts clinical burnout2012In: Journal of Occupational Health Psychology, ISSN 1076-8998, E-ISSN 1939-1307, Vol. 17, no 2, p. 175-183Article in journal (Refereed)
    Abstract [en]

    The present prospective study aimed to identify risk factors for subsequent clinical burnout. Three hundred eighty-eight working individuals completed a baseline questionnaire regarding work stress, sleep, mood, health, and so forth. During a 2-year period, 15 subjects (7 women and 8 men) of the total sample were identified as "burnout cases," as they were assessed and referred to treatment for clinical burnout. Questionnaire data from the baseline measurement were used as independent variables in a series of logistic regression analyses to predict clinical burnout. The results identified "too little sleep (<6 h)" as the main risk factor for burnout development, with adjustment for "work demands," "thoughts of work during leisure time," and "sleep quality." The first two factors were significant predictors in earlier steps of the multivariate regression. The results indicate that insufficient sleep, preoccupation with thoughts of work during leisure time, and high work demands are risk factors for subsequent burnout. The results suggest a chain of causation.

  • 45. Varsi, C.
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Oslo University Hospital, Norway.
    Gammon, D.
    Børøsund, E.
    Ruland, C. M.
    Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice2015In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 33, no 6, p. 249-257Article in journal (Refereed)
    Abstract [en]

    The role of nurse and physician managers is considered crucial for implementing eHealth interventions inclinical practice, but fewstudieshaveexplored this. The aim of the current study was to examine the perceptions of nurse and physicianmanagers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physicianmanagers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.

  • 46.
    Varsi, Cecilie
    et al.
    Oslo University Hospital.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH).
    Elin Börösund, Cornelia
    Oslo University Hospital.
    Gammon, Deede
    Oslo University Hospital.
    Ruland, Cornelia
    Oslo University Hospital.
    Barriers Related To The Implementation Of An Informatics Intervention Into Regular Clinical Practice: A Leadership Perspective2012In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 43, p. S197-S197Article in journal (Other academic)
  • 47. Varsi, Cecilie
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Oslo University Hospital, Norway.
    Gammon, Deede
    Ruland, Cornelia M.
    Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study2015In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 17, no 11, article id e262Article in journal (Refereed)
    Abstract [en]

    Background: Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective: The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods: This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results: Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers' beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions: The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR's strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions.

  • 48.
    Wibe, T.
    et al.
    Oslo University.
    Ekstedt, Mirjam
    Oslo University Hospital.
    Hellesø, R.
    Oslo University.
    Slaughter, L.
    Oslo University.
    Why do people want a paper copy of their electronic patient record?2010In: 13th World Congress on Medical and Health Informatics, Medinfo 2010, 2010, Vol. 160, no Pt 1, p. 676-680Conference paper (Refereed)
    Abstract [en]

    Changes have recently been passed in the Norwegian legislation, allowing for more exchange of patient information between health personnel. These legal changes came as a result of a long and still ongoing debate concerning the potential conflict between confidentiality issues and patient safety as health care is getting more fragmented. At the same time, an increasing number of patients now make use of their legal right to access their patient record. In this paper, we shed light on some of the reasons why patients request a copy of their record. We report the preliminary results from an interview study in which seventeen patients who have asked for a copy of their patient record following a hospital stay have been interviewed. In our interview study, securing transmission of information between health care workers is one of the main reasons for requesting a copy of the record. We will discuss how this finding might contribute to the ongoing debate.

  • 49.
    Wibe, T.
    et al.
    Oslo University.
    Hellesø, R.
    Oslo University.
    Slaughter, L.
    Oslo University.
    Ekstedt, Mirjam
    Oslo University.
    Lay people's experiences with reading their medical record2011In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 72, no 9, p. 1570-1573Article in journal (Refereed)
    Abstract [en]

    An increasing number of patients now make use of their legal right to read their medical record. We report findings from a study in which we conducted qualitative interviews with 17 Norwegian adult patients about their experiences of requesting a copy of their medical record following a hospital stay. Interviews took place between May, 2008 and April 2009. The analytical process, guided by qualitative content analysis, identified two main themes; "keeping a sense of control" and "not feeling respected as a person". The informants' experiences with reading their own medical record were often connected to their experiences in direct communication with health care professionals during the hospital stay, revealing a delicate interaction between trust and power. The informants were hoping for a more mutual exchange of information and knowledge from which they could benefit in the management of their own health. We conclude that to meet patients' expectations of mutuality, health care professionals in hospitals need to be more conscious about their attitudes and communication skills as well as how they exercise their power to define the patient's situation. At the same time, there should be more focus on how structural changes in the organization of hospitals may have impaired the capacity of health care professionals to meet these expectations. In the future, greater attention should also be paid to information exchange to avoid placing unreasonable responsibility on the patient to compensate for deficits in the health care system.

  • 50. Wibe, Torunn
    et al.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Hellesö, Ragnhild
    Information Practices of health care professionals related to patient discharge from hospital2014In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the practices of hospital professionals in providing information to patients and to professionals in primary care at patient discharge from hospital.

    Methods: We used a qualitative methodology with individual face-to-face interviews with 22 hospital physicians and nurses.

    Results: We identified two themes in the information practices of health care professionals at patient discharge from hospital: (i) producing information in parallel processes and (ii) challenges in tailoring information to different recipients.

    Conclusion: Hospital routines and professional norms prescribing that discharge information should take place in parallel processes by hospital physicians and by nurses impede transparency and interdisciplinary coordination in primary care. A strong focus on providing patients only with information that is tailored for them neglects the interest patients may have in seeing what information about them is transmitted to primary care.

    Practice implications: Hospital routines and professional culture are important factors to consider in efforts to promote more transparent health care for patients and improved interdisciplinary communication. This is not only a matter of attitudes in the individual health care professional. In the development of solutions for electronic exchange of information in health care, all these factors should be taken into account.

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