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Aamodt, Ina Thon
Oslo Univ Hosp Ulleval, Norway; Univ Oslo, Norway.
Lycholip, Edita
Vilnius Univ, Lithuania.
Celutkiene, Jelena
Strömberg, Anna
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Atar, Dan
Oslo Univ Hosp, Norway; Univ Oslo, Norway.
Falk, Ragnhild Sorum
Oslo Univ Hosp, Norway.
von Lueder, Thomas
Helleso, Ragnhild
Univ Oslo, Norway.
Jaarsma, Tiny
Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Lie, Irene
Oslo Univ Hosp Ulleval, Norway.
Health Care Professionals Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 2, article id e10362 Article in journal (Refereed)
Background: Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim of this study was to describe health care professionals (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. Results: This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.
Agren, Susanna
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Luttik, ML
Caregiving tasks and caregiver burden over time: effects of an intervention for patients with post-operative heart failure and their partners.2014Conference paper (Refereed)
Aidemark, Jan
Linnaeus University, Sweden.
Askenas, Linda
Martensson, Jan
Jonköping University, Sweden.
Challenges for Heart Failure Patients Self-Care Systems Analysis of Patients Needs2014In: CENTERIS 2014 - CONFERENCE ON ENTERPRISE INFORMATION SYSTEMS / PROJMAN 2014 - INTERNATIONAL CONFERENCE ON PROJECT MANAGEMENT / HCIST 2014 - INTERNATIONAL CONFERENCE ON HEALTH AND SOCIAL CARE INFORMATION SYSTEMS AND TECHNOLOGIES, Elsevier, 2014, Vol. 16, p. 1256-1264Conference paper (Refereed)
Self-care is important for heart failure patients. However, what are the views of patients on their situation when it comes to realizing self-care? The aim of the paper is to investigate the self-care needs of HF patients, by understanding the issues they embrace in their self-care processes. In this paper we make a review of 17 interviews and make a classification of what the needs are for possible information technology support systems. Based on the analysis of these interviews, we identify the diversity of needs in support of activities related to different background conditions and the dynamics of change of learning and changes in the heart failure condition. The contribution of the paper is a framework for understanding the diversity of needs and the specific situations of this group of patients.
Nygardh, Anette
User involvement in the co-design of self-care support systems for heart failure patients2015In: CONFERENCE ON ENTERPRISE INFORMATION SYSTEMS/INTERNATIONAL CONFERENCE ON PROJECT MANAGEMENT/CONFERENCE ON HEALTH AND SOCIAL CARE INFORMATION SYSTEMS AND TECHNOLOGIES, CENTERIS/PROJMAN / HCIST 2015, ELSEVIER SCIENCE BV , 2015, Vol. 64, p. 118-124Conference paper (Refereed)
In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users input, which are discussed in the context of previous research on benefits of user contributions in systems development. (C) 2015 The Authors. Published by Elsevier B.V.
Allemann, Hanna
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Sue and Bill Gross School of Nursing, University of California Irvine, USA.
Thylén, Ingela
Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 6, p. E1-E8Article in journal (Refereed)
BACKGROUND: The links between chronic illness, psychological well-being, and social support have previously been established. Social isolation and loneliness have shown an increased mortality risk for those with heart failure (HF). Increasingly more people with HF are living with an implantable cardioverter defibrillator (ICD), but only a few small-scale studies have focused on social support in this population.
OBJECTIVE: The aim of this study was to explore factors related to perceived social support in a large cohort of individuals with HF living with an ICD.
METHODS: All eligible adult ICD recipients in the Swedish ICD registry were invited to participate in this cross-sectional study. For this analysis, those with HF and complete data on perceived social support were included (N = 1550; age, 67.3 (SD, 9.8) years; 19.5% female).
RESULTS: Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity were not related to the outcome.
CONCLUSION: One in five participants reported low/medium social support. Our study underlines the complex relationships between perceived social support, psychological well-being and perceived control over the heart condition. Multiple aspects need to be taken into account when developing interventions to provide psychosocial support and optimize outcomes in this patient group.
Ågren, Susanna
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Liljeroos, Maria
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
Perceptions of Information and Communication Technology as Support for Family Members of Persons With Heart Failure: Qualitative Study2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 7, article id e13521 Article in journal (Refereed)
Background: Heart failure (HF) affects not only the person diagnosed with the syndrome but also family members, who often have the role of informal carers. The needs of these carers are not always met, and information and communications technology (ICT) could have the potential to support them in their everyday life. However, knowledge is lacking about how family members perceive ICT and see opportunities for this technology to support them. Objective: The aim of this study was to explore the perceptions of ICT solutions as supportive aids among family members of persons with HF. Methods: A qualitative design was applied. A total of 8 focus groups, comprising 23 family members of persons affected by HF, were conducted between March 2015 and January 2017. Participants were recruited from 1 hospital in Sweden. A purposeful sampling strategy was used to find family members of persons with symptomatic HF from diverse backgrounds. Data were analyzed using qualitative content analysis. Results: The analysis revealed 4 categories and 9 subcategories. The first category, about how ICT could provide relevant support, included descriptions of how ICT could be used for communication with health care personnel, for information and communication retrieval, plus opportunities to interact with persons in similar life situations and to share support with peers and extended family. The second category, about how ICT could provide access, entailed how ICT could offer solutions not bound by time or place and how it could be both timely and adaptable to different life situations. ICT could also provide an arena for family members to which they might not otherwise have had access. The third category concerned how ICT could be too impersonal and how it could entail limited personal interaction and individualization, which could lead to concerns about usability. It was emphasized that ICT could not replace physical meetings. The fourth category considered how ICT could be out of scope, reflecting the fact that some family members were generally uninterested in ICT and had difficulties envisioning how it could be used for support. It was also discussed as more of a solution for the future. Conclusions: Family members described multiple uses for ICT and agreed that ICT could provide access to relevant sources of information from which family members could potentially exchange support. ICT was also considered to have its limitations and was out of scope for some but with expected use in the future. Even though some family members seemed hesitant about ICT solutions in general, this might not mean they are unreceptive to suggestions about their usage in, for example, health care. Thus, a variety of factors should be considered to facilitate future implementations of ICT tools in clinical practice.
Andreae, Christina
Arestedt, Kristofer
Linnaeus Univ, Sweden; Res Sect, Sweden.
Evangelista, Lorraine
Univ Calif Irvine, CA USA.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Univ Calif Irvine, CA USA.
The relationship between physical activity and appetite in patients with heart failure: A prospective observational study2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 5, p. 410-417Article in journal (Refereed)
Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II-IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps (p = 0.019) and the six-minute walk test (p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps (p = 0.001) and metabolic equivalent daily averages (p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.
Franzén Årestedt, Kristofer
Sweden Lorraine Evangelista, RN, Prof, University of California, Irvine, CA, USA.
The associations between physical activity and appetite in patients with heart failure – a prospective observational study2018Conference paper (Refereed)
Introduction: Physical activity and appetite both play a crucial role for health outcomes and quality of life in patients with heart failure. Nevertheless, both of these key functions are frequently decreased in patients with heart failure. Whilst most attention focuses independently on the physical activity levels, the associations with appetite has been insufficiently investigated. The aim was therefore to explore the associations between physical activity and appetite in community dwelling heart failure patients.
Methods: This prospective observational study consisted of 186 patients with symptomatic heart failure of whom 56 (30%) were women and 130 (70%) were men. Mean age was 70.7 (SD=11 years), the majority had NYHA-class II, 114 (63%). Objective and subjective methods were used to measure physical activity include a wearable actigraph (SenceWear) for 4 days and six minutes' walk test. The actigraph calculate total energy expenditure, active energy expenditure, number of steps and METs daily average index. Patients also stated their physical activity level on a numeric rating scale. A self-reported questionnaire, the Council on Nutrition Appetite Questionnaire was used to assess appetite. Simple linear regression was conducted to explore the associations between physical activity and appetite at baseline and at 18-month follow-up.
Results: In general, the levels of physical activity in this sample was low and appetite was poor. There was a significant association between objective physical activity measures and appetite at baseline ranging between (p=<0.001-0.041). The number of steps and walking distance had the strongest association, each explaining 6% and 7% of the total variance in appetite. At the 18-month follow-up, all objective and subjective physical activity measures were associated with appetite (p=0.001-0.035) with the number of steps being most strongly associated (p=<0.001) explaining 14% of the total variation in appetite.
Conclusions: Patients with heart failure who are more physically active experiences better appetite. These findings underscore the importance of placing greater attention on both physical activity and appetite in clinical practice as these factors has implications for patient's health outcomes. Further longitudinally oriented studies are needed to determine whether there is a causal relationship between physical activity and appetite in heart failure populations.
Keywords: Appetite, Heart Failure, Physical activity
The associations between physical activity and appetite in patients with heart failure – a prospective observational study
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
The assosciation between depressive symptoms and appetite among patients with chronic heart failure2012Conference paper (Other academic)
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
Chung, Misook L
College of Nursing, University of Kentucky, Lexington, USA.
Hjelm, Carina
Årestedt, Kristofer
Linnaeus University, Kalmar, Kalmar County Hospital, Kalmar Sweden.
Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 2, p. E15-E20Article in journal (Refereed)
BACKGROUND: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status.
OBJECTIVE: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association.
METHODS: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status.
RESULTS: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001).
CONCLUSIONS: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.
Chung, Misook
College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
Lennie, Terry
Depressive symptoms as a moderator and mediator of the relationship between physical activity, appetite and perceived health among patients with heart failure2015Conference paper (Other academic)
Purpose: Depressive symptoms have been shown to directly influence perceived health among persons with heart failure (HF). Decreased physical activity and appetite may also be predictive of poor perceived health.The purposes of this study were to determine whether appetite and physical activity predicted perceived health, and to determine whether depressive symptoms mediated or moderated their relationship with perceived health.
Methods: A total of 184 patients with mild to severe HF were included. Appetite, depressive symptoms and perceived health were measured by self-report questionnaires (Council on Nutrition Appetite Questionnaire, Patient Health Questionnaire and EuroQol 5D index). Physical activity was measured by SenceWearTM for 6 days. A separate series of multiple linear regression analyses were run to determine whether depressive symptoms mediated or moderated the relationship between physical activity and perceived health, and between appetite and perceived health.
Results: Higher physical activity predicted better perceived health (ß=0.202, p=.006) but the strength of the association decreased (ß=0.13, p=.048) when depressive symptoms were included in the model. There was a significant mediation effect for depressive symptoms on perceived health (sobel=2.03, p=.041) (Fig 1). Appetite was a significant predictor of perceived health. Examination of this association among those with and without depressive symptoms, however showed positive association between appetite and perceived health remained only for patients without depressive symptoms demonstrating a moderating effect (p<.001) (Fig 2).
Conclusion: Identifying and treating depression simultaneously while addressing appetite and physical activity may be key to improving perceived health among persons with HF.
Factors influencing nutritional status in chronic heart failure2011Conference paper (Refereed)
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Uppsala University, Sweden.
Sawatzky, Richard
Trinity Western University, Canada; Centre Health Evaluat and Outcome Science, Canada.
Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015)2016In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 3, p. 245-245Article in journal (Other academic)
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
Trinity Western University, Canada; Providence Health Care Research Institute, Canada.
Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure2015In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 21, no 12, p. 954-958Article in journal (Refereed)
Background: Decreased appetite in heart failure (HF) may lead to undemutrition which could negatively influence prognosis. Appetite is a complex clinical issue that is often best measured with the use of self-report instruments. However, there is a lack of self-rated appetite instruments. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are validated instruments developed primarily for elderly people. Yet, the psychometric properties have not been evaluated in HF populations. The aim of the present study was to evaluate the psychometric properties of CNAQ and SNAQ in patients with HE Methods and Results: A total of 186 outpatients with reduced ejection fraction and New York Heart Association (NYHA) functional classifications II-IV were included (median age 72 y; 70% men). Data were collected with the use of a questionnaire that included the CNAQ and SNAQ. The psychometric evaluation included data quality, factor structure, construct validity, known-group validity, and internal consistency. Unidimensionality was supported by means of parallel analysis and confirmatory factor analyses (CFAs). The CFA results indicated sufficient model fit. Both construct validity and known-group validity were supported. Internal consistency reliability was acceptable, with ordinal coefficient alpha estimates of 0.82 for CNAQ and 0.77 for SNAQ. Conclusions: CNAQ and SNAQ demonstrated sound psychometric properties and can be used to measure appetite in patients with HF.
Caring for appetite among patients with chronic heart failure - the extent of appetite and associated factors in outpatient clinic settings2013Conference paper (Refereed)
Factors associated with appetite among patients with symptomatic heart failure2014Conference paper (Other academic)
Institutionen för hälso- och vårdvetenskap, Linnéuniversitetet, Kalmar, Sweden.
Predictors for appetite among patients with chronic heart failure2013Conference paper (Other academic)
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden.
Prevalence and associated factors for decreased appetite among patients with stable heart failure2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1703-1712Article in journal (Refereed)
Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. DesignObservational, cross-sectional study. MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.
Evangelista, Lorraine L
Sue and Bill Gross School of Nursing, University of California, Irvine, CA,.
Physical activity and appetite in patients with stable heart failure – A cross sectional study2017Conference paper (Refereed)
Sue and Bill Gross School of Nursing, University of California, Irvine, CA.
Sedentary lifestyle is associated with poor appetite in patients with heart failure.2017Conference paper (Refereed)
Arestedt, K
Linnaeus University.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Inger Flemme, I F
Halmstad University.
Bedbra Moser, D M
University Kentucky.
Psychometric properties of the swedish version of the Control Attitudes Scale (CAS) for patients with cardiac disease and their partners in EUROPEAN HEART JOURNAL, vol 31, issue , pp 230-2302010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 230-230Conference paper (Refereed)
Axelsson, Asa
Gothenburg University.
Thoren, A B
Växjö University.
Aune, S
Sahlgrens University Hospital.
Fridlund, B
Jönköping University.
Moons, P
Catholic University Louvain.
Martensson, J
Smith, K
University of Dundee.
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Thompson, D R
University of Leicester.
Norekval, T M
Haukeland Hospital.
European cardiovascular nurses and allied professions practical skills in cardiopulmonary resuscitation2009In: in CARDIOLOGY, vol 113, 2009, Vol. 113, p. 118-118Conference paper (Refereed)
Axelsson, Åsa B
Fridlund, Bengt
Vaxjö University.
Moons, Philip
Catholic University of Louvain.
Jonköping University.
Scholte op Reimer, Wilma
University Amsterdam.
Smith, Karen
Thompson, David R
Norekval, Tone M
European cardiovascular nurses experiences of and attitudes towards having family members present in the resuscitation room2010In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, ISSN 1474-5151, Vol. 9, no 1, p. 15-23Article in journal (Refereed)
Purpose: To investigate cardiovascular nurses experiences of and attitudes towards the presence of family members during resuscitation of adult patients. Methods: A 36-item questionnaire exploring the experiences of and attitudes towards family members being present in the resuscitation room was distributed to a convenience sample of nurses attending three national and one international cardiovascular nursing conferences held in Europe during 2007. Results: Of 820 questionnaires distributed, 411(50%) completed ones were returned. Of these 411 respondents, 178 (44%) had experienced at least one situation of families being present. Positive (23%) and negative (21%) experiences of family presence were equally distributed. Only 28 (7%) respondents stated that their unit had a protocol covering family presence. Nurses in Ireland (n=30; 59%) and the UK (n=18; 55%) were most likely to have experienced family presence and protocols relating to this were most commonly found in the UK (n=4; 14%). Conclusion: Less than half of the included European cardiovascular nurses had experienced a situation of families being present during resuscitation and protocols pertaining to this were rare. There was no clear attitude towards family presence, though experience in nursing made nurses more favourable towards it.
Ben Gal, Tuvia
Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University.
Perkiö Kato, Naoko
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
Yaari, Vicky
Avraham, Ben
Klompstra, Leonie
Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale2019In: Heart, Lung and Circulation, ISSN 1443-9506, E-ISSN 1444-2892, article id S1443-9506(19)31523-9Article in journal (Refereed)
BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.
AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.
METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.
RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.
CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.
Berben, L.
University of Basel, Switzerland .
Bogert, L
Leventhal, M. E.
Hälsohögskolan i Jönköping.
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Norekvål, T. M.
Haukeland University Hospital, Norway .
Ninewells Hospital, UK .
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
Thompson, David
Australian Catholic University, Melbourne.
De Geest, Sabine
Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice2011Conference paper (Refereed)
Berben, Lut
University of Basel, Switzerland.
Bogert, Laura
Leventhal, Marcia E
Jönköping University, Sweden.
Haukeland University Hospital, Norway.
Ninewells Hospital, UK.
De Geest, Sabina
Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 1, p. 14-21Article in journal (Refereed)
Background: Complex medication regimens are often required to manage cardiovascular diseases. As non-adherence, which can have severe negative outcomes, is common among cardiovascular patients, various interventions to improve adherence should be implemented in daily practice.
Aim: To assess which strategies cardiovascular nurses and allied health professionals utilize to (1) assess patients' adherence to medication regimen, and (2) enhance medication adherence via educational/cognitive, counseling/behavioral, and psychological/affective interventions.
Method: A 45-item questionnaire to assess adherence assessment and interventional strategies utilized by health care professionals in daily clinical practice was distributed to a convenience sample of attendants of the 10th Annual Spring Meeting of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions conference in Geneva (Switzerland) in March 2010. Respondents not in direct clinical practice were excluded. Descriptive statistics were used to describe practice patterns regarding adherence management.
Results: Of 276 distributed questionnaires, 171 (62%) were returned, of which 34 (20%) were excluded as respondents performed no direct patient care. Questioning patients about non-adherence during follow-up was the most frequently reported assessment strategy (56%). Educational/cognitive adherence enhancing interventions were used most frequently, followed by counseling/behavioral interventions. Psychological/affective interventions were less frequently used. The most frequent intervention used was providing reading materials (66%) followed by training patients regarding medication taking during inpatient recovery (48%). Slightly over two-thirds (69%) reported using a combination of interventions to improve patient's adherence.
Conclusion: Educational interventions are used most in clinical practice, although evidence shows they are less effective than behavioral interventions at enhancing medication adherence.
Blackburn, S
Adelphi Values, England .
Humphrey, L
Maguire, L
Deschasaux, C
Novartis, Switzerland .
The Caregiver Burden Questionnaire for Chronic Heart Failure (CBQ-CHF): Development and Validation in JOURNAL OF CARDIAC FAILURE, vol 18, issue 8, pp S83-S832012In: JOURNAL OF CARDIAC FAILURE, Elsevier , 2012, Vol. 18, no 8, p. S83-S83Conference paper (Refereed)
Bolse, K
Johansson, Ingrid
Organisation of care for swedish patients with an implantable cardioverter defibrillator, a national survey in EUROPEAN HEART JOURNAL, vol 31, issue , pp 236-2362010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 236-236Conference paper (Refereed)
Bolse, Kärstin
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Johansson, Ingela
Experiences of delivering care to patients with an Implantable Cardioverter Defibrillator from the perspective of health care professionalsManuscript (preprint) (Other academic)
Objective: To describe healthcare professionals' experiences of delivering care to patients with an Implantable Cardioverter Defibrillator (ICD).
Methods: A qualitative, descriptive design based on a phenomenographic approach. Data was collected between October and December 2007 through interviews with 24 healthcare professionals representing all 16 implanting ICD centres in Sweden.
Results: Two descriptive categories comprising seven subcategories emerged. Striving to provide competent care comprised: providing access to care, improving one's quantifications, individualising care and Striving to infuse confirmation involved: promoting independence providing existential support, mediating security and comprising needs of next of kin.
Conclusion: The healthcare professional striving to provide competent and confirming care based on a holistic perspective. The results describe a variation of how healthcare professionals' strive to be professional in clinical care in order to give the patient tools to handle their life situation.
Practice Implications: The findings from healthcare professionals' experiences can complement studies from the patients' perspective and are important when improving care or ICD patients. This study can serve as a base for developing and redefining holistic follow-up programmes for ICD patients.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Organisation of care for Swedish patients with an Implantable Cardioverter Defibrillator, a national survey2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2600-2608Article in journal (Refereed)
Aim: To describe the clinical aspects of Implantable Cardioverter Defibrillators (ICD) care in Sweden with focus on organisation, the role and education of nurses, patient information and education, and areas in need of improvement.
Background: ICD implantations have developed rapidly in recent years and is now an established arrhythmia treatment. The expanding indication for ICD implantation demands new competencies and resources in the ICD team members.
Methods: Participants were recruited among physicians and nurses in all of the hospitals implanting ICDs (N=16). Data was collected by a questionnaire. Additionally, all written educational materials provided to patients pre- and post-implant were collected from all 16 hospitals. Deductive content analysis using Sarvimäki and Stenbock-Hult's five holistic dimensions was employed to ascertain how information was provided in brochures and information materials.
Results: Half of the hospitals (n=8) had nurse-based outpatient clinics and several others planned to introduce them. Three hospitals carried out distance follow-ups by means of telemonitoring. The nurses had received specific ICD education from ICD companies and/or various university courses. The biophysical dimension dominated in the information material while the emotional, intellectual, and socio-cultural dimensions were scarcely described, and the spiritual- existential was not referred to at all.
Conclusion: Holistic care of ICD patients can be achieved by means of a multi-disciplinary ICD team and more patient-centred educational strategies. In Sweden, the organisation of ICD care and follow-up is developing towards more nurse-based clinics.
Relevance to clinical practice: Development and implementation of structured care programmes with a more holistic approach, can improve future ICD care. The content of the written educational materials need to be more holistic, rather than mainly focusing on the biophysical and technical aspects of living with an ICD.
Healthcare professionals experiences of delivering care to patients with an implantable cardioverter defibrillator2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 4, p. 346-352Article in journal (Refereed)
Background: An implantable cardioverter defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After an ICD implantation, the entire life situation of the patient their next of kin can be affected psychologically and socially. Healthcare professionals play a vital role in providing educational counselling, support and technical follow-up of the device, but little is known about their experiences. less thanbrgreater than less thanbrgreater thanAim: This paper describes the experiences of Swedish healthcare professionals in delivering care to patients with an ICD. less thanbrgreater than less thanbrgreater thanMethods: A qualitative, descriptive design based on a phenomenographic approach was used. Data were collected through interviews with 12 specialist ICD nurses and 12 physicians, representing 16 ICD implantation centres in Sweden. less thanbrgreater than less thanbrgreater thanFindings: Two descriptive categories comprising seven subcategories emerged. Striving to provide competent care comprised the subcategories: providing access to care, improving ones qualifications and individualising care. Striving to infuse confirmation incorporated the subcategories: promoting independence, providing existential support, mediating security and comprising needs of next of kin. less thanbrgreater than less thanbrgreater thanConclusions: The healthcare professionals described how they wished to develop the care further. Both nurses and physicians were consistent in wanting to provide competent and confirming care based on a holistic perspective with high accessibility to the ICD team. The findings describe how healthcare professionals strive to provide professional clinical care in order to give the patients tools to handle their life situation. They suggested that more structured education and counselling according to guidelines should be provided. They also highlighted the need to increase their own competence by improving their knowledge and skills.
Broström, A
Strömberg, A
Dahlström, U
Högskolan i Jönköping.
Decisive situations influencing spouses' support to patients with congestive heart failure in relation to the couple's sleep situation: A critical incident technique analysis.2002Conference paper (Other academic)
Patients with congestive heart failure and their conception of the sleep situation.1999Conference paper (Refereed)
Sleeping difficulties, daytime sleepiness and health-related quality of life in patients with chronic heart failure.2003Conference paper (Other academic)
Sleep, health-related quality of life and daytime sleepiness in patients with chronic heart failure2002Conference paper (Other academic)
Broström, Anders
Omvårdnad, Högskolan i Jönköping.
Nilsen, Per
Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
Ulander, Martin
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
Svanborg, Eva
The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, p. 603-611Article in journal (Refereed)
Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74–0.86) and acceptable for the subscales (Cronbach's α = 0.62–0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.
Johansson, Peter
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
Albers, J
County Hospital Ryhov.
Mårtensson, Jan
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
Obstructive sleep apnoea syndrome - Patients' perceptions of their sleep and its effects on their life situation2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 3, p. 318-327Article in journal (Refereed)
Title. Obstructive sleep apnoea syndrome - patients' perceptions of their sleep and its effects on their life situation Aim. This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation. Background. Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated. Methods. A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations. Conclusion. The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment. © 2007 The Authors.
Albers, Jan
Wiberg, Jan
Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
Obstructive sleep apnea syndrome - Patient perceptions of their life situation before initiation of CPAP treatment2006In: 8th World Congress on Sleep Apnea 27-30 September, 2006,2006, 2006, p. 124-124Conference paper (Other academic)
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
Johansson, P
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Swahnborg, E
Adherence to CPAP treatment - a qualitative contnt analysis in patients with OSAS.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Conference paper (Refereed)
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis2010In: SLEEP MEDICINE, ISSN 1389-9457, Vol. 11, no 2, p. 126-130Article in journal (Refereed)
Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
Dahlström, Ulf
Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 2, p. 223-233Article in journal (Refereed)
• Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple.
• The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation.
• A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden.
• Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems.
• An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.
Patients with congestive heart failure and their conceptions of their sleep situation2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 34, no 4, p. 520-529Article in journal (Refereed)
Aim. To describe, from a nursing perspective, how patients with CHF conceived their sleep situation.
Background. Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes.
Methods. A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients.
Findings. The findings showed that the patients' sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment.
Conclusions. Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.
Department of Nursing, Lund University, Lund, Sweden and School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
Sleep difficulties, daytime sleepiness, and health-related quality of life in patients with chronic heart failure2004In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 19, no 4, p. 234-242Article in journal (Refereed)
Normal sleep changes with age in duration, fragmentation, and depth. The prevalence of insomnia is high in the elderly general population. In patients with chronic heart failure (HF) objective sleep assessments have shown disturbances such as a shorter total duration of sleep, frequent arousals, and sleep stage changes.
To describe self-assessed sleep difficulties, daytime sleepiness, and their relation to health-related quality of life (HRQOL) in men and women with HF, as well as to make a comparison to data from a norm population.
Cross-sectional design including 223 patients with HF, New York Heart Association classification II-IV, assessed using the Uppsala Sleep Inventory-Chronic Heart Failure, the Epworth Sleepiness Scale, Medical Outcomes Study 36-Item Short Form Health Survey, and Minnesota Living With Heart Failure Questionnaire.
The most commonly reported sleep difficulties were initiating and maintaining sleep. The ratio of habitual sleep to the amount of estimated need for sleep was significantly shorter for women (P < .05), and the number of awakenings per night was significantly increased for men (P < .001). A total of 21% suffered from daytime sleepiness. Patients suffering from difficulties maintaining sleep, initiating sleep, and early morning awakenings reported significantly lower HRQOL in almost all dimensions of the SF-36 (P < .05-P < .001) compared to patients without sleeping difficulties, as well as to the normal population. The disease-specific Minnesota Living With Heart Failure Questionnaire showed significantly reduced (P < .05-P < .001) HRQOL as measured by the total and subscale scores for patients suffering from sleeping difficulties compared to patients without sleeping difficulties.
Patients with HF have a reduced HRQOL especially if difficulties maintaining sleep, initiating sleep, and early morning awakenings are involved.
Jönköping.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
Harder, Lena
Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, no 4, p. 439-447Article in journal (Refereed)
Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires, the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment. © 2007 European Sleep Research Society.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Mårtensson, J
Informational needs, side effects and their consequences on adherence: A comparison between swedish healthcare professionals and CPAP-treated patients with obstructive sleep apnoea syndrome2007In: World Sleep 07,2007, 2007, p. 141-141Conference paper (Other academic)
Perceived informational needs, side-effects and their consequences on adherence-A comparison between CPAP treated patients with OSAS and healthcare personnel2009In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 74, no 2, p. 228-235Article in journal (Refereed)
Objective: To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence.
Methods: A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP.
Results: Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p < 0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p < 0.05), self-care (p < 0.001) and troubleshooting (p < 0.01). A total of I I out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p < 0.01 - p < 0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p < 0.001).
Conclusion: Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence.
Practice implications: Measurement of these parameters before, during and after educational programs are suggested.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurophysiology.
Association of type D personality to perceived side effects and adherence in CPAP-treated patients with obstructive sleep apnoea syndrome2007In: World Sleep 07,2007, 2007, p. 142-142Conference paper (Other academic)
Buck, Harleah G.
Univ S Florida, FL 33620 USA.
Bekelman, David
Univ Colorado Denver Anschutz Med Campus, CO USA.
Cameron, Jan
Monash Univ, Australia.
Univ Kentucky, KY USA.
Hooker, Stephanie
Univ Minnesota Twin Cities, MN USA.
Pucciarelli, Gianluca
Univ Roma Tor Vergata, Italy.
Riegel, Barbara
Univ Penn, PA 19104 USA.
Vellone, Ercole
A body of work, a missed opportunity: Dyadic research in older adults2019In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 4, p. 854-855Article in journal (Other academic)
Chung, Misook L.
Donovan, Kristine A.
Moffit Canc Ctr, FL USA.
Harkness, Karen
McMaster Univ, Canada.
Howard, Allison M.
Univ S Florida, FL USA.
Polo, Randall
Evangelista, Lorraine S.
Univ Calif Irvine, CA 92697 USA.
A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes2018In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 77, p. 232-242Article, review/survey (Refereed)
Background: Having support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes. Objective: To examine the components, context, and outcomes of dyadic self-care interventions. Design: A systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples. Review methods: We used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions. Results: Eighteen papers - 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed. Intervention components fell into three groups education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes. Conclusions: We found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice.
Cacciata, Marysol
Lee, Jung-Ah
Sorkin, Dara
Lombardo, Dawn
Univ Calif Irvine Hlth, CA USA.
Clancy, Steve
Nyamathi, Adeline
Evangelist, Lorraine S.
Effect of exergaming on health-related quality of life in older adults: A systematic review2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 93, p. 30-40Article, review/survey (Refereed)
Introduction: Exercise through video or virtual reality games (i.e. exergames) has grown in popularity among older adults; however, there is limited evidence on efficacy of exergaming on well-being related to health in this population. This systematic review examined the effectiveness of exergaming on health related quality of life in older adults. Methods: PRISMA guidelines for this systematic review. Several databases were searched using keywords to identify peer-reviewed journal articles in English. Randomized control trials that evaluated the effect of exergaming on health-related quality of life in older adults when compared to a control group and published between January 2007 to May 2017 were included. Results: Nine articles that in total included 614 older adults with varying levels of disability, mean age 73.6 + 7.9 years old, and 67% female were analyzed. Significant improvements in health-related quality of life of older adults engaged in exergaming were reported in three studies. Sample sizes were small in 7 of the studies (N amp;lt; 60). The study participants, exergaming platforms, health-related quality of life instruments, study settings and length, duration and frequency of exergaming varied across studies. Conclusion: Exergaming is a new emerging form of exercise that is popular among older adults. However, findings from this analysis were not strong enough to warrant recommendation due to the small sample sizes and heterogeneity in the study participants, exergaming platforms, health-related quality of life instruments, length, duration and frequency of the intervention and study settings. Further research is needed with larger sample sizes and less heterogeneity to adequately explore the true effects of exergaming on health-related quality of life of older adults. (C) 2019 Elsevier Ltd. All rights reserved.


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President urges upholding values of Cuc Phuong National Park
A 1000-year-old tree at Cuc Phuong National Park (Photo: VNA) Hanoi (VNA) – President Nguyen Xuan Phuc has wished that the entire society would join hands to maintain, preserve and uphold the sustainable values of Cuc Phuong National Park for later generations. In his letter recently sent to the park on the occasion of its 60th anniversary, President Phuc recalled that even in the struggle against foreign invaders six decades ago, the Government, with its strategic and contemporary vision, issued a decision naming Cuc Phuong as the first national park which is also one of the earliest-established national parks in the world. He hailed generations of officials, cadres and workers of the park for standing united and overcoming difficulties to maintain and uphold values of forest ecosystem's natural resources and biodiversity. Cuc Phuong National Park has long been a reliable destination for the conservation of biodiversity and genes of endangered and rare species of flora and fauna in particular. Known as a "school in the middle of thick forest" of generations of students in the country and the world, this place is also dubbed as a "Capital of Nature Conservation" of Vietnam. In consecutive years from 2019 to 2022, the… Read full this story
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Thomas Edison formed the Edison Electric Light Company in 1879. Edison was a prolific inventor, holding 1,093 patents in his name in the U.S. his inventions are electric light, power utilities, sound recording and motion pictures. General Electric Company was formed by merging Edison General Electric Company and the Thomas-Houston Company. Every 2 Seconds an aircraft powered by GE engine technology takes off they are the first company to create a 3D printed aircraft engine component and a sensor housing. GE Aviation's flight management team system provides the technology to enable south-west airline pilots to fly navigation at eleven airports. General Electric Company was selected to supply India's railways with 1000 diesel locomotives for India to upgrade their 162-year-old rail network, Which transports then out of millions of people on a daily basis.


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Jay Ryan Joins 'It: Chapter 2' Cast as Adult Ben
Posted on Wednesday, May 23rd, 2018 by Chris Evangelista
The It: Chapter 2 cast is almost complete. Jay Ryan is the latest addition to the horror sequel, taking the role of Ben Hanscome – a part originated by Jeremy Ray Taylor in 2017's It.
The adult version of the Losers' Club is almost completely assembled, and it's shaping up nicely. Jessica Chastain is playing Bev; James McAvoy and Bill Hader are in talks to play Bill and Richie, respectively; James Ransone will play Eddie; and Andy Bean is taking on the part of Stan. Now, the cast has a new addition: Jay Ryan. Deadline reports Ryan will play the adult Ben Hanscome – the character played as a child by Jeremy Ray Taylor.
In Stephen King's novel, Ben grows up, loses the weight that plagued him as a child, and becomes a world-famous architect. He also still harbors his crush on Beverly Marsh – a crush that's rekindled when the pair reunite as adults. Andy Muschietti's 2017 adaptation of It changed several key elements from the novel, so it's unclear if he'll be keeping Ben's profession in the sequel. In fact, we still don't have many details about the sequel at all. All we know for certain is that It: Chapter 2 will find the Losers' Club all-grown-up and forced to return home to Derry, Maine to once again battle Pennywise the Clown (Bill Skarsgard).
I'll be honest: I'm slightly disappointed by Ryan's casting. I have nothing against Mr. Ryan, it's just that I was expecting someone more…exciting? Or at least, more recognizable. The bulk of the cast so far is made up of either big names or at least recognizable indie players, save for Andy Bean. But Bean's casting made a sort-of sense, considering Stan's role in the sequel (I'm being vague to avoid spoilers). Ben, however, plays a very big part in the story – at least in Stephen King's novel. With that in mind, I was expecting a more well-known name in the role. Ryan isn't exactly a nobody, of course. He's appeared in the eOne/Hulu series Mary Kills People, and on Top of the Lake. He also appeared on The CW's Beauty and the Beast series. But he's also not exactly someone who came up when people were fan-casting this sequel.
Then again, to be fair, the bulk of 2017's It cast was made up of somewhat unknown actors – the only truly recognizable face was Stranger Things' Finn Wolfhard – and I loved that film. So perhaps It: Chapter 2 doesn't really need any more famous faces to fill out its cast. As long as Ryan delivers a great performance, I'll be happy.
Still, I can't help but hope the film lands a more recognizable actor to play the one remaining Losers' Club character – Mike Hanlon, played by Chosen Jacobs in the 2017 film. I imagine we'll find out who is playing Mike sooner rather than later, especially since It: Chapter 2 is expected to begin filming in the summer, which is right around the corner.
It: Chapter 2 hits theaters September 6, 2019.
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Adaptation, Casting, Horror, New Line, Sequels, Andy Bean, Andy Muschietti, Bill Skarsgård, Bill-Hader, It, It: Chapter 2, James Rnasone, James-McAvoy, Jay Ryan, Jessica Chastain


This class allows up to 30 participants.
I enjoyed both trainers. They were both knowledgeable and I enjoyed their humor.
The instructor had excellent knowledge of IdentityIQ. Great training!
Excellent training. Our trainer was superb. He was very knowledgeable and engaging. He made additional time if needed to ensure all help that was needed or questions that needed answering were fulfilled.


How do I love thee? Let me count the square feet.
Welcome to the week of love. At Zentila, we're all into the love thing. We have a core value dedicated to it – Love and be Loved – and even have it in our phone number (it's 407-656-LOVE. Don't believe us? Go ahead and call. We'd love to talk with you.).
But what exactly does the hotel look at to best judge whether your meeting is the best match for them or not? Besides driving occupancy and room rate, there are other factors that you should understand to best position your meeting for the LOVE it so well deserves. Let's head back to the revmax form and talk about one key measurement: The Space-to-Rooms Ratio.
Space-to-Rooms Ratio: This is the amount of space you use for every guest room you occupy. And it's by far the most important metric a meeting hotel uses to determine how much LOVE they can give a customer. You should always ask up-front for each hotel's ratio. In order to get the best possible deal from a hotel, your meeting space should stay within the hotel's space-to-rooms ratio. When hotels decline RFPs, it's not personal – it's likely a space issue. So what can you do?
Simple tip #1: Know your own meeting's space-to-rooms ratio.
Space-to-rooms ratio = (The total number of seats in all meeting room set-ups by day X 25) / Sleeping room block by day.
You'll notice a couple of things here. First, your arrival day is way under (25 sq.ft/guest room) because you're occupying sleeping rooms but haven't begun to meet. Your checkout day, however, is very high (5,000 sq.ft/guest room). This is a naturally occurring event with most meetings, but it's here – around the edges of the meeting – that hotels have the greatest exposure and work the hardest to reduce the space given.
Simple tip #2: Focus on minimizing the Ratio on your pre and post days to get better deals.
Hotels rarely struggle with the space ratio during the main days of your program; it's the pre and post days that will often kill the LOVE. So, what can you do to keep the fire going? Here are some ideas on saving hotel space that have little or no impact on your overall meeting results but have huge impacts on your ratio.
Keep your set-up to the first day of arrival. If you set up prior to when your room block starts, say Saturday for a Sunday arrival, you'll lower your chances dramatically in finding availability and the right deal.
Reuse your main meeting room for one of your break-outs and dinners: Hotels would rather turn a room set-up than use an additional room. With the example above, your space-to-rooms ratio drops from 101 sqft/room to 67 sqft/room – a 34% decrease in space usage, without really affecting your meeting.
On the last day, ask if there is alternate space you can use for breakouts: Most hotels have restaurants, suites, other areas that would work fine for your last half day of meetings. If you're willing to do it, the hotel will show their love in $$$ of savings.
When it comes down to it, meeting hotels are more concerned about managing meeting space; after all, they rarely run out of sleeping rooms before they run out of space. Knowing how your meeting affects their meeting space inventory and more importantly, what you can do to help them sell more space, will make every hotel fall in love with you. And in this case, it's more than just roses and a nice dinner you'll get: With the right space-to-rooms ratio you'll be able to negotiate one hot deal. Who said money can't buy you love?


Wright, Frank Lloyd, jun. (1890–1978). American architect, elder son of Frank Lloyd Lincoln Wright. He was trained in his father's studio, and helped (1909) to prepare the drawings for the celebrated Wasmuth portfolio (1910). He later worked for the Boston firm of Olmsted, then with his father on the Barnsdall Hollyhock House (1916–21) and on the various concrete-block houses of the 1920s, all in CA. His own output included houses constructed of precast concrete blocks (e.g. Derby House, Chevy Chase, CA (1926) ), whilst pre-Columbian and Art Deco motifs occurred in the Sowden House, Los Angeles (1926), and the Samuel-Navarro House, Hollywood, CA (1926–8). He was responsible for the shell-concrete structure at the Hollywood Bowl, CA (1924–5 and 1928). The Swedenborg Memorial Wayfarer's Chapel, Palos Verdes, CA (1946–71), in which the architecture is integrated with the landscape, is arguably his best work.
"Wright, Frank Lloyd, jun." A Dictionary of Architecture and Landscape Architecture. . Encyclopedia.com. 17 Apr. 2019 <https://www.encyclopedia.com>.


Being in New York, I was able to learn how municipal government worked in the largest city in the country while interning in both the Mayor's Office and City Council. I also got my start in the community development field as an intern at a community development corporation in Bedford-Stuyvesant, Brooklyn, which was the first step in my current career path.
I am a senior executive of McCormack Baron Salazar, a national urban real estate development firm that focuses on revitalizing urban communities that have suffered under long-term disinvestment. I am based in San Francisco, CA and am responsible for leading our development projects in Northern California and building our pipeline of deals throughout the country.
The Wagner network is everywhere! I have friends in the Bay Area who were in my graduating class, I served on a housing round-table in Chicago with one of my Wagner professors earlier this year, and spoke at a similar event in Washington, D.C. with another one of my professors last month.


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GOP Sen. Cynthia Lummis Gives Moving Speech In Support Of Same-Sex Marriage Protections
November 29, 2022, 11:00 p.m. ·4 min read
Sen. Cynthia Lummis (R-Wyo.) gave an impassioned speech Tuesday in support of marriage equality protections, a position that garnered her praise from Democrats and "brutal" criticism from social conservatives.
"I — and many like me — have been vilified and despised by some who disagree with our beliefs," Lummis said on the Senate floor. "They do not withhold bitter invective. They use their own hateful speech to make sure that I — and others who believe as I do — that we are hated and despised by them."
She noted that the days following her decision to support the Respect for Marriage Act, which the Senate passed with bipartisan support on Tuesday, were "fairly brutal, self-soul-searching [and] entirely avoidable, I might add, had I simply chosen to vote no."
The bill codifies protections for same-sex and interracial marriages, a move aimed at protecting people's civil rights in the event the U.S. Supreme Court moves to overturn marriage equality decisions in the future. The House is expected to pass the bill as soon as this week and send it to President Joe Biden for his signature.
Lummis surprised many in Washington when she voted to advance the bill with 11 of her GOP colleagues earlier this month. The senator hails from a deeply red state, and she is likewise socially conservative on many issues. Lummis, the first woman to represent Wyoming in the Senate when she was elected in 2020, voted against certifying Pennsylvania's presidential electoral results on Jan. 6, 2021, based on false allegations of election fraud.
Lummis emphasized that the marriage legislation was carefully crafted to protect people's religious freedom despite what its critics argued, and she said America is due for some compassion and acceptance of other people's differences.
"These are turbulent times for our nation," said the Wyoming Republican. "Americans address each other in more crude and cruel terms than ever in my lifetime. It is jarring and unbecoming of us as human beings. It is highly intolerant and frequently the most so when expressed by those who advocate for tolerance. Many of us ask ourselves, our nation is so divided, when will this end? And how will it end?"
Her comments drew praise from Senate Majority Whip Dick Durbin (D-Ill.).
"That was an outstanding statement," Durbin said after she spoke. "I'm sure your position has not been an easy one at home, but it reflects some thoughtful consideration on your part. Most importantly, it reflects your appeal to us in this chamber and to the nation to really seize this opportunity for tolerance."
Lummis also got a hug from Sen. Kyrsten Sinema (D-Ariz.), the first openly bisexual member of the Senate and a main sponsor of the legislation.
HuffPost caught up with Lummis after the vote and asked her about the response she'd received.
"This was a tough one," she said, citing a flood of calls and letters to her office from people who were "extremely disappointed in me and disagree strongly with me."
The Federalist, a conservative website, singled out Lummis in particular in recent days over her stance in support of the legislation. "Even the Never Trumper Senate Minority Leader Mitch McConnell and Wyoming's senior Sen. John Barrasso voted against bringing the outrageously named 'Respect for Marriage Act' to the floor. They know gaslighting when they see it. How did Lummis miss the memo?" wrote Federalist contributor and pastor Jonathan Lange.
Lummis said her decision was guided in part by America's early founders, including Roger Williams, a minister who founded Rhode Island and who advocated for religious freedom and tolerance.
"The concern that people have expressed to me is that my views run counter to God's definition of marriage," she said. "And I've tried to distinguish the fact that I support God's definition of marriage but now there's a second definition of marriage ― it is secular and established by the [Supreme Court] Obergefell decision ― and it deserves respect, too.
She added: "I hope that message will resonate. So far it's been a tough sell."
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Vietnam's economy steadfast amid the headwinds
tranthuy02
Global economic prospects have worsened. Inflation continues to accelerate in most economies on high global energy and food prices. Global oil, gas, and food prices have come down from their peaks earlier this year but remain higher than in early 2022. Tightening monetary and financial conditions will continue to drag on economic activity in the United States and the Eurozone in 2023, with the latter likely to experience a technical recession.
Developing Asia's recovery is expected to continue but lose some steam. Headline inflation in developing Asia stood at 5.6 per cent in September, up from 3 per cent at the start of the year, reflecting a consistently upward trend across the region's economies.
Central banks continue to raise policy rates to curb inflation and safeguard financial stability. This has tightened financial conditions in the region, which have also been greatly influenced by aggressive rate hikes in the US and Europe.
The Asian Development Bank has revised down 2022 GDP growth in developing Asia marginally to 4.2 per cent, reflecting downward revisions for East Asia and, particularly, in China, where pandemic-induced disruption and unresolved problems in the property market have weakened growth.
By contrast, the bank raised the economic growth forecast for Southeast Asia in 2022 up to 5.5 per cent thanks to higher forecasts for Malaysia, the Philippines, Thailand, Timor-Leste, and Vietnam after surprisingly robust performances in the last quarter due to stronger consumption, trade and services, and tourism.
In Vietnam, economic activities recovered faster than expected following the removal of pandemic restrictions and the achievement of nationwide vaccine coverage. A strong performance across sectors boosted the country's economy, and growth rebounded to 8.8 per cent in the first three quarters and continued to expand by the end of 2022.
Exports grew at 13 per cent on-year, and imports grew at 10 per cent on-year, making a trade surplus of $10.6 billion in the first 11 months of last year. Disbursements of foreign direct investment remained strong, increasing by 7.8 per cent on-year, estimated at $7.7 billion, the highest disbursement in five years.
Normalised mobility boosted domestic tourism, reaching nearly 100 million domestic visitors in the first eleven months of 2022, higher than the pre-pandemic period. The domestic consumption in November was up 2.6 per cent from the previous month and up 17.5 per cent over the same period last year.
As Vietnam's GDP growth is strong, inflation and other factors affecting the economy are much less severe than in neighbouring countries. Vietnam's public debt-to-GDP ratio was 43 per cent, which is relatively low, giving the country solid macroeconomic foundations.
Many other countries in the region are not holding up nearly as well as Vietnam to these global challenges and economic shocks. However, headwinds have been strengthening since the last quarter of 2022. Though trade continues to expand, key economic indicators have shown weakening global demand for the country's exports.
The number of new orders is likely to drop early this year. Employment could also fall due to declining economic activities. Recent monetary tightening, irregularities in the corporate bond market and slow disbursement of public investment have tightened liquidity for economic recovery.
High inflation in the US and other advanced economies, though slightly abating in November, could prolong the current monetary tightening cycle. The appreciating US dollar resulted from the Fed's monetary tightening, which could continue to put depreciating pressure on the Vietnamese currency, creating inflationary pressure, and putting pressure on foreign reserves.
Growth deceleration in China will also impact Vietnam's economic prospects in 2023. The worsening situation with Russia and Ukraine could renew surges in commodity prices, further stoking global inflation and inducing further monetary tightening. Against this background, our growth forecast for Vietnam in 2023 has been adjusted from 6.7 to 6.3 per cent.
Global inflation remains uncertain. Supply chain disruptions by continued geopolitical tensions and rising demand for energy from eased mobility restrictions in China could push up global commodity prices. The policy responses for Vietnam need to strike a dedicated balance between containing inflation and maintaining economic growth and, at the same time, ensuring stability in the financial sector.
In 2022, the government succeeded in managing flexible monetary policy and prudent fiscal policy to ensure macroeconomic stability. There should be greater and more efficient coordination between fiscal and monetary policy in 2023.
While monetary measures have tightened to stem imported inflation, targeted fiscal support is desirable to support businesses and strengthen social protection, given the increasing negative impact on the labour force due to the global economic downturn.
There are many reasons for optimism on Vietnam's economic prospects in 2023. Looking forward, economic growth in 2022 was on par with pre-pandemic growth levels, despite a challenging global economic environment and a volatile stock market. Investment from overseas was strong and has even picked up. There is no doubt that Vietnam's economic prospects for the medium and long term remain positive.
Foreign investors think long-term when they make their investments, and we noted that there is continued strong interest in Vietnam as a destination to place funding, which clearly shows a long-term vote of confidence in the country. With sound economic fundamentals and strong leadership, we strongly believe that Vietnam will be able to brace the headwinds of 2023 and beyond.
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Upgrading Vietnam's GDP forecast for 2022 to 8.2 per cent