Lars Andersson

Moral Stress: synthesis of a concept

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

Storage of Experimentally Avulsed Teeth in Milk Prior to Replantation

Extracted monkey teeth were endodontically treated, stored in milk or saliva for two or six h, and then replanted. Periodontal conditions were evaluated after eight wk. Teeth that had been stored for two or six h in milk or for two h in saliva showed periodontal healing almost as good as that of immediately replanted teeth. Teeth that had been kept in saliva for six h or bench-dried for one h showed extensive replacement resorption. Milk may thus be recommended as a storage medium for ex-articulated teeth prior to replantation in cases when immediate replantation is not possible.

A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP. Ninety-five male patients with confirmed OSA, subjective daytime sleepiness and an apnoea index (AI) > 5 were randomized for subsequent treatment with either a dental appliance or UPPP. There were 49 patients in the dental appliance group and 46 in the UPPP group. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up. The success rate (rate of patients with at least a 50% reduction in AI) for the dental appliance group was 95%, which was significantly higher (p < 0.01) than the 70% success rate for the UPPP group. According to the criteria for OSA (apnoea index > or = 5 or apnoea/hypopnoea index > or = 10), 78% of the dental appliance group and 51% of the UPPP group were normalized after 12 months. The difference between the groups was significant (p < 0.05). These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA.

Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome

Habitual heavy snoring may be considered a preliminary stage of sleep apnea syndrome. This investigation deals with the craniofacial morphology of 51 heavily snoring patients, with and without obstructive sleep apnea, and with 28 healthy control patients. The apnea group showed a reduced posterior airway and a posterior rotation of the mandible. Reduction of the anterior-posterior diameter of the cranial base, maxilla and mandible and vertical reduction of the posterior facial height appeared to be common facial characteristics in both snoring and apnea patients. These findings indicate an anatomical disposition for snoring and apnea.

Association of IQ scores and school achievement with suicide in a 40‐year follow‐up of a Swedish cohort

Objective:u2002 Few studies have investigated the association of childhood IQ and school achievement with suicide. The aim of this study was to investigate the association of childhood IQ with suicide in a cohort of Swedish women and men.

Diagnosis and treatment of the unicystic ameloblastoma

Two cases of unicystic ameloblastoma are presented. The lesions were pain-free and expanded the mandible. They were removed by curettage. Recurrent lesions had similar clinical appearances and histological pictures compared to the original lesions. The unicystic ameloblastoma manifested itself as a cystic cavity without solid neoplastic features, which differs from the solid ameloblastoma with regard to the age of the patients and the rate of recurrence. The behavior of the unicystic ameloblastoma was similar to that of the primordial cyst. Despite the obvious risk of recurrence, conservative treatment with enucleation and curettage seemed to be justified in preference to mutilating radical surgery.

Intervention Against Loneliness in a Group of Elderly Women: A Process Evaluation

This article describes a method (the CCC design) for undertaking social work with the elderly. The presenting symptom is the experience of loneliness. Also examined is how far the sample was representative of elderly people who had shown interest in institutional living and among whom the experience of loneliness could be expected, and also whether the intervention efforts were undertaken as specified. The results indicate that when subjects are randomly assigned to a treatment they have not sought, the participants, as compared to nonparticipants, seem to be somewhat higher in socioeconomic status and some of its correlates, but lower in self-esteem. On the whole the proposed method seems easy enough to execute and can accordingly be applied to other populations.

Loneliness and social isolation in Sweden : differences in age, sex, labor force status, self-rated health, and income adequacy

Using a created typology, we explore the conjoint conditions of emotional and social isolation with respect to age, sex, labor force status, perceived health status, and adequacy of income among a representative sample of 1,005 persons aged 16 and older in Sweden. Data were collected through telephone interviews. Cross-tabular analysis and analysis of variance results indicate the following: (a) persons living alone were significantly more lonely; (b) those 65 and older and those retired were more socially isolated, but not necessarily more lonely; and (3) those who felt that their health was a problem and their income was less than adequate were more lonely, but not necessarily more socially isolated. No differences in the typology were found with regard to sex. Findings are discussed in the light of other studies and data from Sweden and the United States.

Nursing Home Staff Attitudes To Ethical Conflicts With Respect To Patient Autonomy and Paternalism

Six case studies on nursing home staff attitudes to patient autonomy have been analysed. The case studies are based on six polarities within autonomy, as developed by Collopy. In total, 189 professional caregivers, comprising the staff of 13 nursing homes in the county of Stockholm, Sweden, responded to questions based on the case studies. Results show that the attitudes within each professional category had a high level of internal correspondence. Nurses consistently supported patient preferences to the highest degree, followed by assistant nurses and auxiliary staff. Nurses aides ranked lowest in supporting patient preferences. In only one of the cases were background variables of significance.

A model of estrangement--including a theoretical understanding of loneliness.

A model for the understanding of the concept of loneliness is presented. Loneliness is said to have three parts: emotional estrangement or the experienced lack of intimacy, social estrangement or the experienced lack of relatedness to social environment, and existential loneliness which is the inevitable consequence of the human finiteness and ultimate aloneness. In addition, the concepts of self-estrangement, structural estrangement, and meaninglessness are also included in the model.