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Coming dissertations at MedFak

  • A nutrition intervention in men with prostate cancer : Exploring effects on bowel symptoms from radiotherapy, patient experience, and nutrient intake Author: Marina Forslund Link: Publication date: 2020-05-13 13:33

    Objective The main objective of this thesis was to explore the effects of a nutrition intervention on acute and late bowel symptoms in men with localised prostate cancer treated with pelvic radiotherapy (study I), participants’ experiences from receiving the nutrition intervention (study II), and associations with nutrient intakes (study III).

    Methods A total of 180 men with localised prostate cancer referred to curative radiotherapy targeting the prostate gland and pelvic lymph nodes were recruited to the trial. The participants were randomised to standard care plus a nutrition intervention aiming to modify fibre and lactose intakes (NIG; n=92) or standard care alone (SCG; n=88). Data on bowel symptoms and dietary intake were collected pre-treatment and at seven time points during a 26-month study period. Analyses of the effects of the nutrition intervention on bowel symptoms were conducted for the acute phase (up to 2 months post radiotherapy), and the late phase (7 to 24 months post radiotherapy). Semi-structured interviews were conducted with 15 participants from the NIG to explore experiences of the nutrition intervention.

    Results The nutrition intervention was associated with statistically significantly, but not clinically significantly, less bother from blood in stools and flatulence during the acute phase. The nutrition intervention was also associated with more bloated abdomen during the late phase (Study I). Social support, contributing to the greater good, prior knowledge, dietary information, and a small need for change facilitated adherence. While feeling limited, wanting to decide for themselves, the timing of the intervention, unmet expectations, and loss of motivation were described as barriers for adherence (Study II). A greater reduction of lactose was associated with decreased intake of calcium at the end of the radiotherapy period. A more modified fibre intake during the radiotherapy period was associated with increased vitamin C, but decreased selenium intake (Study III).

    Conclusions The effects from the nutrition intervention were small and inconclusive and do not support routine dietary advice aiming to modify fibre and lactose intakes as a mean to substantially reduce adverse effects from pelvic radiotherapy. Tailored nutritional interventions based on individual preferences, prior knowledge, and context, could enhance adherence. There were few associations between modified fibre and lactose intakes and nutrient intakes, thus, no recommendations can be made on whether such dietary advice should continue to be provided to men with prostate cancer undergoing pelvic radiotherapy.

  • Endoscopic retrograde cholangiopancreatography : Perforation and long-term outcomes after endoscopic sphincterotomy Author: Ann Langerth Link: Publication date: 2020-05-08 13:42

    Endoscopic retrograde cholangio pancreatography (ERCP) is a commonly used procedure in various disorders of the pancreatobiliary tract. When extracting common bile duct stones (CBDS), the major duodenal papilla is divided using a papillotome to perform an endoscopic sphincterotomy (ES). Adverse events occurring shortly after ES are well-known and include perforation which, however, is difficult to investigate due to its low frequency. ES is often used in elderly and/or infirm patients with gallstone pancreatitis and cholangitis, to prevent relapse in biliary events linked to CBDS. Subsequent cholecystectomy in these patients remains controversial. What happens in the long term after ES is still partially unknown.

    In Paper I, we found an increased risk for both cholangitis and pancreatitis after ES for CBDS, without synchronic relapse of CBDS and when compared with the general population was found. In Paper II, we retained the ES group, but replaced the control group with controls with a history of gallstone disease. The increased risk for both cholangitis and pancreatitis without relapse of CBDS still remains but, no higher risk for malignancy in the pancreatobiliary tract was noted.

    We conducted study III, a prospective follow-up after ES, to evaluate to what extent ES prevents relapse into biliary events after cholangitis and pancreatitis caused by bile duct stones. We included 100 patients who did not have earlier gallbladder surgery and who were treated for pancreatitis and/or cholangitis. The patients then underwent ES but not cholecystectomy and were followed for a mean of 42 months. None of the patients had recurrent pancreatitis and one had cholangitis. This indicates that ES alone is an alternative to cholecystectomy in the prevention of further attacks of acute pancreatitis and cholangitis.

    Paper IV consists of 52,140 ERCPs that were registered with GallRiks, a Swedish population based register. A total of 376 cases were registered as perforations and 75 patients had a fatal outcome. These data showed that sphincterotomy in the pancreatic duct increased the risk of death from perforation but the risk of death was reduced when ERCP was performed at a Q4 centre.

  • Self-efficacy in breastfeeding mothers of term and preterm born infants Author: Emma Gerhardsson Link: Publication date: 2020-05-06 11:13

    Breast milk is beneficial for all infants, but especially for infants born preterm and optimizing breastfeeding can enhance health outcomes. Despite this, breastfeeding duration has declined in more than twenty years in Sweden and even more among preterm infants. Mothers’ self-efficacy is a modifiable factor that can affect breastfeeding duration and Breastfeeding Self-efficacy Scale-Short Form (BSES-SF) has been tested in several countries in order to identify mothers with low self-efficacy in breastfeeding, however, the scale has not been validated for a Swedish sample. Moreover, there is a need for evidence-based breastfeeding support programs adapted for the healthcare professionals (HCPs) working with mothers of preterm infants.

    A first aim of the present thesis was to psychometrically test the BSES-SF among mothers to both term- and preterm infants and to examine whether self-efficacy predicts breastfeeding duration. A secondary aim was to evaluate a breastfeeding support program based on Baby-Friendly Hospital Initiative for Neonatal Intensive Care (Neo-BFHI) and to describe HCPs’ experiences of the program.

    Papers I and II show potential for BSES-SF to be used in research with the aim to identify mother’s self-efficacy in breastfeeding. In Paper III findings reveal that self-efficacy predicts the mother’s adaptation to the infant. This is an important finding as the mother's adaptation to the infant is closely related to the theories of bonding and attachment. Paper IV describes and evaluates a training program for neonatal intensive HCPs based on Neo-BFHI’s ten steps to successful breastfeeding, with main results indicating that the training program was appreciated by the HCPs. In Paper V, we constructed and evaluated an instrument that measures the attitudes to breastfeeding and skin-to-skin contact among neonatal intensive care units’ HCPs. Findings suggest that the instrument could be used to evaluate future Neo-BFHI interventions to improve breastfeeding duration as well as HCPs’ support and skills.

    The main conclusion of this thesis is that mothers’ low self-efficacy in the early phase can be an important predictor for shorter breastfeeding duration. The breastfeeding training program was regarded as relevant and useful according to different HCPs categories and was shown to increase the HCPs’ interest in breastfeeding and provide them with tools for improved breastfeeding support. The program is designed in a way that makes it easy to copy and spread to other neonatal intensive care units in Sweden and it can also be used for newly employed HCPs.