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Theander, Kersti
Publications (10 of 47) Show all publications
Giezeman, M., Arne, M. & Theander, K. (2017). Adherence to guidelines in patients with chronic heart failure in primary health care. Scandinavian Journal of Primary Health Care, 35(4), 336-343
Open this publication in new window or tab >>Adherence to guidelines in patients with chronic heart failure in primary health care
2017 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 336-343Article in journal (Refereed) Published
Abstract [en]

Objective: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care. Design: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire. Setting: Three primary health care centres in Sweden. Subjects: Patients with a CHF diagnosis registered in their medical record. Main outcome measures: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Results. The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour. Conclusion: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-65928 (URN)10.1080/02813432.2017.1397253 (DOI)000416735200006 ()29105550 (PubMedID)
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-05-17Bibliographically approved
Granrud, M. D., Steffenak, A. K. & Theander, K. (2017). Gender differences in symptoms of depression among adolescents in Eastern Norway: Results from a cross-sectional study. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Gender differences in symptoms of depression among adolescents in Eastern Norway: Results from a cross-sectional study
2017 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to compare and describe gender differences and the associations between symptoms of depression and family conflict and economics, lifestyle habits, school satisfaction and the use of health-care services among adolescents. Methods: Data were retrieved from Ungdata which is a cross-sectional study. Adolescents (n=8052) from secondary school grades 8, 9 and 10 (age 13–16 years) participated in the study from 41 municipal schools in four counties. Results: Girls reported a higher prevalence of symptoms of depression than boys. Gender differences were seen on all items related to symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and health-care services. Multiple regressions showed that family conflicts and economics contributed to 19.2% of the variance in symptoms of depression in girls and 12.4% in boys. School satisfaction made a strong contribution: 21.5% in girls and 15.4% in boys. The total model explained 49% of the total variance in symptoms of depression in girls and 32.5% in boys. Conclusions: Gender demonstrated a pattern through a higher proportion of girls reporting symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and use of health-care services. Even though the adolescents reported symptoms of depression, few used the school health-care services and public health nurses. This indicates that they need a person-centered approach for symptoms of depression. The findings may have important implications for planning for adolescents in school health services.

Place, publisher, year, edition, pages
SAGE Publications Ltd, 2017
Keywords
Adolescent, depression, gender, lifestyle habits, school health-care, school satisfaction, socioeconomics
National Category
Nursing
Identifiers
urn:nbn:se:kau:diva-66553 (URN)10.1177/1403494817715379 (DOI)2-s2.0-85042186768 (Scopus ID)
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-05-07Bibliographically approved
Zakrisson, A.-B., Hiyoshi, A. & Theander, K. (2016). A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study. Journal of Clinical Nursing, 25(7-8), 962-971
Open this publication in new window or tab >>A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 962-971Article in journal (Refereed) Published
Abstract [en]

Aims and objectivesTo investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over threeyears among patients with Chronic Obstructive Pulmonary Disease. BackgroundAlthough Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established. DesignA quasi-experimental design. MethodPrimary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after oneyear and threeyears. Exacerbation frequency was calculated from oneyear before to threeyears after the programme. ResultsNo significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after oneyear and threeyears. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p=0091) but increased again in both groups after threeyears. ConclusionThere was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after oneyear. There is a need for support and coaching at regular follow-ups in primary health care. Relevance to clinical practiceThere is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
Chronic Obstructive Pulmonary Disease, exacerbations, long-term effects, primary health care, pulmonary rehabilitation, quality of life
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-41995 (URN)10.1111/jocn.13132 (DOI)000372928900008 ()26878838 (PubMedID)
Available from: 2016-05-11 Created: 2016-05-11 Last updated: 2017-11-30Bibliographically approved
Theander, K., Wilde-Larsson, B., Carlsson, M., Florin, J., Gardulf, A., Johansson, E., . . . Nilsson, J. (2016). Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence. Nurse Education Today, 37, 178-183
Open this publication in new window or tab >>Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence
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2016 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 178-183Article in journal (Refereed) Published
Abstract [en]

Background: Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported. Objectives: To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented. Setting: A higher education nursing program at a Swedish university. Participants: In total, 119 (2011 n = 69, 2014 n = 50) nursing students responded. Methods: Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale. Results: There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students. Conclusions: Our findings indicate that newly graduated nursing students- both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing. (C) 2015 Elsevier Ltd. All rights reserved.

Keywords
Nurse competence, Professional nursing, Nursing education, Nursing curriculum, Nursing student, NPC scale
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-41200 (URN)10.1016/j.nedt.2015.11.012 (DOI)000371098300029 ()26703792 (PubMedID)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2017-11-30Bibliographically approved
Gardulf, A., Nilsson, J., Florin, J., Leksell, J., Lepp, M., Lindholm, C., . . . Johansson, E. (2016). The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation. Nurse Education Today, 36, 165-171
Open this publication in new window or tab >>The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation
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2016 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 165-171Article in journal (Refereed) Published
Abstract [en]

Background: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. Objectives: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. Methods and participants; The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1[20-56] years, 87.3% women) from 11 universities/university colleges participated. Results: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27 years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (932% vs 875% of NSPGs). Summary and conclusion: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs. (C) 2015 Elsevier Ltd. All rights reserved.

Keywords
Nurses' competence, Professional nursing, Nursing education, Nursing students, Graduate nurses, Quality in care, Safety in care, NPC Scale
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-40990 (URN)10.1016/j.nedt.2015.09.013 (DOI)000367117000028 ()
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-12-06Bibliographically approved
Todt, K., Skargren, E., Jakobsson, P., Theander, K. & Unosson, M. (2015). Factors associated with low physical activity in patients with chronic obstructive pulmonary disease: a cross-sectional study. Scandinavian Journal of Caring Sciences, 29(4), 697-707
Open this publication in new window or tab >>Factors associated with low physical activity in patients with chronic obstructive pulmonary disease: a cross-sectional study
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2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 697-707Article in journal (Refereed) Published
Abstract [en]

Objectives: Low physical activity (PA) in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. In addition, physical activity seems to be low early in the disease. The aim of this study was to describe the level of PA in patients with stable COPD and to explore factors associated with low PA, with a focus on fatigue, symptom burden and body composition Methods: In a cross-sectional study, 101 patients (52 women) with COPD were classified having low, moderate or high PA according to the International Physical Activity Questionnaire - Short. Fatigue, dyspnoea, depression and anxiety, symptom burden, body composition, physical capacity (lung function, exercise capacity, muscle strength), exacerbation rate and systemic inflammation were assessed. A multiple logistic regression was used to identify independent associations with low PA. Results: Mean age was 68 (+/- 7) years, and mean percentage of predicted forced expiratory volume in 1 second was 50 (+/- 16.5). Forty-two patients reported a low PA level, while 34 moderate and 25 reported high levels. Factors independently associated with low PA, presented as odds ratio (95% confidence interval), were severe fatigue 5.87 (1.23-28.12), exercise capacity 0.99 (0.99-1.0) and the number of pack-years 1.04 (1.01-1.07). No relationship was found between depression, anxiety, body composition, exacerbation rate or systemic inflammation and PA. Conclusions: Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. Promoting physical activity is important in all patients with COPD. Our result suggests that patients with severe fatigue might need specific strategies to prevent physical inactivity.

Keywords
physical activity, chronic obstructive pulmonary disease, fatigue, body composition, exercise tolerance, symptom burden
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-41014 (URN)10.1111/scs.12200 (DOI)000368345900010 ()25653122 (PubMedID)
Available from: 2016-03-11 Created: 2016-03-11 Last updated: 2017-11-30Bibliographically approved
Eckerblad, J., Theander, K., Ekdahl, A., Unosson, M., Wirehn, A.-B., Milberg, A., . . . Jaarsma, T. (2015). Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatrics, 15, Article ID 1.
Open this publication in new window or tab >>Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people >= 75 years, who had been hospitalized >= 3 times during the previous year, had >= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2015
Keywords
Chronic disease, Older people, Symptom assessment
National Category
Nursing
Research subject
Public Health Care Administration; Nursing Science
Identifiers
urn:nbn:se:kau:diva-41643 (URN)10.1186/1471-2318-15-1 (DOI)000347569800001 ()25559550 (PubMedID)
Available from: 2016-04-11 Created: 2016-04-11 Last updated: 2017-11-30Bibliographically approved
Eckerblad, J., Theander, K., Ekdahl, A., Jaarsma, T. & Hellstrom, I. (2015). To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity.. Applied Nursing Research, 28(4), 322-327
Open this publication in new window or tab >>To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity.
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2015 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, no 4, p. 322-327Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.

OBJECTIVES: The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

METHOD: A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

RESULTS: The experience of living with a high symptom burden revealed the overall theme, "To adjust and endure" and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

CONCLUSION: This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

Keywords
Multimorbidity; Older people; Symptom burden; Content analysis
National Category
Other Medical Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-40968 (URN)10.1016/j.apnr.2015.03.008 (DOI)000366148700012 ()26608433 (PubMedID)
Available from: 2016-03-03 Created: 2016-03-03 Last updated: 2017-11-30Bibliographically approved
Nilsson, J., Johansson, E., Egmar, A.-C., Florin, J., Leksell, J., Lepp, M., . . . Wilde-Larsson, B. (2014). Development and validation of a new tool measuring nursesself-reported professional competence—The nurse professionalcompetence (NPC) Scale. Nurse Education Today, 2014(34), 574-580
Open this publication in new window or tab >>Development and validation of a new tool measuring nursesself-reported professional competence—The nurse professionalcompetence (NPC) Scale
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2014 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 2014, no 34, p. 574-580Article in journal (Refereed) Published
Abstract [en]

Objectives: To develop and validate a new tool intended for measuring self-reported professional competenceamong both nurse students prior to graduation and among practicing nurses. The new tool is based on formalcompetence requirements from the Swedish Board of Health and Welfare, which in turn are based on WHOguidelines.Design: A methodological study including construction of a new scale and evaluation of its psychometricproperties.Participants and settings: 1086 newly graduated nurse students from 11 universities/university colleges.Results: The analyses resulted in a scale named the NPC (Nurse Professional Competence) Scale, consisting of 88items and covering eight factors: “Nursing care”, “Value-based nursing care”, “Medical/technical care”, “Teaching/learning and support”, “Documentation and information technology”, “Legislation in nursing and safetyplanning”, “Leadership in and development of nursing care” and “Education and supervision of staff/students”.All factors achieved Cronbach's alpha values greater than 0.70. A second-order exploratory analysis resulted intwo main themes: “Patient-related nursing” and “Nursing care organisation and development”. In addition,evidence of known-group validity for the NPC Scale was obtained.

Place, publisher, year, edition, pages
Midlothian, Scotland: Churchill Livingstone, 2014
Keywords
Nurses' competence, Professional nursing, Nursing education, Nursing students, Graduate nurses, Quality of care, Safety in healthcare, Scale development, Validation, Psychometric properties
National Category
Nursing
Research subject
Education
Identifiers
urn:nbn:se:kau:diva-33841 (URN)10.1016/j.nedt.2013.07.016 (DOI)000333781600016 ()23938092 (PubMedID)
Available from: 2014-09-26 Created: 2014-09-26 Last updated: 2017-12-07Bibliographically approved
Todt, K., Skargren, E., Kentson, M., Theander, K., Jakobsson, P. & Unosson, M. (2014). Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD. The International Journal of Chronic Obstructive Pulmonary Disease, 9, 17-25
Open this publication in new window or tab >>Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD
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2014 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 9, p. 17-25Article in journal (Refereed) Published
Abstract [en]

Introduction: Several differences have been reported in the clinical characteristics of chronic obstructive pulmonary disease (COPD) between men and women. Differences have been found in the association between respiratory symptoms and lung function, and in the factors associated with dyspnea. This raises the question of whether there are differences between the sexes in the relationship between fatigue, the second most prevalent symptom, and the variables of physical capacity and disease severity. Objectives: To examine the experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD. Methods: In a cross-sectional study 121 patients with COPD (54 men and 67 women), the experience of fatigue (frequency, duration, and severity) and physical capacity (lung function, 6-minute walk distance [6MWD], grip strength, and timed-stand test) were assessed. Disease severity was graded according to the Body mass index, airway Obstruction, Dyspnoea and Exercise capacity (BODE) index. Two multiple logistic regression models were tested, both of which were performed separately in men and women, to examine the association between the experience of fatigue and variables of physical capacity and the BODE index. Results: Eighty-nine (73.6%) patients experienced fatigue, with similar proportions in men and women. The men with fatigue had worse physical capacity and more severe disease than did the men without fatigue: for men with and without fatigue, respectively, the percent of predicted forced expiratory volume in 1 second (FEV1) (mean [standard deviation]) was 47 (14) vs 64 (17); the 6MWD (mean [standard deviation]) was 398 (138) vs 539 (105) m; and the BODE index (median [quartile 1-3]) was 3 (2-5) vs 1 (0-1) (P<0.01). In women, only higher leg fatigue post-6MWD was seen among those experiencing fatigue compared with women without fatigue: for women with and without fatigue, respectively, leg fatigue (median [quartile 1-3]) was 4 (3-5) vs 2 (0-3) (P<0.001). The regression models showed that the 6MWD and the BODE index were associated with fatigue in both men and women, but in women, leg fatigue remained an independent associate in both models. Conclusion: Exercise capacity and disease severity were associated with fatigue in both men and women. In women, leg fatigue was strongly associated with fatigue, which warrants further investigation.

Place, publisher, year, edition, pages
Dove medical Press, 2014
Keywords
chronic obstructive pulmonary disease, disease state, functional capacity, sex differences, symptom experience, leg fatigue
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-41595 (URN)10.2147/COPD.S52506 (DOI)000328463500001 ()24368883 (PubMedID)
Available from: 2016-04-22 Created: 2016-04-11 Last updated: 2017-11-30Bibliographically approved
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