| 51. |
- Goulding, Anneli, 1966, et al.
(författare)
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Person-centered psychosis care (PCPC) in an inpatient setting: Patient outcomes
- 2018
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Ingår i: Schizophrenia Bulletin. 44 (suppl 1), S426. - : Oxford University Press (OUP). - 0586-7614 .- 1745-1701.
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Konferensbidrag (refereegranskat)abstract
- Background The person-centered care approach has been little tested in inpatient settings for persons with schizophrenia and similar psychoses. We developed a staff educational intervention, Person-Centered Psychosis Care (PCPC) tailored to our care setting (4 hospital wards for persons with psychoses, 43 beds). The intervention was co-created by professionals, patients, and researchers using a participatory approach. There was a focus on the patient’s narrative, the creation of partnership between staff and patient, an agreement between staff and patient concerning care, and a bridging of inpatient and outpatient care and support. The present study aims to describe patient outcomes associated with PCPC. Methods The study had a before and after design. Before the PCPC intervention started, questionnaire data was collected from 50 inpatients shortly before discharge. Post intervention data are currently under collection (anticipated n=50). The primary outcome measure is self-reported empowerment (Empowerment Scale, Range 0–112) and the secondary measure is consumer satisfaction (UKU-ConSat Rating Scale, converted to range between 11 and 77). Participants also complete questionnaires related to possible confounding variables such as overall health (EQ-5D), symptom burden (PANSS), and functional ability (GAF). Results The participants (46% women) included in the pre-intervention sample had a mean age of 47.5 years (SD=14.5). The total mean empowerment score for the pre-intervention sample was 82.6 (SD=8.1) whereas the mean consumer satisfaction score was 51.5 (SD=12.9). There were no statistically significant gender differences regarding empowerment or consumer satisfaction. There were no significant correlations between age, any of the confounding variables, and empowerment and consumer satisfaction. We will present results from comparisons between the pre- and post-intervention groups regarding empowerment and consumer satisfaction. Discussion The before and after design has its limitations, but if the PCPC intervention proves beneficial, such a model could be tested with a cluster randomized study design.
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| 52. |
- Goulding, Anneli, 1966, et al.
(författare)
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Person Centred Psychosis Care (PCPC) in an Inpatient Setting: The Implementation Process and Staff Experiences.
- 2016
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Ingår i: Npj Schizophrenia. - 2334-265X.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Persons with schizophrenia-spectrum disorders might benefit from increased involvement in the care process. To this end, integrated care models have been successfully implemented in outpatient settings. We wanted to develop an inpatient care model inspired by integrated care. Further, we wanted to include central components of person-centred care (asdefined by the Gothenburg Centre for Person-Centred Care) including a focus on the patient's narrative, the creation of partnership between staff and patient, and an agreement between staff and patientconcerning the care. The present research project, Person Centred Psychosis Care (PCPC), aims to develop, implement, and evaluate an inpatient care approach that utilizes aspects of integrated care as well as person-centred care. In the present study we will describe the PCPC staff educational intervention, the implementation process that followed, and staff experiences of the intervention and implementation. Methods: Emplyoing a participatory design, the PCPC staff educational intervention involved one third (n=40) of the staff working at four wards at a clinic providing inpatient care for persons with schizophrenia-spectrum disporders. Facilitators with previous experience in the implementation of person-centred care in somatic settings served as coaches. During six full day workshop, staff learned to apply theoretical concepts of both integrated care and person-centred care to their everyday ward situation and worked in groups to develop ward-level projects with the aim of stimulating patient involvement. Service users took part in the educational intervention. Staff who participated in the educational intervention transferred their new approaches to care tasks. This means that all ward staff became involved in the implementation process. Results A purposeful sample of staff memebers (both with and without course participation, n=20) were asked to praticipate in focus group interviews to relate their experiences of the PCPC staff educational intervention, the transfer to those staff memebers who did not take the course, and of recorded, transcribed verbatim, and thematically analyzed. Results regarding the implementation process will be presented, with a focus on barriers and facilitators to change. Discussion: Findings from the focus group interviews will shed light on staff members' experiences of the education intervention, as well as the experiences of staff memebers who participated in transfer activities but not in the course itself. It is our expectation that the participatory design will facilitate long lasting behaviour change in staff, resulting in patients feeling more involved in their care. Future studies will report on patient outcomes (empowerment and care satisfaction) as well as ward level outcomes. If the PCPC-intervention shows positive outcomes for patients and staff, it might be a model that other psychiatric care providers can use to enhance patient involvemebt and satisfaction with care.
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| 53. |
- Goulding, Anneli, 1966, et al.
(författare)
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Study protocol design and evaluation of a hospital-based multi-professional educational intervention: Person-Centred Psychosis Care (PCPC)
- 2018
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:269
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Tidskriftsartikel (refereegranskat)abstract
- Background: While patient involvement in mental health care is repeatedly stressed in policy documents, there are actually few studies that evaluate person-centred care interventions within psychiatric services. We present here the design and planned evaluation of an educational intervention for inpatient staff involved in the care of persons with schizophrenia and similar psychoses. Methods/design: The care intervention will be assessed using a non-randomised trial with a before and after approach. The intervention involves an educational and experimental learning phase for hospital staff, followed by an implementation phase. The intervention is multi-professional; psychiatrists, psychiatric nurses, psychiatric carers, social workers, occupational therapists, and a medical secretary will be engaged in a participatory approach where they practice how to create a partnership and explore recovery-related goals together with patients. Patient-related outcomes include empowerment and satisfaction with care. Ward-level outcomes include daily ward burden, length of inpatient stay, and number of days with involuntary care. In addition, qualitative methods will be applied to capture patient, next-of-kin, and staff perspectives. Discussion: The care intervention is expected to contribute to the improvement of inpatient care for persons with severe and complex mental health issues. Trial registration: The trial was retrospectively registered at ClinicalTrials.gov June 9, 2017, identifier: NCT03182283.
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| 54. |
- Gudmundsson, Pia, 1978, et al.
(författare)
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Depression in Swedish women: relationship to factors at birth.
- 2011
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Ingår i: European journal of epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 26:1, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.
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| 55. |
- Gudmundsson, Pia, 1978, et al.
(författare)
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Is there a CSF biomarker profile related to depression in elderly women?
- 2010
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Ingår i: Psychiatry Research. - 0165-1781. ; 176:2-3, s. 174-178
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Tidskriftsartikel (refereegranskat)abstract
- In light of our previous observation of higher levels of cerebrospinal fluid (CSF) amyloid beta-42 (Aβ42) and CSF/serum albumin ratio in major depressive disorder (MDD), we analyzed two additional CSF biomarkers reflecting neurodegeneration—neurofilament protein light (NFL) and glial fibrillary acidic protein (GFAp)—in relationship to prevalent geriatric depression. Neuropsychiatric, physical, and lumbar puncture examinations, with DSM-III-R-based depression diagnoses and measurement of CSF levels of NFL and GFAp, were evaluated among a population-based sample of 78 elderly women (mean age, 73.9±3.2 years) without dementia for at least 10 years after CSF collection. Eleven (13.1%) women had MDD, and higher levels of NFL compared with women without depression. A multivariate model including age, NFL, Aβ42 and the CSF/serum albumin ratio showed that each biomarker was independently and positively associated with MDD, and that this biomarker profile explained more variation in the model compared with single or combined biomarkers. A CSF profile with higher levels of NFL, Aβ42, and CSF/serum albumin ratio may indicate neuropathological and vascular events in depression etiology. This contrasts with the well-characterized pattern of low Aβ42, higher CSF/serum albumin ratio, and higher NFL in Alzheimer's disease.
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| 56. |
- Gudmundsson, Pia, 1978, et al.
(författare)
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Longitudinal associations between physical activity and depression scores in Swedish women followed 32 years
- 2015
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 132:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Physical activity is negatively associated with depressive symptoms. However, few studies consider dynamic associations of changes in physical activity and reciprocal relationships. This study aimed to perform comprehensive evaluations of relationships between physical activity and depression scores in women followed from mid- to late life. Method: The Prospective Population Study of Women in Gothenburg, Sweden, provided repeated measures of self-reported physical activity and depressive symptoms between 1974 and 2005 (baseline N = 676, 84.5% response rate). Depressive symptoms were assessed using the Montgomery–Åsberg Depression Rating Scale, and physical activity was evaluated by the Saltin–Grimby Physical Activity Level Scale. Latent growth curve analyses were used to evaluate associations of change, and cross-lagged models were used to study the reciprocal relationship between physical activity and depression scores. Results: At baseline, lower levels of physical activity were related to higher depression scores. Individuals with decreasing physical activity over time evidenced higher depression scores at 32-year follow-up. Higher average baseline depression score was related to declining levels of physical activity at subsequent examinations. Conclusion: Reduced physical activity may be a long-term consequence of depression. It is important to address individual changes in physical activity and not merely absolute levels of physical activity in relationship to depression.
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| 57. |
- Gudmundsson, Pia, 1978, et al.
(författare)
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The relationship between cerebrospinal fluid biomarkers and depression in elderly women.
- 2007
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Ingår i: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. - 1064-7481. ; 15:10, s. 832-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Cerebrospinal fluid (CSF) biomarkers including the 42 amino-acid form of beta-amyloid (Abeta42), total tau protein (T-tau), and the CSF/serum albumin ratio are markers of brain pathology and metabolism. Abeta42 and T-tau are sometimes used to discriminate geriatric depression from mild forms of Alzheimer disease (AD) in clinical studies. However, studies focusing on the relationship between these CSF biomarkers and geriatric depression are lacking. METHODS: This was a cross-sectional study with a population-based sample of 84 nondemented elderly women in Sweden. Measurements included neuropsychiatric, physical, and lumbar puncture examinations, with Diagnostic and Statistical Manual of Mental Disorders, Third Revision-based depression diagnoses and measurement of CSF levels of Abeta42, T-tau, albumin, and serum albumin. RESULTS: Fourteen women (mean age: 72.6 years) had any depression (11 with major depressive disorder [MDD]). Compared to women without depression, women with MDD had higher levels of Abeta42 and the CSF/serum albumin ratio. The CSF/serum albumin ratio was also higher in women with any depression. No differences in T-tau were observed; however, T-tau increased with age. CONCLUSION: Higher levels of CSF Abeta42 were observed among elderly depressed women, in contrast to lower levels usually observed in AD, indicating potential neuropathological differences between the two disorders. Higher CSF/serum albumin ratios observed in depressed women point to potential vascular processes.
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| 58. |
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| 59. |
- Guo, Xinxin, 1972, et al.
(författare)
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Midlife respiratory function and Incidence of Alzheimer's disease: a 29-year longitudinal study in women
- 2007
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Ingår i: Neurobiology of Aging. ; 28, s. 343-350
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Tidskriftsartikel (refereegranskat)abstract
- Neuropsychiatric Epidemiology Unit, Institute of Clinical Neurosciences, Sahlgrenska Academy at Göteborg University, SE 413 45 Göteborg, Sweden. xinxin.guo@neuro.gu.se Normal cognitive function depends on sufficient supply and efficient utilization of oxygen in the brain. Prospective studies on respiratory function and dementia are lacking. This study investigated the relationship between midlife respiratory function and incidence of dementia in a population-based sample of 1291 women followed from 1974 to 2003. Respiratory function was measured by peak expiratory flow in 1974, and forced vital capacity and forced expiratory volume in 1980. Dementia diagnoses were based on information from neuropsychiatric examinations, informant interviews, hospital records and registry data. Better respiratory function in midlife was associated with a lower late-life risk of developing dementia and Alzheimer's disease (AD). Per 1 standard deviation increase in peak expiratory flow, forced vital capacity and forced expiratory volume, hazard ratios (95% confidence intervals) for dementia were 0.77 (0.65-0.91), 0.72 (0.57-0.92) and 0.75 (0.59-0.95), respectively, and for AD 0.76 (0.62-0.94), 0.71 (0.54-0.95) and 0.74 (0.56-0.98), respectively, after adjustment for potential confounders. These data reinforce the advantages of maintaining good respiratory function in midlife, even though causation cannot be established. PMID: 16513221 [PubMed - indexed for MEDLINE]
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| 60. |
- Gustafson, Deborah, 1966, et al.
(författare)
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Adiposity indicators and dementia over 32 years in Sweden
- 2009
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Ingår i: Neurology. - 1526-632X. ; 73:19, s. 1559-66
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: High midlife and late-life adiposity may increase risk for dementia. Late-life decrease in body mass index (BMI) or body weight within several years of a dementia diagnosis has also been reported. Differences in study designs and analyses may provide different pictures of this relationship. METHODS: Thirty-two years of longitudinal body weight, BMI, waist circumference, and waist-to-hip ratio (WHR) data, from the Prospective Population Study of Women in Sweden, were related to dementia. A representative sample of 1,462 nondemented women was followed from 1968 at ages 38-60 years, and subsequently in 1974, 1980, 1992, and 2000, using neuropsychiatric, anthropometric, clinical, and other measurements. Cox proportional hazards regression models estimated incident dementia risk by baseline factors. Logistic regression models including measures at each examination were related to dementia among surviving participants 32 years later. RESULTS: While Cox models showed no association between baseline anthropometric factors and dementia risk, logistic models showed that a midlife WHR greater than 0.80 increased risk for dementia approximately twofold (odds ratio 2.22, 95% confidence interval 1.00-4.94, p = 0.049) among surviving participants. Evidence for reverse causality was observed for body weight, BMI, and waist circumference in years preceding dementia diagnosis. CONCLUSIONS: Among survivors to age 70, high midlife waist-to-hip ratio may increase odds of dementia. Traditional Cox models do not evidence this relationship. Changing anthropometric parameters in years preceding dementia onset indicate the dynamic nature of this seemingly simple relationship. There are midlife and late-life implications for dementia prevention, and analytical considerations related to identifying risk factors for dementia.
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