| 61. |
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| 62. |
- von Thiele Schwarz, Ulrica, 1975-, et al.
(författare)
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Professionals’ management of the fidelity–adaptation dilemma in the use of evidence-based interventions—an intervention study
- 2021
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Ingår i: Implementation Science Communications. - : Springer Science and Business Media LLC. - 2662-2211. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and healthpromotion. However, their implementation often requires a delicate balance between the need to adjust theintervention to the context in which it is implemented and the need to keep the core components that make theintervention effective. This so-called dilemma between fidelity and adaptation is often handled by healthprofessionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted andinstitutionalized in an organization), but not much is known about how and to what extent health professionals areaffected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity andadaptation are managed by professionals using an EBI, (2) how the fidelity–adaptation dilemma affectsprofessionals’ psychosocial working conditions, and (3) how a structured decision support influences professionals’management of the dilemma and their psychosocial working conditions.Methods: The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). Alongitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sourcesinclude web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and writtendocumentation, collected at multiple time points with both group leaders and parents as respondents.Discussion: This project approaches fidelity and adaptation from the perspective of the professionals that manageEBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change overtime, it remains to be understood how the fidelity–adaptation dilemma can be managed so that the effectivenessof interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting anoccupational health perspective on the fidelity–adaptation dilemma. It is acknowledged that fidelity and adaptationmay have consequences for not only clients but also the occupational wellbeing of the professionals managing thedilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.
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| 63. |
- Wheeler, Eleanor, et al.
(författare)
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Impact of common genetic determinants of Hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations : A transethnic genome-wide meta-analysis
- 2017
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Ingår i: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 14:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated with erythrocyte traits) or glycemic (associated with other glucose-related traits). In this study, we tested the hypotheses that, in a very large scale GWAS, we would identify more genetic variants associated with HbA1c and that HbA1c variants implicated in erythrocytic biology would affect the diagnostic accuracy of HbA1c. We therefore expanded the number of HbA1c-associated loci and tested the effect of genetic risk-scores comprised of erythrocytic or glycemic variants on incident diabetes prediction and on prevalent diabetes screening performance. Throughout this multiancestry study, we kept a focus on interancestry differences in HbA1c genetics performance that might influence race-ancestry differences in health outcomes.Methods & findings: Using genome-wide association meta-analyses in up to 159,940 individuals from 82 cohorts of European, African, East Asian, and South Asian ancestry, we identified 60 common genetic variants associated with HbA1c. We classified variants as implicated in glycemic, erythrocytic, or unclassified biology and tested whether additive genetic scores of erythrocytic variants (GS-E) or glycemic variants (GS-G) were associated with higher T2D incidence in multiethnic longitudinal cohorts (N = 33,241). Nineteen glycemic and 22 erythrocytic variants were associated with HbA1c at genome-wide significance. GS-G was associated with higher T2D risk (incidence OR = 1.05, 95% CI 1.04-1.06, per HbA1c-raising allele, p = 3 x 10-29); whereas GS-E was not (OR = 1.00, 95% CI 0.99-1.01, p = 0.60). In Europeans and Asians, erythrocytic variants in aggregate had only modest effects on the diagnostic accuracy of HbA1c. Yet, in African Americans, the X-linked G6PD G202A variant (T-allele frequency 11%) was associated with an absolute decrease in HbA1c of 0.81%-units (95% CI 0.66-0.96) per allele in hemizygous men, and 0.68%-units (95% CI 0.38-0.97) in homozygous women. The G6PD variant may cause approximately 2% (N = 0.65 million, 95% CI0.55-0.74) of African American adults with T2Dto remain undiagnosed when screened with HbA1c. Limitations include the smaller sample sizes for non-European ancestries and the inability to classify approximately one-third of the variants. Further studies in large multiethnic cohorts with HbA1c, glycemic, and erythrocytic traits are required to better determine the biological action of the unclassified variants.Conclusions: As G6PD deficiency can be clinically silent until illness strikes, we recommend investigation of the possible benefits of screening for the G6PD genotype along with using HbA1c to diagnose T2D in populations of African ancestry or groups where G6PD deficiency is common. Screening with direct glucose measurements, or genetically-informed HbA1c diagnostic thresholds in people with G6PD deficiency, may be required to avoid missed or delayed diagnoses.
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| 64. |
- Willer, Cristen J., et al.
(författare)
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Discovery and refinement of loci associated with lipid levels
- 2013
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 45:11, s. 1274-1283
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Tidskriftsartikel (refereegranskat)abstract
- Levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and total cholesterol are heritable, modifiable risk factors for coronary artery disease. To identify new loci and refine known loci influencing these lipids, we examined 188,577 individuals using genome-wide and custom genotyping arrays. We identify and annotate 157 loci associated with lipid levels at P < 5 x 10(-8), including 62 loci not previously associated with lipid levels in humans. Using dense genotyping in individuals of European, East Asian, South Asian and African ancestry, we narrow association signals in 12 loci. We find that loci associated with blood lipid levels are often associated with cardiovascular and metabolic traits, including coronary artery disease, type 2 diabetes, blood pressure, waist-hip ratio and body mass index. Our results demonstrate the value of using genetic data from individuals of diverse ancestry and provide insights into the biological mechanisms regulating blood lipids to guide future genetic, biological and therapeutic research.
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| 65. |
- Zetterlund, Johanna, et al.
(författare)
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A Slippery Slope When Using an Evidence-Based Intervention Out of Context. How Professionals Perceive and Navigate the Fidelity-Adaptation Dilemma—A Qualitative Study
- 2022
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Ingår i: Frontiers in Health Services. - : Frontiers Media SA. - 2813-0146. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Adaptations are often necessary to effectively translate evidence-based interventions (EBI) between contexts, but compliance with the EBIs' core components is still important, which is referred to as the fidelity–adaptation dilemma. In the sustainment phase of implementation, it is the professionals delivering the EBIs who are tasked with the decision-making regarding adaptations, but the currently used models and frameworks mostly focus on the initial phases of implementation. To better understand and guide professionals in using EBIs, there is a need to explore professionals' perceptions of the fidelity–adaptation dilemma. The aim of this study is consequently to explore how professionals perceive and navigate the fidelity–adaptation dilemma when using an EBI out of context.Materials and Methods: Semi-structured interviews were held with 19 psychologists working in primary care. The interviews concerned EBIs in general and Cool Kids, an evidence-based parenting education program designed for children with anxiety that is now used for children with lower levels of anxiety in another setting. The data were analyzed using an inductive content analysis method.Results: The analysis resulted in two themes: My standpoint regarding fidelity and adaptation is clear and Managing fidelity and adaptations is complicated. The first theme summarizes the professionals' perceptions of confidence for either favoring fidelity or adaptations, as well as reasons for why they made adaptations. For the second theme, the professionals expressed concern about sometimes meeting difficulties with the dilemma when following their original inclination and having second thoughts about the impact the adaptations have in practice.Conclusion: The professionals generally had strong preferences regarding fidelity and adaptations, but neither preference prevented them from facing difficulties with the dilemma. The results point to a need for better information about possible adaptations from developers but also better support and guidance for professionals when implementing EBIs to ensure quality implementation and facilitate implementation. The results of this study can inform the design of support for professionals in managing the dilemma.
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| 66. |
- Åkerstedt, Torbjörn, et al.
(författare)
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Effects of late-night short-sleep on in-home polysomnography : relation to adult age and sex
- 2018
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 27:4
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Tidskriftsartikel (refereegranskat)abstract
- Bedtime is frequently delayed by many factors in life, and a homeostatic response to the delay may compensate partly for increased time awake and shortened sleep. Because sleep becomes shorter with age and women complain of disturbed sleep more often than men, age and sex differences in the homeostatic response to a delayed bedtime may modify the homeostatic response. The purpose of the present study was to investigate the effect of late-night short-sleep (3 h with awakening at about 07:00 hours) on in-home recorded sleep in men and women in two age groups (20-30 and 65-75 years). Results (N = 59) showed that late-night short-sleep was associated with an increase in percentage of N3 sleep and a decrease in percentage of rapid eye movement sleep, as well as decreases in several measures of sleep discontinuity and rapid eye movement density. Men showed a smaller decrease in percentage of rapid eye movement sleep than women in response to late-night short-sleep, as did older individuals of both sexes compared with younger. Older men showed a weaker percentage of N3 sleep in response to late-night short-sleep than younger men. In general, men showed a greater percentage of rapid eye movement sleep and a lower percentage of N3 sleep than women, and older individuals showed a lower percentage of N3 sleep than younger. In particular, older men showed very low levels of percentage of N3 sleep. We conclude that older males show less of a homeostatic response to late-night short-sleep. This may be an indication of impaired capacity for recovery in older men. Future studies should investigate if this pattern can be linked to gender-associated differences in morbidity and mortality.
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| 67. |
- Åkerstedt, Torbjörn, et al.
(författare)
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Gray Matter Volume Correlates of Sleepiness : A Voxel-Based Morphometry Study in Younger and Older Adults
- 2020
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Ingår i: Nature and Science of Sleep. - 1179-1608. ; 12, s. 289-298
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Tidskriftsartikel (refereegranskat)abstract
- Background: Subjectively experienced sleepiness is a problem in society, possibly linked with gray matter (GM) volume. Given a different sleep pattern, aging may affect such associations, possibly due to shrinking brain volume.Purpose: The purpose of the present study was to investigate the association between subjectively rated sleepiness and GM volume in thalamus, insula, hippocampus, and orbitofrontal cortex of young and older adults, after a normal night’s sleep.Methods: Eighty-four healthy individuals participated (46 aged 20– 30 years, and 38 aged 65– 75 years). Morphological brain data were collected in a 3T magnetic resonance imaging (MRI) scanner. Sleepiness was rated multiple times during the imaging sessions.Results: In older, relative to younger, adults, clusters within bilateral mid-anterior insular cortex and right thalamus were negatively associated with sleepiness. Adjustment for the immediately preceding total sleep time eliminated the significant associations.Conclusion: Self-rated momentary sleepiness in a monotonous situation appears to be negatively associated with GM volume in clusters within both thalamus and insula in older individuals, and total sleep time seems to play a role in this association. Possibly, this suggests that larger GM volume in these clusters may be protective against sleepiness in older individuals. This notion needs confirmation in further studies.
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| 68. |
- Åkerstedt, Torbjörn, et al.
(författare)
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Having to stop driving at night because of dangerous sleepiness : awareness, physiology and behaviour
- 2013
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 22:4, s. 380-388
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Tidskriftsartikel (refereegranskat)abstract
- A large number of accidents are due to the driver falling asleep at the wheel, but details of this link have not been studied on a real road. The purpose of the present study was to describe the development of sleepiness indicators, leading to the drive being terminated prematurely by the onboard expert driving instructor because of imminent danger. Eighteen individuals participated during a day drive and a night drive on a motorway (both 90 min). Eight drivers terminated (N) prematurely (after 43 min) because of sleep-related imminent danger [according to the driving instructor or their own judgement (two cases)].The results showed very high sleepiness ratings (8.5 units on the Karolinska Sleepiness Scale) immediately before termination (<7 at a similar time interval for those 10 who completed the drive). Group N also showed significantly higher levels of sleep intrusions on the electroencephalography/electro-oculography (EEG/EOG) than those who completed the drive (group C). The sleep intrusions were increased in group N during the first 40 min of the night drive. During the day drive, sleep intrusions were increased significantly in group N. The night drive showed significant increases of all sleepiness indicators compared to the day drive, but also reduced speed and driving to the left in the lane. It was concluded that 44% of drivers during late-night driving became dangerously sleepy, and that this group showed higher perceived sleepiness and more sleep intrusions in the EEG/EOG.
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| 69. |
- Åkerstedt, Torbjorn, et al.
(författare)
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Short sleep-poor sleep? A polysomnographic study in a large population-based sample of women
- 2019
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 28:4
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population-based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of usual duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real-life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self-reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG-recorded sleep duration does not reflect habitual reported sleep duration in the present real-life context.
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| 70. |
- Åkerstedt, Torbjörn, et al.
(författare)
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The relation between polysomnography and subjective sleep and its dependence on age - poor sleep may become good sleep
- 2016
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 25:5, s. 565-570
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Tidskriftsartikel (refereegranskat)abstract
- Women complain more about sleep than men, but polysomnography (PSG) seems to suggest worse sleep in men. This raises the question of how women (or men) perceive objective (PSG) sleep. The present study sought to investigate the relation between morning subjective sleep quality and PSG variables in older and younger women. A representative sample of 251 women was analysed in age groups above and below 51.5 years (median). PSG was recorded at home during one night. Perceived poor sleep was related to short total sleep time (TST), long wake within total sleep time (WTSP), low sleep efficiency and a high number of awakenings. The older women showed lower TST and sleep efficiency and higher WTSP for a rating of good sleep than did the younger women. For these PSG variables the values for good sleep in the older group were similar to the values for poor sleep in the young group. It was concluded that women perceive different levels of sleep duration, sleep efficiency and wake after sleep onset relatively well, but that older women adjust their objective criteria for good sleep downwards. It was also concluded that age is an important factor in the relation between subjective and objective sleep.
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