| 11. |
- Arkkukangas, Marina, et al.
(author)
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High Challenge Exercise and Learning Safe Landing Strategies among Community-Dwelling Older Adults : A Randomized Controlled Trial
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:12
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Journal article (peer-reviewed)abstract
- There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6-9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p < 0.001) and learning falling techniques (p < 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries.
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| 12. |
- Arkkukangas, Marina
(author)
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Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention
- 2023
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In: Clinical Interventions in Aging. - : Dove Medical Press Ltd. - 1176-9092 .- 1178-1998. ; 18, s. 2165-2170
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Journal article (peer-reviewed)abstract
- Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a “train-The-trainer” approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.
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| 13. |
- Arkkukangas, Marina, et al.
(author)
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Risk factors for fall-related injuries among community-dwelling men and women over 70 years of age, based on social cognitive theory : results from a population study
- 2021
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In: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 23:4, s. 221-226
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Journal article (peer-reviewed)abstract
- Introduction: Healthcare professionals', especially physiotherapists' role as promoters, preventers and rehabilitators play a significant role in prevention of falls. The purpose of this study was to gain knowledge on the risk factors which are associated with fall-related injuries among community dwelling men and women, based on Social Cognitive Theory (SCT) concepts. Patients and methods: The study includes 13,151 people who responded to a postal survey questionnaire in 2017. The random sample consisted of men and women aged 70 years and older. Multivariate regression models were used to explore associations between theory-based risk factors and fall-related injuries. Results: A total of 16% (1951 people) reported a fall-related injury during the past 12 months. For men, a total of seven risk factors were associated with fall-related injury: age, pain (neck/shoulder), incontinence, depression, help in daily living, education and sedentary behaviour. For women, a total of nine risk factors were associated with fall-related injury: age, pain (extremities and neck/shoulder), tiredness, incontinence, appetite, economy, accommodation and participation in social activities. Conclusions: This study identified risk factors from all aspects of the SCT, serving as a clinically useful theory in addition to traditional fall preventive actions. Gender differences should be considered when designing fall prevention strategies.
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| 14. |
- Arkkukangas, Marina, et al.
(author)
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Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions : A Cohort Study
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:22
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Journal article (peer-reviewed)abstract
- This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20–6.71), the self-rated health score (2.80, 1.42–5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04–4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6–9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults’ physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.
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| 15. |
- Augustsson, Hanna, et al.
(author)
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Determinants for the use and de-implementation of low-value care in health care : a scoping review.
- 2021
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In: Implementation Science Communications. - : Springer Science and Business Media LLC. - 2662-2211. ; 2:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: A considerable proportion of interventions provided to patients lack evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary or even harmful care. However, despite some empirical studies in the field, there has been no synthesis of determinants impacting the use of low-value care (LVC) and the process of de-implementing LVC.AIM: The aim was to identify determinants influencing the use of LVC, as well as determinants for de-implementation of LVC practices in health care.METHODS: A scoping review was performed based on the framework by Arksey and O'Malley. We searched four scientific databases, conducted snowball searches of relevant articles and hand searched the journal Implementation Science for peer-reviewed journal articles in English. Articles were included if they were empirical studies reporting on determinants for the use of LVC or de-implementation of LVC. The abstract review and the full-text review were conducted in duplicate and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data charting form and the determinants were inductively coded and categorised in an iterative process conducted by the project group.RESULTS: In total, 101 citations were included in the review. Of these, 92 reported on determinants for the use of LVC and nine on determinants for de-implementation. The studies were conducted in a range of health care settings and investigated a variety of LVC practices with LVC medication prescriptions, imaging and screening procedures being the most common. The identified determinants for the use of LVC as well as for de-implementation of LVC practices broadly concerned: patients, professionals, outer context, inner context, process and evidence and LVC practice. The results were discussed in relation to the Consolidated Framework for Implementation Research.CONCLUSION: The identified determinants largely overlap with existing implementation frameworks, although patient expectations and professionals' fear of malpractice appear to be more prominent determinants for the use and de-implementation of LVC. Thus, existing implementation determinant frameworks may require adaptation to be transferable to de-implementation. Strategies to reduce the use of LVC should specifically consider determinants for the use and de-implementation of LVC.REGISTRATION: The review has not been registered.
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| 16. |
- Augustsson, Hanna, et al.
(author)
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National governance of de-implementation of low-value care : a qualitative study in Sweden
- 2022
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In: Health Research Policy and Systems. - : BMC. - 1478-4505 .- 1478-4505. ; 20:1
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Journal article (peer-reviewed)abstract
- Background The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC. Methods We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis. Results Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation. Conclusions Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.
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| 17. |
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| 18. |
- Axelsson, Carl-Anton Werner, 1981-, et al.
(author)
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Learning How to Separate Fake From Real News : Scalable Digital Tutorials Promoting Students’ Civic Online Reasoning
- 2021
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In: Future Internet. - : MDPI. - 1999-5903. ; 13:3
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Journal article (peer-reviewed)abstract
- With the rise of misinformation, there is a great need for scalable educational interventions supporting students’ abilities to determine the trustworthiness of digital news. We address this challenge in our study by developing an online intervention tool based on tutorials in civic online reasoning that aims to teach adolescents how to critically assess online information comprising text, videos and images. Our findings from an online intervention with 209 upper secondary students highlight how observational learning and feedback support their ability to read laterally and improve their performance in determining the credibility of digital news and social media posts.
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| 19. |
- Backeman, Peter, et al.
(author)
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Interpolating bit-vector formulas using uninterpreted predicates and Presburger arithmetic
- 2021
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In: Formal methods in system design. - : SPRINGER. - 0925-9856 .- 1572-8102. ; 57:2, s. 121-156
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Journal article (peer-reviewed)abstract
- The inference of program invariants over machine arithmetic, commonly called bit-vector arithmetic, is an important problem in verification. Techniques that have been successful for unbounded arithmetic, in particular Craig interpolation, have turned out to be difficult to generalise to machine arithmetic: existing bit-vector interpolation approaches are based either on eager translation from bit-vectors to unbounded arithmetic, resulting in complicated constraints that are hard to solve and interpolate, or on bit-blasting to propositional logic, in the process losing all arithmetic structure. We present a new approach to bit-vector interpolation, as well as bit-vector quantifier elimination (QE), that works by lazy translation of bit-vector constraints to unbounded arithmetic. Laziness enables us to fully utilise the information available during proof search (implied by decisions and propagation) in the encoding, and this way produce constraints that can be handled relatively easily by existing interpolation and QE procedures for Presburger arithmetic. The lazy encoding is complemented with a set of native proof rules for bit-vector equations and non-linear (polynomial) constraints, this way minimising the number of cases a solver has to consider. We also incorporate a method for handling concatenations and extractions of bit-vector efficiently.
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| 20. |
- Baric, Vedrana B., et al.
(author)
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Partnering for change (P4C) in Sweden : a study protocol of a collaborative school-based service delivery model to create inclusive learning environments
- 2023
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In: BMC Public Health. - : Springer Nature. - 1471-2458. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting.Aim: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C.Methods: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions.
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