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- Bendtsen, Preben, 1956-
(författare)
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Rheumatoid arthritis - patient perception of disease, care, quality of life, coping and well-being : a study from a Swedish health care district
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the past decades, the focus of outcome studies in chronic diseases such as rheumatoid arthritis (RA) has changed from a technical and biological preoccupation towards a more patient-concemed psychosocial perspective. The changing paradigm of chronic disease impact has been conceptualised in a number of self-report health status and outcome measurements that have been called 11one of the primary achievements of rheumatology in the 1980s". The overall aim of the study was to make a broad elucidation of the perceived selfMreported impact of rheumatoid arthritis in a representative group of individuals from a health care district, with regard to treatment and care, quality oflife, coping and well-being.A total of 321 patients from a health care district in the northern part of Kalmar county, Sweden, with both early/mild and more severe disease were enrolled in the first part of the study, in which the medical records of these individuals were scrutinised for information about previous treatment and care. In the second part of the study, 222 of the initial 321 persons participated in an extensive postal survey exploring perceived impact of RA by self-report.The uncertain outcome of RA disease was emphasised by a high frequency of discontinuations of drug therapy due to lack of effect or side-effects. Underlining the lack of a medical cure for RA, more than 40% of the individuals had undergone some kind of surgical procedure due to the disease. The rehabilitation services to individuals with RA appear to be functioning fairly adequately since those still working were employed in administrative work rather than in production. The participants indicated a preference for a good reception by health care workers rather than technically correct care. Only a minority of the patients who had been treated as in-patients felt that they had been involved in the planning of the care. Also, the physicians seemed to underestimate the patients desire for information concerning both medical and social aspects of the disease.Quality of life scores exhibited a change for the worse with increasing self-reported functional disability. Physical, psychological and social life domains were fairly highly interrelated and all revealed lower levels with increasing self-reported functional disability. Also, lower levels of well-being were closely associated with a more severe RA disease, in particular loneliness, indolence, tension, security, future-orientation and endurance. Coping and wellMbeing were only weakly interrelated, but individuals who declared an active lifostyle exhibited a better well-being with a higher basic mood, greater fotureorientation and less indolence, loneliness and inferiority. Individuals accepting the RA disease displayed less guilt and tension, and greater endurance and basic mood.The study depicts how individuals with RA in a health care district are provided with both the basic treatment and more specialised care in a collaboration between medical and surgical specialists. In general, satisfaction with the care provided was more closely related with clinical signs rather than self-reported functional performance, although the latter might more adequately reflect the perceived need of the patients. Thus, the results support the application of self-reported functional disability assessment in routine clinical rheumatological practice. The study displays methods that measure and quantify the increasing negative psychosocial impact of RA with increasing functional disability. Some evidence was also found supporting the inclusion of coping enhancement elements in health care programmes targeting patients with RA. Consequently, the inclusion of counselling enhancing acceptance of the RA and encouraging decisions about new relevant goals might, at least theoretically, increase well-being in patients with RA.
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- Bendtsen, Preben, 1956-
(författare)
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Sekundärprevention av alkoholproblem inom hälso- och sjukvården
- 2002
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Ingår i: Den svenska supen i det nya Europa. - Stockholm : Folkhälsoinstitutet. - 9172571411 ; , s. 159-178
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- En kunskapsöversikt som tar upp olika risk- och skyddsfaktorer för alkoholproblem och beskriver vilka åtgärder som har bäst förebyggande effekt. Boken är skriven av några av landets mest framstående alkohol- och preventionsforskare
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- Carlfjord, Siw, 1959-
(författare)
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The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
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- Holmqvist, Marika, 1959-
(författare)
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Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol.This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey.Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient.OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories.Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy.MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
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- Johansson Capusan, Andrea, 1970-
(författare)
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Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research in past decades has demonstrated the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood, but many questions regarding prevalence, causes, and comorbidities of ADHD in adults remain to be investigated. Previous research focusing on childhood ADHD identified high heritability. Genetic and environmental influences on ADHD symptoms in adults and their association with comorbid conditions are not fully understood.The overall aim of this thesis was to study adult ADHD symptoms in the population and investigate associations with substance use disorders (SUD) and binge eating. In all four papers, we used population-based self-report data from twins aged 20–46 years from the Swedish Twin Registry. We used twin methods to explore the role of genetic and environmental factors underlying ADHD symptoms and their comorbidities.Study I examined the phenotypic association between ADHD and various forms of SUD. ADHD in adults was strongly associated with alcohol abuse and alcohol dependence, illicit drug use and regular nicotine use, with no differences between ADHD subtypes and no apparent substance preference. In Studies II and IV, we used bivariate twin models to examine the role of genetic and environmental factors in the association of adult ADHD symptoms with alcohol dependence (II) and with binge eating (IV). For ADHD symptoms and alcohol dependence, 64% of the overlap was explained by common genetic factors. The remaining variance was accounted for by environmental factors specific for each twin, with no sex differences for the overlap. Similarly, 91% of the association between ADHD symptoms and binge-eating behaviour was explained by common genetic factors. In Study III, using a within-twin pair analysis, we demonstrated that although most of the association between adult ADHD symptoms and self-reported childhood maltreatment (an environmental risk factor for ADHD) was explained by familial (genetic and environmental) confounding, our results were also consistent with a causal interpretation.In conclusion, adult ADHD symptoms are associated with SUD and binge-eating behaviour. We replicated findings from adolescent studies regarding shared genetic risk factors for alcohol dependence and ADHD symptoms in adults. For binge eating, we showed for the first time that shared genetic factors mainly explained the association with ADHD symptoms. Alterations in mesolimbic reward processing as well as the frontal, executive and inhibitory systems have been described for ADHD, alcohol dependence and binge-eating behaviour, possibly suggesting common genetic and neurobiological factors for all three conditions. Results that support a causal hypothesis regarding the association between childhood maltreatment and ADHD symptoms in adults need follow-up in longitudinal clinical samples that can examine neurobiological underpinnings of environmental effects. Clinically, the results of this thesis support that ADHD in adults be considered and addressed in adults with SUD or binge-eating behaviour. Given the common genetic risk factors and the role of the early childhood environment, family interventions should be considered for these populations.
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- Johansson, Kjell, et al.
(författare)
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Towards implementation of alcohol preventive interventions into primary health care : testing a new model for selection of clinically meaningful patient groups for alcohol screening
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim of the study was to explore alcohol consumption and drinking patterns among primary health care patients in relation to their complaints as presented to the nurse in the reception at the health care centre. A model for identifying clinically meaningful groups of patients to be included in systematic screening for hazardous alcohol consumption was empirically tested.Methods : The study was conducted at two primary health care centres in a large city in the county of Ostergiitland in southern Sweden. All patients 16 years or older visiting the health care centres during a 2-week period, received a questionnaire concerning their complaints and alcohol habits when registering at the reception. The patients returned the completed questionnaires in sealed boxes before leaving the health care centre. A model for identifying clinically meaningful patient groups to be included in systematic alcohol screening was developed and applied on the results from the questionmrire.Results: Among 358 female respondents 10.6% (38 patients) were hazardous drinkers and among the 203 male respondents 20.2% (41 patients). When applying the model on the questionnaire results, it was possible to identify the most optimal patient groups for systematic alcohol screening on basis of the patient's complaints. Among the female respondents the most optimal patient groups to screen were those presenting skin, stomach/bowel, psychological, lung, or urinary tract complaints. Among the males were the patient groups presenting complaints concerning lungs, psychological problems, back, neck or shoulder problems, hypertension or injuries found to be the most optimal. There were, however, no significant differences in the proportion of hazardous drinkers for the different complaints, with the exception of male respondents with lung complaints, where 100% were hazardous drinkers.Conclusions: As the proportion of hazardous drinkers among primary health care patients within each presented complaint was found to be rather low during the two week study period, it was not possible to make any definite conclusion about an optimal screening strategy. However the model presented may be useful in future research to identify clinically meaningful patient groups to be included in selective screening, although this requires a much larger data collection
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| 10. |
- Leijon, Matti, 1970-
(författare)
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Activating People : Physical activity in the general population and referral schemes among primary health care patients in a Swedish county
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis the need for physical activity interventions is investigated in a general adult population, the characteristics of physical activity referral (PAR) scheme recipients and referral practitioners, and the effectiveness of PAR in a routine primary health-care (PHC) setting in the county of Östergötland, Sweden. The thesis consists of four papers: three papers are based on a quantitative, uncontrolled prospective PAR study and one paper is based on a population survey in the county of Östergötland, Sweden.In 2006, only one in four of the adult population, aged 18–84 years, in Östergötland was considered sufficiently active to meet the Swedish national public health recommendations, stated as “30 minutes of moderate physical activity a day”. More than one-third (37%) reported that they hade no intentions to change their physical activity levels, while 36% had thought about change, and 27% were determined to change. Although the individuals felt a large responsibility for their own physical activity, they also believed that this responsibility is partly shared by health-care providers. Among those who wanted to increase their physical activity level, almost one in seven of the total population and one in four among those reporting poor general health, with a BMI over 30 and those who were inactive reported that they wanted support to bring about this change. More than half of them wanted this support from their health-care provider.During 2004 and 2005, a total of 6300 patients received PARs as part of the Östergötland PAR scheme. Two-thirds of the patients were female and half of the patients were 45–64 years old. The PAR scheme reached a relatively high proportion of physically inactive people. PARrelated statistics, including the numbers of referrals made at individual PHC centres and by different professional categories, showed large differences in prescribing activities, both by patient categories, and by prescribing professionals, indicating great potential for further improvements of this scheme in the future.Half of the patients (51%) who received PARs were recommended home-based activities, such as walking. Patient follow-up showed that an increase in self-reported physical activity level was achieved by 52% of the patients at the 12-month follow-up. The proportion of inactive patients decreased from 33% at baseline to 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 32% at 12 months. Neither patient age, diagnosis/PAR reason nor the profession of the prescriber were associated with differences in effectiveness. Low activity levels at baseline and homebased activities were significantly associated with increased physical activity at 12 months. Half of the patients (50%) achieved adherence to PARs at the 12-month follow-up, with adherence assessed by simply asking the patients about their adherence to prescribed activity. Patients’ activity levels at baseline (being at least somewhat physically active) and being issued home-based activities were significantly associated with higher adherence at 12 months.
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