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- Färdig, Rickard, 1975-
(författare)
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Illness Management and Recovery : Implementation and evaluation of a psychosocial program for schizophrenia and schizoaffective disorder
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present thesis was to examine the effectiveness of the Illness Management and Recovery (IMR) program for teaching clients with schizophrenia or schizoaffective disorder to better manage their illness and to promote recovery. This was accomplished through an examination of the program’s effects on psychosocial functioning and psychopathology, the evaluation of general and specific impact of neurocognition on learning the fundamentals of illness self-management, and the impact of symptom severity on outcome of the IMR program. The utility of the illness management and recovery scale to evaluate illness self-management of clients with schizophrenia and schizoaffective disorder was also investigated.The effects of the IMR program were evaluated in a randomized controlled trial that compared participants in the program to participants receiving treatment as usual. 41 participants were recruited at six psychiatric outpatient rehabilitation centers in Uppsala, Sweden, and were randomly assigned to IMR groups for approximately 40 sessions or to a treatment as usual control condition. The IMR program participants demonstrated greater improvement compared to participants in treatment as usual in illness self-management, reduced psychiatric symptoms, improved coping skills, and decreases in suicidal ideation. The findings suggest that the IMR program is effective in improving the ability of individuals with schizophrenia and schizoaffective disorder to better manage their illness.Possible association between neurocognitive functioning and the acquisition of illness self-management skills was investigated in a total of 53 participants who completed the IMR program. Speed of processing was related to client reported illness self-management skills acquisition, before and after controlling for psychiatric symptoms and medication, but neurocognitive functioning did not predict improvement in clinician ratings of client illness self-management skills. The findings suggest that compromised neurocognitive functioning does not reduce response to training in illness self-management.The impact of symptom severity on outcome of the IMR program was explored in 52 participants who completed the program. The results suggest that significantly more participants met the severity criterion of remission at post-treatment, and it appears that participants not reaching the severity criterion at post-treatment, also benefited from the IMR program, as indicated by the similar effect sizes of the two subgroups (meeting versus not meeting the severity criterion at post-treatment).The psychometric properties of the Illness Management and Recovery Scale (IMRS) were evaluated in 107 participants with a diagnosis of schizophrenia or schizoaffective disorder. And an item-by-item investigation was conducted in order to establish their utility in monitoring the clients' progress in the IMR program. Both the client and clinician version of the IMRS demonstrated satisfactory internal consistency, large test-retest reliability, and convergent validity with conceptually related measures of psychiatric symptoms, quality of life, and perception of recovery. The findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia and schizoaffective disorder.The general findings of this thesis support the IMR program to be effective in improving the ability of the participants to manage their disorder. The impact of neurocognitive dysfunction on the participants’ ability to learn the fundamentals of illness self-management seems to be limited, and symptom severity did not limit the benefits of the IMR program. Support for the utility of the IMRS to monitor the participants’ progress in the program was also found, providing a brief and economical method for assessing outcome of the IMR program.
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| 2. |
- Hamdan, Mohammed, 1978-
(författare)
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Effects of temperature and terrestrial carbon on primary production in lake ecosystems
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Climate warming is predicted to affect northern lake food webs in two ways: (1)directly via changes in water temperature and ice conditions, and (2) indirectlyvia changes in catchment characteristics and processes that influence input ofallochthonous coloured dissolved organic matter (cDOM) and nutrients. Input ofcDOM increases carbon dioxide (CO2) availability, causes brownification andreduced light conditions, and may increase nutrient availability especially forpelagic primary producers. Increased water temperature and light penetrationand longer ice-free periods affect metabolic rates. These changes are expected toinfluence gross primary production (GPP) and growth of higher trophic levels.However, majority of studies focus on pelagic processes and net effects at wholelake scale is not well understood. Consequently, the lack of knowledge of whatfactors control benthic GPP makes predictions of net effects of climate change onwhole-ecosystem GPP spurious. The aim of this thesis was to experimentally testeffects of warming and increased input of allochthonous cDOM on habitatspecific and whole-ecosystem GPP in lakes. First, by manipulating the CO2concentrations in large scale pond ecosystems, we showed that increased CO2stimulated whole-ecosystem GPP. In a separate incubation study with naturallake sediments in a boreal lake, we tested the role of CO2 as a limiting factor forbenthic GPP under different light levels. The results showed that CO2 supplystimulated benthic GPP at high but not at low light availability, suggesting thatbenthic GPP can be CO2-limited. In the same experimental pond ecosystems, thecombined effect of increased allochthonous cDOM and warming (+3.5°C) on GPPwas studied. The results showed that cDOM input decreases whole-ecosystemGPP, mainly as a result of decreased benthic GPP due to light limitation not fullycounteracted by an increase in pelagic GPP under ambient conditions. Warmingon the other caused a hump shaped increase in whole-ecosystem GPP withincreasing cDOM input mainly due to a positive response in pelagic GPP due torelaxed nutrient limitation. Finally, by manipulating the fish consumer biomassin the same experimental pond ecosystems we showed that whole-ecosystem GPPcan be controlled by top-down effects under warm (+ 3.0°C) but not ambienttemperature conditions. The decline in whole-ecosystem GPP was mainlyattributed to a warming-stimulated consumer-driven trophic cascade in thepelagic habitat and top-down control by zooplankton on phytoplankton growth,while no corresponding cascade was evident in the benthic habitat.Taken together, the results suggest that climate change impacts, as increasinginputs of cDOM, warming and changes in food webs, have different effects onhabitat specific GPP and alone or in combination have impacts on whole-lakeGPP. This thesis offers important insights to better understand the factors thatcontrol lake GPP and to predict future lake ecosystem responses to environmentalchange.
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| 3. |
- Mindemark, Mirja, 1982-
(författare)
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The Use of Laboratory Analyses in Sweden : Quality and Cost-Effectiveness in Test Utilization
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.
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