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- Duberg, Anna, 1976-, et al.
(författare)
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Adolescent girls with internalizing problems : Can dance intervention improve health? A randomized, controlled trial with cost-utility analysis
- 2012
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier. - 1440-2440 .- 1878-1861. ; 15:Suppl. 1, s. S345-S346
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health are widespread. Dance is a popular form of exercise also known to increase a sense of self-control which can contribute to reduced stress. The purpose of this study was to investigate if dance intervention for adolescent girls with internalizing problems influenced self-rated health. A secondary aim was to assess the cost-effectiveness of the intervention in addition to usual school health services, compared with usual school health services alone.Methods: Randomized controlled intervention trial with follow-up measures of self-rated health at 8, 12 and 20 months after baseline. A total of 112 girls, 13–18 years old, with internalizing problems, i.e. stress and psychosomatic symptoms, were randomized to intervention group or control group. The intervention comprised dance classes twice weekly during 8 months. Each dance class lasted 75 minutes and the focus was on the joy of movement, not on performance. Costs for the stakeholder of the intervention, treatment effect and healthcare costs were considered. Gained quality-adjusted life-years (QALY) were used to measure the effects. Quality of life (QOL) was measured with the Health Utility Index Mark 3 (HUI 3). Cost-effectiveness ratios were based on the changes in QALY and net costs for the intervention group compared with the control group. Net monetary benefit (NMB) was also calculated.Results: A year after baseline 65% of the girls in the intervention group and 32% of the girls in the control group had increased their self-rated health. The differences in change score between groups were significant at all follow-ups. After 8-months U = 895.5 (P = .037), after 12-months U = 680.0 (P = .001), and after 20-months U = 801 (P = .022).Cost effectiveness showed that after 20 months, QOL had increased by 0.083 units more in the intervention group than in the control group (P = .04), translating to 0.095 gained QALY. The cost-effectiveness ratio was $7187.4 and the NMB was $3846.0 (Willingness to pay $50 000 for a gained QALY).Discussion: This study suggests that an 8-month dance intervention can improve self-rated health for adolescent girls with internalizing problems. The improvement remained a year after the intervention. The intervention in addition to usual school health services showed cost-effectiveness compared with usual school health services alone. The cost-effectiveness ratio was far below the recommended threshold value.
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- Höglund, Erik, 1983-
(författare)
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Non-conveyance within the Swedish ambulance service : A prehospital patient safety study
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThere is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.AimThe overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.MethodsAll non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.Conclusions Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused
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- Norén, Paulina, 1987-
(författare)
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Measurement properties of the Swedish self-administered version of the World Health Organization Disability Assessment Schedule 2.0
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a leading patient-reported outcome measure of disability. However, patients' perspective of the WHODAS 2.0 self-administered Swedish version have not been sufficiently described. Similarly, knowledge of its construct validity in the general population is missing. This creates a gap because updated norm data to use as reference is also missing. The overall aim of this study was to establish evidence of the measurement properties of the self-administered Swedish version of the WHODAS 2.0.Both qualitative and quantitative methods were adopted. In Study I, interviews with patients (n = 12) with orthopaedic or psychiatric conditions were performed and data were analysed by deductive content analysis. In Study II, a cross-sectional general population survey (n = 3 482) was conducted, and statistical methods based on classical test theory were used in the data analysis.The results show that the items were well understood, acceptable and easy to answer by outpatients, with the exception of six items (Study I).The internal consistency reliability was good or excellent and the construct validity was overall acceptable, with partial support for the factor structure in the general populations (Study II).The self-administered Swedish 36-item version of the WHODAS 2.0 is comparable to other language versions of the instrument. Some of the previous known weaknesses of its construct validity in relation to the item content and insufficient instructions were confirmed. The evidence of overall good content and construct validity together with available norm data supports its use in clinical settings and research.
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- Philipson, Anna, 1978-
(författare)
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Health economic aspects of emotional problems and pain symptoms in childhood and adolescence : Long-term outcomes, efficacy and cost-effectiveness of interventions
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emotional problems and pain symptoms among children and adolescents are a global public health challenge that imposes a great burden on the individuals affected and on society. Because resources are limited, allocation and prioritization are needed. Health economic analysis can constitute a foundation for such decisions.The overall aim of this thesis is to estimate long-term outcomes associated with adolescent depression and to evaluate interventions for emotional problems and pain symptoms in childhood and adolescence from a health economic perspective. The thesis is based on four papers: paper I is a longitudinal cohort study of 539 participants, showing that adolescent depression is associated with reduced earnings in adulthood, papers II, III, and IV are based on two randomized controlled trials of interventions. In paper II, a dance intervention for 112 adolescent females with internalizing symptoms were evaluated. A cost–utility analysis was performed, indicating that the intervention was costeffective given a willingness-to-pay threshold of USD 50,000 with an incremental cost-effectiveness ratio of USD 3830/quality-adjusted life year. Papers III and IV evaluated a dance and yoga intervention for 121 girls, 9–13 years old, with functional abdominal pain disorders. Paper III showed that the intervention group decreased their abdominal pain more than did the control group. In paper IV, the cost–utility analysis of the trial indicated a negative incremental cost-effectiveness ratio, investigated from a societal perspective, over both one and ten years.In conclusion, this thesis identifies a need for preventive as well as treatment interventions for emotional problems in adolescence, to decrease the prevalence of emotional problems and mitigate negative outcomes. Dance or dance and yoga combined can be effective and cost-effective early treatment interventions for emotional problems and pain symptoms among females in childhood and adolescence. These findings may assist decision-makers in resource allocation within this area
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