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Sökning: WFRF:(Melin Lennart Professor)

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1.
  • Strömbom, Ylva, 1959- (författare)
  • Frequent attenders in primary care : Patient characteristics, help seeking patterns and cognitive behavioral therapy
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Frequent attenders consist of a small proportion of the total population seek-ing health care non-proportionally often for various symptoms. This hetero-genic group of patients requires special attention as symptoms often cannot be explained medically and influence both physical and psychological well-being.The overall aim was to describe characteristics and health issues that insti-gate help seeking behavior among frequent attenders and to piece together a treatment program addressing heterogeneous health problems with the pur-pose to reduce psychological distress, enhance quality of life and reduce visiting rates at general practitioners. Study I aimed to characterize frequent attenders in primary care with respect to symptomatology and utilization of health care resources. Data was collected from medical journals and compar-isons were made between frequent attenders and a comparison group. Among frequent attenders proportionally more women than men visited the health care system and both sexes had a large diversity and amount of health complaints and utilized health care staff resources more frequently. In study II health related quality of life was examined in relation to frequent attend-ance. Questionnaires were sent out to frequent attenders and a comparison. Results show a substantially reduced life quality among frequent attenders affecting almost all facets of life and individual differences in complaints translated into corresponding areas of reduced life quality. Cognitive behav-ior therapy given in a group format was performed and evaluated in study III. Improvements of illness symptoms and negative affect were found and remained over a year, but visits to health care did not diminish.In summation, frequent attenders used more health care resources and dis-played more health complaints as compared to non-frequent attenders. The nature of complaints was relatively independent suggesting symptom speci-ficity. They also experienced lower health related quality of life and symp-tom profiles matched domains with reduced life quality. Group CBT may be an efficient way to deal with some aspects related to health issues connected to frequent attenders. Generally, a biopsychosocial model seemed to account better for data than a purely biological model.
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2.
  • Forster, Martin, 1971- (författare)
  • When Cheap is Good : Cost-Effective Parent and Teacher Interventions for Children with Externalizing Behavior Problems
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • There is strong empirical support for behavioral parent training (BPT) as an intervention for children with externalizing behavior problems (EBP). However, there is a lack of studies that have investigated the effectiveness of BPT in routine care. Furthermore, most families in need of service do not gain access to it. Another issue of concern is that a sizable portion of children who take part in BPT does not show clinical significant improvement. With regard to behavioral teacher training (BTT) for students with EBP, there is a paucity of intervention trials using randomized design. The training procedures have rarely been standardized, which have resulted in interventions that are dependent upon heavy involvement of external consultants. To improve the accessibility to service for students with EBP, intervention models that are feasible for typical school personnel need to be developed. Study I investigated the effects of BPT in routine care. The participants were randomized to BPT with full practitioner support (BPT-P), self-administered BPT with minimal practitioner support (BPT-S), or a waitlist control group (WL). The study showed that BPT implemented by briefly trained social service employees (BPT-P) resulted in at least as large effects as previous efficacy studies. PMT-S also showed significant effects compared to the WL, but was less effective than PMT-P. Improvements in child behaviors were mediated by improved parenting behaviors. Study II investigated the effects of an enhanced version of the BPT-program from study I. The program targeted families with risk factors for non-response that were referred to service within the social services. The results showed strong intervention effects on child EBP and parent anxiety/depression for enhanced BPT compared to regular BPT. Study III used a randomized design to evaluate the effects of a standardized and feasible BTT program. At both posttest and follow-up, significant effects favoring the BTT-group over the active control group were found on student EBP, teacher behavior management, and peer problems. The study also showed that the effect on student EBP was mediated by change in teacher behavior management.
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3.
  • Färdig, Rickard, 1975- (författare)
  • Illness Management and Recovery : Implementation and evaluation of a psychosocial program for schizophrenia and schizoaffective disorder
  • 2012
  • 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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4.
  • Karlberg, Martin, 1969- (författare)
  • Skol-Komet : Tre utvärderingar av ett program för beteendeorienterat ledarskap i klassrummet
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Children who express externalizing behaviors in school are at greater risk of school failure and peer rejection. They are also at greater risk of developing antisocial behaviors, addiction to drugs, mental health problems and delinquency. Many teachers experience difficulties in working with pupils expressing externalizing behaviors. The aim of this thesis is to evaluate a classroom behavior management program called Comet. The main principle of Comet is to get the teacher to use effective strategies when the pupil who is targeted for intervention, and the rest of class, are behaving appropriately and inappropriately. Two versions of the program are evaluated in the thesis: Comet for teachers (Comet-T) and Comet for parents (Comet-P). Three studies are committed to evaluate Comet-T. In the first study Comet-T was compared to an active control group. 100 children (aged 8) were randomized into Comet-T or the control group. At post test and follow-up Comet-T received a better results in reducing externalizing problems, peer problems and teacher behavior management. An analysis of mediators showed that changes in teacher behaviors mediated externalizing behavior. In the second study, children (aged 6 -13) were randomized into two groups. 44 pupils received Comet-T and 42 pupils received a combined intervention consisting of Comet-T at school and Comet-P at home. At post test and follow-up the results show that the combination of Comet-T and Comet-P reduced the externalizing behaviors at home more than Comet-T (only). However, there were no significant differences between the two conditions regarding decrease in externalizing behaviors at school. In the third study Comet-T was compared to a brief version called Comet-TB. At post test Comet-TB had a greater reduction of externalizing behaviors compared to Comet-T. The studies conclude that teachers can use behavior management techniques to decrease externalizing behaviors in the classroom. Furthermore, teachers cannot rely on parent management programs in order to decrease externalizing problems in school. Instead, behavior problems in school need to be solved within school settings. Finally, even a brief program can be effective in order to decrease externalizing behaviors.
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5.
  • af Wåhlberg, Anders, 1965- (författare)
  • The Prediction of Traffic Accident Involvement from Driving Behavior
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of the studies was to predict individual traffic accident involvement by the quantification of driving style in terms of speed changes, using bus drivers as subjects. An accident database was constructed from the archives of the bus company whose drivers were used as subjects. The dependent variable was also discussed regarding whether responsibility for crashes should be included, and what time period to use for optimal prediction. A new theory was constructed about how accidents are caused by driver behavior, more specifically the control movements of the driver, i.e. all actions taken which influence the relative motion of the vehicle in a level plane when v>0. This theory states that all traffic safety related behavior can be measured as celerations (change of speed of the vehicle in any direction of a level plane) and summed. This theoretical total sum is a measure of a person's liability to cause accidents over the same time period within a homogenous traffic environment and a similarly homogenous driving population. Empirically, the theory predicts a positive correlation between mean driver celeration behavior and accident record. The theory was tested in three empirical studies. The first tested equipment and methods, the second studied the question whether driver celeration behavior is stable over time. Celeration behavior turned out to be rather variable between days, and repeated measurements were therefore needed to stabilize the measure. In the third study, a much larger amount of data brought out correlations of sizes sufficient to lend some credibility to the theory. However, the predictive power did not extend beyond two years of time. The reported results would seem to imply that the celeration variable can predict accident involvement (at least for bus drivers), and is practical to use, as it is easily and objectively measured and semi-stable over time.
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6.
  • Bergman Nordgren, Lise, et al. (författare)
  • Polariserad debatt om riktlinjer skymmer viktiga frågor
  • 2018
  • Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115:37, s. 1372-1372
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Debatten om Socialstyrelsens nya riktlinjer för ångest och depression har varit polariserad och inte konstruktiv. Diskussionen bör inte handla om PDT eller KBT utan om evidensbaserade metoder och kompetensbrist.
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