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  • Jonsson, Ulf, et al. (författare)
  • Psychological Treatment of Depression in People Aged 65 Years and Over A Systematic Review of Efficacy, Safety, and Cost-Effectiveness.
  • 2016
  • Ingår i: PLoS ONE. - Public Library of Science. - 1932-6203 .- 1932-6203. ; 11:8
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVES:</strong> Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence.</p><p><strong>METHOD:</strong> The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p><p><strong>RESULTS:</strong> Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual.</p><p><strong>CONCLUSION:</strong> Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.</p>
  • Tham, Anne, et al. (författare)
  • Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder - A systematic review and a meta-analysis.
  • 2016
  • Ingår i: Journal of Affective Disorders. - Elsevier. - 0165-0327 .- 1573-2517. ; 205, s. 1-12
  • Forskningsöversikt (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> There has been a steady increase in the prescription of antidepressants for the elderly. This study comprises a systematic review of randomized, placebo-controlled trials of antidepressants for treatment of depressive disorder in people aged 65 years or more.</p><p><strong>METHODS:</strong> PubMed, EMBASE, Cochrane Library, CINAL, and PsycINFO were searched until May 2016. Where appropriate, the results were synthesized in meta-analyses.</p><p><strong>RESULTS:</strong> Twelve trials met the inclusion criteria. For patients with major depressive disorder, selective serotonin re-uptake inhibitors (SSRI) were not superior to placebo in achieving remission (OR: 0.79, 95% CI: 0.61-1.03) or response (OR=0.86, 95% CI: 0.51-1.10) after 8 weeks of treatment (three trials). However, maintenance treatment with SSRIs was superior to placebo in preventing relapse (OR: 0.22, 95% CI: 0.13-0.36; NNT=5, 95% CI: 3-6; two trials). Duloxetine was superior to placebo in achieving remission (OR: 1.78, 95% CI: 1.20-2.65; NNT=9, 95% CI: 6-20; three trials) and response (OR: 1.83, 95% CI: 1.96-4.08; two trials) in recurrent major depression after 8 weeks, but increased the risk of adverse events that can be problematic in the elderly.</p><p><strong>LIMITATIONS:</strong> The quality of evidence was generally low or moderate, emphasizing the uncertainty of the results. Study populations only partly covered the heterogeneous population of elderly with depressed mood, limiting the generalizability.</p><p><strong>CONCLUSION:</strong> The results underscore the importance of close monitoring of the effects of antidepressants in treatment of elderly patients with a depressive disorder. Methods for early detection of non-responders and effective treatment options for this group are needed.</p>
  • Thunborg, Charlotta, 1965- (författare)
  • Exploring dementia care dyads' person transfer situations from a behavioral medicine perspective in physiotherapy development of an assessment scale
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Individuals who suffer from severe dementia require assistance when performing activities of daily living. The highly important person transfer situation is influenced by complex, intertwined biopsychosocial factors that are related to the expression of personal, environmental and behavioral variables, which can interfere with the performance of dementia-care dyads' transfer situations.</p><p>The overall aim of this study was to leverage a behavioral medicine perspective in physiotherapy to explore, intervene in, and develop an assessment scale for problematic person transfer situations including persons with dementia and the interaction with the caregiver in these transfer situations.</p><p>Interviews were performed with ten caregivers who were recruited to two focus groups and worked in a special care unit for persons with dementia; interviewees described their experiences pursuant to assisting persons with dementia in transfer situations (I).</p><p>Literature review and video recordings elicited 93 possible items for the new scale. Expert opinions and item-content validity index reduced the number of items to 17 that spanned two areas. Eight items related to the actions of persons with dementias, whereas nine related to caregiver actions. The feasibility testing of the scale in eight person transfer situations showed that the scale was ready for inter- and intra-rated reliability testing (II). Inter- and intra- rater reliability was good (III). In two single-case experimental design studies, the new scale was shown to contribute to a substantial gathering of data on behaviors in care dyads' person transfer situations (IV). In summary, the results of the thesis show that person transfer situations in dementia special care units are influenced by different biopsychosocial factors and that the new assessment scale can support decision-making about treatment strategies. These findings are important in promoting evidence-based behavior change strategies that can facilitate both sets of individuals—i.e., both persons with dementia and caregivers—in transfer situations. The results highlight important research issues that merit attention in future studies.</p>
  • Akhavan, Sharareh, et al. (författare)
  • Blev det ett genombrott? Utvärdering av det nationella lärandeprojektet – Vård på lika villkor
  • 2014
  • Ingår i: Lärandeprojektet - Vård på lika villkor. - Eskilstuna/ Västerås : Akademin för hälsa, vård och välfärd, Mälardalens högskola. - 978-91-7485-152-6
  • Rapport (övrigt vetenskapligt)abstract
    • <p>Sjukvården i Sverige är i dag inte jämlik, har brister i tillgänglighet och erbjuds inte på likvärdiga villkor trots Hälso- och sjukvårdslagens mål om en god hälsa och en vård på lika villkor för hela befolkningen.</p><p>För att bryta den pågående trenden och öka jämlikheten gjordes en överenskommelse mellan regeringen och SKL om lärandeprojektet Vård på lika villkor (under åren 2011–2014). Syftet med projektets har varit att inom socioekonomiskt resurssvaga bostadsområden öka jämlikheten i första linjens vård. Detta genom att testa, utveckla och identifiera effektiva arbetssätt och metoder vid sju primärvårdsverksamheter från fem landsting i Sverige.</p><p>Mälardalens högskola, Akademin för hälsa, vård och välfärd, fick av SKL i uppdrag att svara för forskarstöd och att genomföra en utvärdering av de metoder och arbetssätt som utvecklades och testades i lärandeprojektet.</p><p>Resultatet från den genomförda utvärderingen som belyser den genomförda processen, mål- och resultat samt hälsoekonomiska aspekter beskrivs närmare i denna rapport.</p>
  • Akhavan, Sharareh, 1963-, et al. (författare)
  • Practice and Policy in Promoting Health and Equity –experiences from a national project in primary health care in Sweden
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • <p><strong>Introduction:</strong> The Swedish Health Care Law requires the health system to provide good care on equal terms to all. However, several reports from different governmental agencies have revealed that health care is uneven in quality, lacking in accessibility, and not offered on equal terms to all people. Recent public health reports show that inequalities in health in the population have increased. To provide health care on equal terms has become a challenge for health care.</p><p>In order to apply methods for developing practice and policy in promoting health and equity the Swedish Association of Local Authorities and Regions developed and implemented a national project entitled Care on Equal Terms. The project began in 2011 and was completed in 2014 at seven Primary Health Care Units (PHCUs) in five regions. The aim of this study was to evaluate the outcomes of this project.</p><p><strong>Methods:</strong> Based on a program theoretical approach an evaluation design was developed which included process, results and economical evaluation. In the data collection and analysis mixed methods were applied.</p><p><strong>Results:</strong> According to the process evaluation, seven different strategies were applied in the process to develop primary health care on equal terms. One of the key observations was that in order to achieve health on more equal terms, health care needs to be provided on unequal terms, i. e. more needs to be done to reach those who need more assistance to access health services. Health promotion was one of the applied strategies and it was the most common strategy at some of the health care centers with the aim of developing patients' knowledge, awareness and understanding about health, care and self-care. The results evaluation showed that the PHCUs staff identified structural and organizational factors in health care as important factors for developing health promotion and equity in access. The health economic evaluation showed that the costs for implementing the activities for an improved equity were limited. Yet the majority of the PHCUs thought that the detailed regulation of their financing and reporting requirements were a limitation in their work for improved equity. Four of five county councils have recently introduced a primary care provider payment system (ACG) which may not be supportive of efforts to improve equity in access.</p><p><strong>Conclusions</strong><strong>:</strong> It is possible to develop and maintain practices that can contribute to more equitable care and increase health care personnel’s awareness about practice and policy in promoting health and equity.</p>
  • Arkkukangas, Marina, et al. (författare)
  • A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing
  • 2015
  • Ingår i: Preventive Medicine Reports. - 2211-3355. ; 2, s. 134-140
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: The aim of this investigation was to study the feasibility of a randomised controlled trial (RCT) based on a multicentre fall prevention intervention including exercise with or without motivational interviewing compared to standard care in community-living people 75. years and older. Method: The feasibility of a three-armed, randomised controlled trial was evaluated according to the following: process, resources, management by questionnaire, and treatment outcomes. The outcome measures were fall frequency, physical performance and falls self-efficacy evaluated after three months. Twelve physiotherapists conducted the measurements and treatments and responded to the questionnaire. The first 45 participants recruited to the ongoing RCT were included: 16 individuals in the Otago Exercise Program group (OEP), 16 individuals in the OEP combined with motivational interviewing group (MI), and 13 individuals in the control group. The study was conducted from November 2012 to December 2013. Results: The feasibility of the study process, resources and management reached the set goals in most aspects; however, the set goal regarding the MI guide and planned exercise for the participating older people was not completely reached. No significant differences were found between the groups regarding the outcome measures. Conclusion: This study confirmed the acceptable feasibility for the study protocol in the ongoing RCT.</p>
  • Arkkukangas, Marina (författare)
  • Evaluation of the Otago Exercise Programme with or without motiv<em></em>ational interviewing<em></em> <em>Feasibility, experiences, effects and adherence among older community-dwelling </em><em>people</em>
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed.</p><p>The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older.</p><p>Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care.</p><p>The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age.</p><p>From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up.</p><p>At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme.</p><p>These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.</p><p><strong> </strong></p>
  • Arkkukangas, Marina, et al. (författare)
  • Fall Preventive Exercise With or Without Behavior Change Support for Community-Dwelling Older Adults : A Randomized Controlled Trial With Short-Term Follow-up
  • 2019
  • Ingår i: Journal of Geriatric Physical Therapy. - Lippincott Williams & Wilkins. - 1539-8412 .- 2152-0895. ; 42:1, s. 9-17
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background and Purpose: In Western countries, falls and fall-related injuries are a well-known threat to health in the aging population. Studies indicate that regular exercise improves strength and balance and can therefore decrease the incidence of falls and fall-related injuries. The challenge, however, is to provide exercise programs that are safe, effective, and attractive to the older population. The aim of this study was to investigate the short-term effect of a home-based exercise program with or without motivational interviewing (MI) compared with standard care on physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency.</p><p>Method: A total of 175 older adults participated in this randomized controlled study. They were randomly allocated for the Otago Exercise Program (OEP) (n = 61), OEP combined with MI (n = 58), or a control group (n = 56). The participants' mean age was 83 years. The recruitment period was from October 2012 to May 2015. Measurements of physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency were done before and 12 weeks after randomization.</p><p>Results and Discussion: A total of 161 participants were followed up, and there were no significant differences between groups after a period of 12 weeks of regular exercise. Within the OEP + MI group, physical performance, fall self-efficacy, physical activity level, and handgrip strength improved significantly; likewise, improved physical performance and fall self-efficacy were found in the control group. A corresponding difference did not occur in the OEP group. Adherence to the exercise was generally high in both exercise groups.</p><p>Conclusion: In the short-term perspective, there were no benefits of an exercise program with or without MI regarding physical performance, fall self-efficacy, activity level, handgrip strength, adherence to the exercise, and fall frequency in comparison to a control group. However, some small effects occurred within the OEP + MI group, indicating that there may be some possible value in behavioral change support combined with exercise in older adults that requires further evaluation in both short- and long-term studies.</p>
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