| 1. |
- Hellstrand Tang, Ulla, 1956, et al.
(författare)
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Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations : Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool
- 2024
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations.OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up.METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting.CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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| 2. |
- Nyberg, Lars, et al.
(författare)
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Memory aging and brain maintenance
- 2012
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Ingår i: Trends in cognitive sciences. - : Elsevier BV. - 1364-6613 .- 1879-307X. ; 16:5, s. 292-305
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Tidskriftsartikel (refereegranskat)abstract
- Episodic memory and working memory decline with advancing age. Nevertheless, large-scale population-based studies document well-preserved memory functioning in some older individuals. The influential 'reserve' notion holds that individual differences in brain characteristics or in the manner people process tasks allow some individuals to cope better than others with brain pathology and hence show preserved memory performance. Here, we discuss a complementary concept, that of brain maintenance (or relative lack of brain pathology), and argue that it constitutes the primary determinant of successful memory aging. We discuss evidence for brain maintenance at different levels: cellular, neurochemical, gray- and white-matter integrity, and systems-level activation patterns. Various genetic and lifestyle factors support brain maintenance in aging and interventions may be designed to promote maintenance of brain structure and function in late life.
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| 3. |
- Checknita, Dave, et al.
(författare)
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Monoamine oxidase A genotype and methylation moderate the association of maltreatment and aggressive behaviour
- 2020
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Ingår i: Behavioural Brain Research. - : ELSEVIER. - 0166-4328 .- 1872-7549. ; 382
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Tidskriftsartikel (refereegranskat)abstract
- Background: The association between childhood maltreatment and subsequent aggressive behaviour is modified by monoamine oxidase A (MAOA) functional polymorphism (MAOA-uVNTR) genotype, MAOA-Long (MAOA-L) in females, MAOA-Short (MAOA-S) in males. Childhood maltreatment is associated with differential DNA methylation in several genes. Consistent with recent proposals, we hypothesized that the association of the interaction of MAOA genotype and maltreatment with aggressive behaviour is further moderated by methylation of a region of interest (ROI) spanning the first exon and partial first intron of MAOA.Method: The sample included 117 women and 77 men who completed interviews and questionnaires to report maltreatment and aggressive behaviour towards others and provided saliva samples for DNA extraction. The MAOA-uVNTR polymorphism was genotyped, and methylation of the MAOA ROI was assessed.Results: Following adjustment for substance misuse, psychoactive medication use, and in males tobacco use, the highest levels of aggressive behaviour were found among maltreated male carriers of MAOA-S with high levels of exonic methylation.Conclusion: Methylation levels within the MAOA ROI further contributed to the interaction of MAOA risk genotypes and maltreatment on aggressive behaviours among men.
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| 4. |
- Munthe, Christian, 1962, et al.
(författare)
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The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening
- 2015
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Ingår i: Public Health Ethics. - : Oxford University Press (OUP). - 1754-9973 .- 1754-9981. ; 8:3, s. 270-283
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Tidskriftsartikel (refereegranskat)abstract
- The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.
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| 5. |
- Thorsson, Max, 1995, et al.
(författare)
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A novel tablet-based motor coordination test performs on par with the Beery VMI subtest and offers superior temporal metrics: findings from children with pediatric acute-onset neuropsychiatric syndrome.
- 2023
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Ingår i: Experimental brain research. - 0014-4819 .- 1432-1106. ; 241:5, s. 1421-1436
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Tidskriftsartikel (refereegranskat)abstract
- Neuropsychiatric and neurodevelopmental disorders are often associated with coordination problems. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) constitutes a specific example of acute and complex symptomatology that includes difficulties with motor control. The present proof-of-concept study aimed at testing a new, bespoke tablet-based motor coordination test named SpaceSwipe, providing fine-grained measures that could be used to follow-up on symptoms evolution in PANS. This test enables computationally precise and objective metrics of motor coordination, taking into account both directional and spatial features continuously. We used SpaceSwipe to assess motor coordination in a group of children with PANS (n=12, assessed on in total of 40 occasions) and compared it against the motor coordination subtest from the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) 6th edition, traditionally used to follow-up symptomatology. Using a bivariate linear regression, we found that 33s of the directional offset from tracking a moving target in SpaceSwipe could predict the Beery VMI motor coordination (VMI MC) raw scores (mean absolute error: 1.75 points). Positive correlations between the predicted scores and the VMI MC scores were found for initial testing (radj=0.87) and for repeated testing (radj=0.79). With its short administration time and its close prediction to Beery VMI scores, this proof-of-concept study demonstrates the potential for SpaceSwipe as a patient-friendly tool for precise, objective assessment of motor coordination in children with neurodevelopmental or neuropsychiatric disorders.
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| 6. |
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| 7. |
- Ambrus, Livia, et al.
(författare)
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Leptin, Anxiety Symptoms, and Hypothalamic-Pituitary-Adrenal Axis Activity among Drug-Free, Female Suicide Attempters
- 2019
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Ingår i: Neuropsychobiology. - : S. Karger AG. - 0302-282X .- 1423-0224. ; 78:3, s. 145-152
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dysregulation of leptin secretion and functioning of the hypothalamic-pituitary-adrenal (HPA) axis may be involved in the pathophysiology of suicide. Preclinical and clinical studies have shown interactions between the HPA axis and leptin. There is also evidence for a negative relationship between leptin and anxiety in humans. However, these possible associations have not been studied in individuals with attempted suicide.OBJECTIVES: To examine the relationship between leptin, HPA axis activity, and anxiety in individuals with a recent suicide attempt.METHOD: Sixty-nine individuals with a recent suicide attempt (n = 37 females; n = 32 males) were recruited and subjected to the Dexamethasone Suppression Test (DST), lumbar puncture, and evaluation with the Comprehensive Psychopathological Rating Scale from which the Brief Scale for Anxiety (BSA) was derived. Leptin was analyzed in cerebrospinal fluid (CSF) and cortisol in serum. Leptin was corrected for body mass index (BMI) by dividing CSF-leptin by BMI (CSF-leptin/BMI). Due to gender-related differences in leptin secretion and HPA axis activity, calculations were made for males and females separately.RESULTS: Significant differences were only found among females; CSF-leptin/BMI levels correlated significantly and negatively with BSA (p < 0.05), pre-DST cortisol, and post-DST serum cortisol at 8 a.m. and 3 p.m. (all p < 0.05). Furthermore, CSF-leptin/BMI was significantly lower in nonsuppressors of dexamethasone as compared to suppressors (p < 0.05).CONCLUSIONS: These findings suggest that in females with a recent suicide attempt, low CSF leptin may be related to symptoms of anxiety and a hyperactive HPA axis.
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| 8. |
- Andersson, Morgan, 1965, et al.
(författare)
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New Swedish forensic psychiatric facilities: visions and outcomes.
- 2013
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Ingår i: Facilities. - : Emerald. - 0263-2772 .- 1758-7131. ; 31:1/2, s. 24-38
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to map significant features of the physical design of nine recently planned facilities for forensic psychiatric care in Sweden. The present paper is focused on differences in the physical design, static security adaptations, visions and goals for the projects, economy and steering processes. Design/methodology/approach – In June 2008, records concerning major forensic psychiatric construction projects, planned or carried out between 1970 and 2008, were requested from all 21 regions in Sweden. The documents were collected, organized, critically examined, and analyzed in their contexts. Extensive data have also been retrieved from the internet. Findings – In spite of the common national legislation governing forensic psychiatric care, the projects show great diversity in the physical design and, after 2006, increasing emphasis on static security. The collected material indicates different visions and goals and little coordination between them. It also suggests that the decisions rarely have been preceded by scientific studies or, as it appears, systematic needs assessments. There were also considerable variations in the interpretation of the legislation stipulating public access to official documentation and the time-frame allowed for such requests. Research limitations/implications – Limitations of the project especially relate to the incompleteness of the documents received. Originality/value – This mainly descriptive paper provides an overview of contemporary Swedish forensic psychiatric construction projects, planned for or realized after 2000. This paper points out structural and physical differences between these projects. The systematised documents are made available for research purposes within different disciplines.
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| 9. |
- Boettcher, Johanna, et al.
(författare)
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Combining attention training with cognitive-behavior therapy in Internet-based self-help for social anxiety : study protocol for a randomized controlled trial
- 2013
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14:68
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guided Internet-based cognitive-behavioral therapy (ICBT) has been found to be effective for social anxiety disorder (SAD) by several independent research groups. However, since the extent of clinically significant change demonstrated leaves room for improvement, new treatments should be developed and investigated. A novel treatment, which has generally been found to be effective, is cognitive bias modification (CBM). This study aims to evaluate the combination of CBM and ICBT. It is intended that two groups will be compared; one group randomized to receiving ICBT and CBM towards threat cues and one group receiving ICBT and control training. We hypothesize that the group receiving ICBT plus CBM will show superior treatment outcomes.Methods/design: Participants with SAD (N = 128), will be recruited from the general population. A composite score combining the scores obtained from three social anxiety questionnaires will serve as the primary outcome measure. Secondary measures include self-reported depression and quality of life. All treatments and assessments will be conducted via the Internet and measurement points will be baseline, Week 2, post-treatment, and 4 months post-treatment.Discussion: There is no direct evidence of the effects of combining CBM and ICBT in SAD. Adding attention-training sessions to ICBT protocols could increase the proportion of participants who improve and recover through Internet-based self-help.
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| 10. |
- Bolic Baric, Vedrana, et al.
(författare)
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The whole journey chain with public transport for people with autism spectrum disorder and attention deficit hyperactivity disorder : a scoping review
- 2024
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Ingår i: Transport reviews. - : Routledge. - 0144-1647 .- 1464-5327.
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Tidskriftsartikel (refereegranskat)abstract
- Independent transport mobility is an important contributor to health, well-being, and participation. Several skills and competences are required for a person to use the transport system. The characteristics of cognitive disorders, such as Autism Spectrum Disorder (ASD) and Attention deficit/hyperactivity disorder (ADHD), may pose barriers to independent travel. The study’s aim was to synthesise knowledge on the use of public transport among individuals with ASD or ADHD using the whole journey chain perspective. A scoping review using the PRISMA ScR framework was conducted, and included articles published between January 2012 and June 2022. A total of 11 studies from four countries were included in the analysis.This study complements the whole journey chain perspective with a phase that takes place long before the journey begins, and which concerns planning and preparation. Confident travellers could easily learn new routes, while those lacking confidence faced challenges, especially with unexpected route changes or cancellations. There is a great need for emphasis on the design of public transport facilities and public spaces to increase the sense of safety for travellers with ASD, and to assist them with information-seeking, comprehension, and recovery between journeys.
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