| 1. |
- af Winklerfelt Hammarberg, Sandra, et al.
(author)
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Clinical effectiveness of care managers in collaborative primary health care for patients with depression : 12-and 24-month follow-up of a pragmatic cluster randomized controlled trial
- 2022
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In: BMC Primary Care. - : Springer Nature. - 2731-4553. ; 23:1
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Journal article (peer-reviewed)abstract
- Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Vastra Gotaland and Dalarna, Sweden. Patients >= 18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient's general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls.
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| 2. |
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| 3. |
- Appelgren, Alva, et al.
(author)
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Läxor och likvärdiga förutsättningar för lärande : – lärares arbetssätt inför, under och efter läxan
- 2022
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Reports (other academic/artistic)abstract
- I denna systematiska översikt sammanställs forskning om hur lärares arbete med läxor kan bidra till likvärdiga förutsättningar för elevers lärande. Översikten utgår från följande frågeställning:Vad kännetecknar lärares arbete med läxor som kan bidra till likvärdiga förutsättningar för elevers lärande?Resultaten från de studier som ingår i översikten är sammanställda med fokus på lärares arbete med läxor inför, under och efter läxan. Sammantaget visar resultaten att lärare kan bidra till likvärdiga förutsättningar för elevers lärande genom att planera utformningen av läxan, ta hänsyn till elevers situation i hemmet samt genom att följa upp läxarbetet i undervisningen.Översiktens resultat bygger på 15 forskningsstudier från olika länder som systematiskt har valts ut efter omfattande litteratursökningar i internationella referensdatabaser.
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| 4. |
- Ara, Mostarin, et al.
(author)
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Pre-commercial thinning in Norway spruce-birch mixed stands can provide abundant forage for ungulates without losing volume production
- 2022
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In: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 520
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Journal article (peer-reviewed)abstract
- Mixed stands of Norway spruce and birch have the potential to simultaneously produce timber and provide large ungulates with a significant amount of forage during the regeneration phase. While the growth and yield of such mixtures are well studied, little is known about potential trade-offs between timber and forage production and which management techniques are suitable for meeting both goals. In this study, four different pre-commercial thinning (PCT) strategies were used to study the trade-offs between production and available forage for free-ranging ungulates in a Norway spruce-birch mixture. The four PCT strategies were: 1) retaining 2000 birch stems ha(-1) with 2000 Norway spruce ha(-1), 2) removing all birches within a 0.75 m radius around Norway spruce stems, 3) removing all birches and other broadleaves, and 4) no PCT (control). Growth of Norway spruce was higher in the 2000 birch ha(-1) and full removal treatments compared to the untreated control, but these two treatments did not differ from one another in volume production of Norway spruce. We found a negative effect of PCT on forage availability but no effect on ungulate browsing. Therefore, PCT strategies that provide both sufficient birch forage and maximize volume production of Norway spruce can be implemented.
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| 5. |
- Augustsson, Pia, 1967, et al.
(author)
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Implementation of care managers for patients with depression: A cross-sectional study in Swedish primary care
- 2020
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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:5
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Journal article (peer-reviewed)abstract
- Objectives To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians' and directors' perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation. Design A cross-sectional study was performed in 2016-2017 in parallel with a cluster-randomised controlled trial. Setting 36 PCCs in south-west Sweden. Participants PCCs' directors and clinicians. Outcome Data regarding the study's aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis. Results Among the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs' directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management. Conclusions Our study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs. © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 6. |
- Bertilsson, Monica, et al.
(author)
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Capacity to work while depressed and anxious - a phenomenological study
- 2013
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In: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 35:20, s. 1705-1711
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Journal article (peer-reviewed)abstract
- Purpose: The aim was to explore experiences of capacity to work in persons working while depressed and anxious in order to identify the essence of the phenomenon capacity to work. Method: Four focus groups were conducted with 17 participants employed within the regular job market. Illness experiences ranged from symptoms to clinical diagnoses. A phenomenological approach was employed. Results: The phenomenon of capacity to work was distinguished by nine constituents related to task, time, context and social interactions. The phenomenon encompassed a lost familiarity with ones ordinary work performance, the use of a working facade and adoption of new time-consuming work practices. Feelings of exposure in interpersonal encounters, disruption of work place order, lost "refueling and a trade-off of between work capacity and leisure-time activities was also identified. The reduced capacity was pointed out as invisible, this invisibility was considered troublesome. Conclusions: A complex and comprehensive concept emerged, not earlier described in work capacity studies. Rehabilitation processes would benefit from deeper knowledge of the individuals capacity to work in order to make efficient adjustments at work. Results can have particular relevance both in clinical and occupational health practice, as well as in the workplaces, in supporting re-entering workers after sickness absence.
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| 7. |
- Björck, Viveka, et al.
(author)
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Morbidity and mortality in critically ill patients with invasive group A streptococcus infection : an observational study
- 2020
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In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 24:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Group A streptococci (GAS) are known to cause serious invasive infections, but little is known about outcomes when patients with these infections are admitted to intensive care. We wanted to describe critically ill patients with severe sepsis or septic shock due to invasive GAS (iGAS) and compare them with other patients with severe sepsis or septic shock. METHODS: Adult patients admitted to a general intensive care unit (ICU) in Sweden (2007-2019) were screened for severe sepsis or septic shock according to Sepsis 2 definition. Individuals with iGAS infection were identified. The outcome variables were mortality, days alive and free of vasopressors and invasive mechanical ventilation, maximum acute kidney injury score for creatinine, use of continuous renal replacement therapy and maximum Sequential Organ Failure Assessment score during the ICU stay. Age, Simplified Acute Physiology Score (SAPS 3) and iGAS were used as independent, explanatory variables in regression analysis. Cox regression was used for survival analyses. RESULTS: iGAS was identified in 53 of 1021 (5.2%) patients. Patients with iGAS presented a lower median SAPS 3 score (62 [56-72]) vs 71 [61-81]), p < 0.001), had a higher frequency of cardiovascular cause of admission to the ICU (38 [72%] vs 145 [15%], p < 0.001) and had a higher median creatinine score (173 [100-311] vs 133 [86-208] μmol/L, p < 0.019). Of the GAS isolates, 50% were serotyped emm1/T1 and this group showed signs of more pronounced circulatory and renal failure than patients with non-emm1/T1 (p = 0.036 and p = 0.007, respectively). After correction for severity of illness (SAPS 3) and age, iGAS infection was associated with lower mortality risk (95% confidence interval (CI) of hazard ratio (HR) 0.204-0.746, p < 0.001). Morbidity analyses demonstrated that iGAS patients were more likely to develop renal failure. CONCLUSION: Critically ill patients with iGAS infection had a lower mortality risk but a higher degree of renal failure compared to similarly ill sepsis patients. emm1/T1 was found to be the most dominant serotype, and patients with emm1/T1 demonstrated more circulatory and renal failure than patients with other serotypes of iGAS.
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| 8. |
- Björkelund, Cecilia, 1948, et al.
(author)
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Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial
- 2018
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In: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Journal article (peer-reviewed)abstract
- Background: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged >= 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [-0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.
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| 9. |
- Björkelund, Cecilia, 1948, et al.
(author)
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[Effects of a care manager organization for care of people with mild-moderate depression in Swedish primary care]. : Vårdsamordnare för depression – effektivt grepp i primärvården - Gav friskare patienter och hälsoekonomiska vinster.
- 2019
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In: Lakartidningen. - 1652-7518. ; 116
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Journal article (other academic/artistic)abstract
- By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.
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| 10. |
- Björkelund, Cecilia, 1948, et al.
(author)
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Effects of adding early cooperation and a work-place dialogue meeting to primary care management for sick-listed patients with stress-related disorders: CO-WORK-CARE-Stress - a pragmatic cluster randomised controlled trial.
- 2024
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In: Scandinavian journal of primary health care. - 1502-7724. ; , s. 1-15
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Journal article (peer-reviewed)abstract
- To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.PCCs in Region Västra Götaland, Sweden, with care manager organisation.Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n=142 intervention, n=116 control PCCs).Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3months. Regular contact with care manager was continued at the control PCCs.12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12months.There were no significant differences between intervention and control groups after 12months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7days (95% confidence interval (CI) 82.6-138.8); control, mean = 99.1days (95% CI 73.9-124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12months. At 3months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6months 38% vs 32.8%, and12 months 16.9% vs 15.5%.Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.
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