| 1. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 2. |
- Murray, Christopher J. L., et al.
(författare)
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Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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| 3. |
- Stanaway, Jeffrey D., et al.
(författare)
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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
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Tidskriftsartikel (refereegranskat)abstract
- Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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| 4. |
- Baianifar, Mahdi, et al.
(författare)
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Effect of users height distribution on the coverage of mmwave cellular networks with 3d beamforming
- 2019
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Ingår i: IEEE Access. - 2169-3536 .- 2169-3536. ; 7, s. 68091-68105
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we study the effect of users' height distribution on the coverage probability of millimeter-wave (mmWave) cellular networks that utilize three-dimensional beamforming (3DBF). The users and base stations (BSs) are equipped with multiple antennas and both line-of-sight (LOS) and non-LOS links exist in the channel which are, respectively, modeled by the Nakagami-m and Rayleigh distribution. In this setup, we investigate the tilt angle optimization of the BS antenna arrays for maximizing the coverage probability under two regimes of noise limited and interference limitedd. In both cases, by adopting a stochastic geometry approach, we analytically derive the coverage probability, and then, find the optimal tilt angle that maximizes this probability. In addition, in the noise limited regime, we show that the optimal tilt angle depends on the average distance between each user and its serving BS and also their effective height. In the interference-limited regime, we further consider different rules for associating users to the BSs. Meanwhile, since in this regime, the tilt angle optimization is very complex, we propose a low complexity approach to find the optimal tilt angle that has a performance close to the optimal solution. We further study the asymptotic behavior when the density of the BSs or signal-To-interference ratio tends to infinity or zero. Finally, through the numerical simulations, we show that using the 3DBF and also incorporating the users' height distribution in the tilt angle optimization lead to a substantial improvement in the coverage probability of the mmWave cellular networks.
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| 5. |
- Baianifar, Mahdi, et al.
(författare)
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Impact of User Height on the Coverage of 3D Beamforming-Enabled Massive MIMO Systems
- 2017
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Ingår i: 2017 IEEE 28TH ANNUAL INTERNATIONAL SYMPOSIUM ON PERSONAL, INDOOR, AND MOBILE RADIO COMMUNICATIONS (PIMRC). - 9781538635315 ; 2017-October, s. 1-5
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Konferensbidrag (refereegranskat)abstract
- In this paper, we perform a coverage analysis of a cellular massive multiple-input multiple-output (MaMIMO) network which adopts 3D beamforming. In contrast to the previous works on 3D beamforming which assume that all users are placed on the ground (i.e., in a 2D environment), we consider a more practical scenario where the users of the network are dropped in a 3D environment with different heights. In this scenario, by adopting a stochastic geometry framework, first we calculate the coverage probability of the network as a function of the users height. Then considering this coverage probability as the objective function, the optimum tilt angle of the base stations antenna pattern is found and the effect of users' heights on this tilt angle is investigated. Our numerical results show that by taking the users' heights into account and using the proposed method, a considerable improvement is achieved in the performance of the network compared to other similar 3D beamforming methods that ignore the users' height distribution.
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| 6. |
- Black, Melissa H., et al.
(författare)
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Multi-informant International Perspectives on the Facilitators and Barriers to Employment for Autistic Adults
- 2020
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Ingår i: Autism Research. - : John Wiley & Sons. - 1939-3792 .- 1939-3806. ; 13:7, s. 1195-1214
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Tidskriftsartikel (refereegranskat)abstract
- Employment rates for autistic individuals are poor, even compared to those from other disability groups. Internationally, there remains limited understanding of the factors influencing employment across the stages of preparing for, gaining, and maintaining employment. This is the third in a series of studies conducted as part of an International Society for Autism Research (INSAR) policy brief intended to improve employment outcomes for autistic individuals. A multi-informant international survey with five key stakeholder groups, including autistic individuals, their families, employers, service providers, and researchers, was undertaken in Australia, Sweden, and the United States to understand the facilitators and barriers to employment for autistic adults. A total of 687 individuals participated, including autistic individuals (n = 246), family members (n = 233), employers (n = 35), clinicians/service providers (n = 123), and researchers (n = 50). Perceptions of the facilitators and barriers to employment differed significantly across both key stakeholder groups and countries, however, ensuring a good job match and focusing on strengths were identified by all groups as important for success. Key barriers to employment included stigma, a lack of understanding of autism spectrum disorder (ASD) and communication difficulties. Results suggest that a holistic approach to employment for autistic individuals is required, aimed at facilitating communication between key stakeholders, addressing attitudes and understanding of ASD in the workplace, using strength-based approaches and providing early work experience. LAY SUMMARY: Autistic individuals experience significant difficulty getting and keeping a job. This article presents a survey study involving autistic individuals, their families, employers, service providers and researchers in Australia, Sweden, and the United States to understand their perspectives on the factors that support or act as barriers to employment. While perspectives varied across key stakeholders, strategies such as using a holistic approach, targeting workplace attitudes and understanding, focusing on strengths, and providing early work experience are important for success.
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| 7. |
- Black, Melissa H., et al.
(författare)
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Perspectives of key stakeholders on employment of autistic adults across the United States, Australia and Sweden
- 2019
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Ingår i: Autism Research. - : John Wiley & Sons. - 1939-3792 .- 1939-3806. ; 12:11, s. 1648-1662
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Tidskriftsartikel (refereegranskat)abstract
- Despite efforts to improve employment outcomes for autistic individuals, internationally their employment rates remain low. There is a need to better understand the factors influencing successful employment for autistic adults in the labor market from the perspectives of multiple keystakeholders. This study represents the second in a series of papers conducted as part of an International Society for Autism Research policy brief aimed at improving employment outcomes for autistic individuals. A community consultation methodology using focus groups, forums, and interviews was applied with autistic individuals (n = 19), family members (n = 18), service providers (n = 21), employers (n = 11), researchers (n = 5), and advocacy group representatives (n = 5) in Australia, Sweden, and the United States, aiming to identify the factors perceived to determine gaining and maintaining employment for autistic individuals. Directed content analysis, guided by the International Classification of Functioning, Disability and Health (ICF), was conducted to investigate the key factors influencing employment outcomes for autistic individuals. Meaningful verbal concepts, or units of text with common themes, were also derived from the qualitative data and then linked and compared to the ICF Autism Spectrum Disorder (ASD) Core-sets. Across countries, activity and participation and environmental factor categories of the ICF were the most associated with employment outcomes. Results suggest that removal of environmental barriers and enhancing environmental facilitators may assist to remediate ASD-related difficulties in the workplace.LAY SUMMARY: This study sought to understand the perspectives of autistic individuals and key stakeholders on factors influencing if autistic adults get and keep jobs. Across Australia, Sweden, and the UnitedStates, focus groups and interviews were conducted to understand international perspectives on what helps and hinders getting and keeping a job for autistic individuals. The environment, including supports, relationships, attitudes, and services, were perceived to be the most important for workplace success. Intervention targeting barriers and facilitators in the workplace environment may support autistic adults to be successful in the labor market.
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| 8. |
- Bölte, Sven, et al.
(författare)
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Standardised assessment of functioning in ADHD : consensus on the ICF Core Sets for ADHD
- 2018
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Ingår i: European Child and Adolescent Psychiatry. - : Dr. Dietrich Steinkopff Verlag GmbH and Co. KG. - 1018-8827 .- 1435-165X. ; 27:10, s. 1261-1281
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Tidskriftsartikel (refereegranskat)abstract
- Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairments in social, educational, and occupational functioning, as well as specific strengths. Currently, there is no internationally accepted standard to assess the functioning of individuals with ADHD. WHO’s International Classification of Functioning, Disability and Health—child and youth version (ICF) can serve as a conceptual basis for such a standard. The objective of this study is to develop a comprehensive, a common brief, and three age-appropriate brief ICF Core Sets for ADHD. Using a standardised methodology, four international preparatory studies generated 132 second-level ICF candidate categories that served as the basis for developing ADHD Core Sets. Using these categories and following an iterative consensus process, 20 ADHD experts from nine professional disciplines and representing all six WHO regions selected the most relevant categories to constitute the ADHD Core Sets. The consensus process resulted in 72 second-level ICF categories forming the comprehensive ICF Core Set—these represented 8 body functions, 35 activities and participation, and 29 environmental categories. A Common Brief Core Set that included 38 categories was also defined. Age-specific brief Core Sets included a 47 category preschool version for 0–5 years old, a 55 category school-age version for 6–16 years old, and a 52 category version for older adolescents and adults 17 years old and above. The ICF Core Sets for ADHD mark a milestone toward an internationally standardised functional assessment of ADHD across the lifespan, and across educational, administrative, clinical, and research settings. © 2018 The Author(s)
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| 9. |
- Bölte, Sven, et al.
(författare)
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The Gestalt of functioning in autism spectrum disorder : Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets
- 2019
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Ingår i: Autism. - : Sage Publications. - 1362-3613 .- 1461-7005. ; 23:2, s. 449-467
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Tidskriftsartikel (refereegranskat)abstract
- Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder–related functioning. World Health Organization’s International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder—one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (⩾17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder–related functioning in educational, administrative, clinical, and research settings.
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| 10. |
- de Schipper, Elles, et al.
(författare)
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Functioning and disability in autism spectrum disorder : A worldwide survey of experts
- 2016
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Ingår i: Autism Research. - : John Wiley & Sons. - 1939-3792 .- 1939-3806. ; 9:9, s. 959-969
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study is the second of four to prepare International Classification of Functioning, Disability and Health (ICF; and Children and Youth version, ICF(-CY)) Core Sets for Autism Spectrum Disorder (ASD).The objective of this study was to survey the opinions and experiences of international experts on functioning and disability in ASD.Methods: Using a protocol stipulated by the World Health Organization (WHO) and monitored by the ICF Research Branch, an email-based questionnaire was circulated worldwide among ASD experts, and meaningful functional ability and disability concepts were extracted from their responses. These concepts were then linked to the ICF(-CY) by two independent researchers using a standardized linking procedure.Results: N = 225 experts from 10 different disciplines and all six WHO-regions completed the survey. Meaningful concepts from the responses were linked to 210 ICF(-CY) categories. Of these, 103 categories were considered most relevant to ASD (i.e., identified by at least 5% of the experts), of which 37 were related toActivities and Participation, 35 to Body functions, 22 to Environmental factors, and 9 to Body structures. A variety of personal characteristics and ASD-related functioning skills were provided by experts, including honesty, loyalty, attention to detail and creative talents. Reported gender differences in ASD comprised more externalizing behaviors among males and more internalizing behaviors in females.Conclusion: The ICF(-CY) categories derived from international expert opinions indicate that the impact of ASD on functioning extends far beyond core symptom domains
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| 11. |
- de Schipper, Elles, et al.
(författare)
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Towards an ICF core set for ADHD : a worldwide expert survey on ability and disability
- 2015
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Ingår i: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 24:12, s. 1509-1521
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Tidskriftsartikel (refereegranskat)abstract
- This is the second in a series of four empirical studies designed to develop International Classification of Functioning, Disability and Health (ICF and Children and Youth version, ICF-CY) core sets for attention deficit hyperactivity disorder (ADHD). The objective of this stage was to gather the opinions from international experts on which ability and disability concepts were considered relevant to functioning in ADHD. An email-based survey was carried out amongst international experts in ADHD. Relevant functional ability and disability concepts were extracted from their responses and linked to the ICF/-CY categories by two independent researchers using a standardised linking procedure. 174 experts from 11 different disciplines and 45 different countries completed the survey. Meaningful concepts identified in their responses were linked to 185 ICF/-CY categories. Of these, 83 categories were identified by at least 5 % of the experts and considered the most relevant to ADHD: 30 of these were related to Body functions (most identified: attention functions, 85 %), 30 to Activities and Participation (most identified: school education, 52 %), 20 to Environmental factors (most identified: support from immediate family, 61 %), and 3 to Body structures (most identified: structure of brain, 83 %). Experts also provided their views on particular abilities related to ADHD, naming characteristics such as high-energy levels, flexibility and resiliency. Gender differences in the expression of ADHD identified by experts pertained mainly to females showing more internalising (e.g. anxiety, low self-esteem) and less externalising behaviours (e.g. hyperactivity), leading to a risk of late- and under-diagnosis in females. Results indicate that the impact of ADHD extends beyond the core symptom domains, into all areas of life and across the lifespan. The current study in combination with three additional preparatory studies (comprehensive scoping review, focus groups, clinical study) will provide the scientific basis to define the ADHD ICF/-CY core sets for multi-purpose use in basic and applied research and every day clinical practice.
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| 12. |
- Lundin, Karl, et al.
(författare)
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Functional gender differences in autism : An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model.
- 2020
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Ingår i: Autism. - : SAGE Publications. - 1362-3613 .- 1461-7005. ; 25:4, s. 1020-1035
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Tidskriftsartikel (refereegranskat)abstract
- LAY ABSTRACT: In this study, we explored if professionals working with autistic people in different regions of the world perceive differences between females and males diagnosed with the condition. A total of 131 professionals responded to a survey that included an open question about gender differences in autism. Of these, 32 responded that they do not perceive gender differences in autism. The information provided by the other 99 experts was analyzed to identify common patterns. Three main differences were found, (1) Matching the clinical conceptualization of autism where professionals described differences in core symptoms of autism, and that autistic females were less similar to the conceptualization of autism. In (2) Co-existing problems, professionals described that autistic males display more apparent problems including hyperactivity, while autistic females were perceived as having more internalizing issues such as anxiety and eating disorders. In the last category, (3) Navigating the social environment, experts perceived autistic females as more socially motivated, and more inclined to camouflage social difficulties, making their challenges less evident. Professionals also perceived differences in the social environment, for example, that autistic girls receive more support from their peers while autistic boys are more often bullied. Our results suggest that professionals working in different parts of the world acknowledge gender differences in autism, but also that there might be some regional differences. Finally, we found that gender differences reported by the international professionals could largely be assessed with a shortened version of the International Classification of Functioning by the World Health Organization, specifically developed for autism.
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| 13. |
- Mahdi, Soheil, et al.
(författare)
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An international clinical study of ability and disability in ADHD using the WHO-ICF framework
- 2018
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Ingår i: European Child and Adolescent Psychiatry. - : Springer. - 1018-8827 .- 1435-165X. ; 27:10, s. 1305-1319
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Tidskriftsartikel (refereegranskat)abstract
- This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research.
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| 14. |
- Mahdi, Soheil, et al.
(författare)
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An International Clinical Study of Ability and Disability in Autism Spectrum Disorder Using the WHO-ICF Framework
- 2018
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Ingår i: Journal of autism and developmental disorders. - : Springer. - 0162-3257 .- 1573-3432. ; 48:6, s. 2148-2163
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Tidskriftsartikel (refereegranskat)abstract
- This is the fourth international preparatory study designed to develop International Classification of Functioning, Disability and Health (ICF, and Children and Youth version, ICF-CY) Core Sets for Autism Spectrum Disorder (ASD). Examine functioning of individuals diagnosed with ASD as documented by the ICF-CY in a variety of clinical settings. A cross-sectional study was conducted, involving 11 units from 10 countries. Clinical investigators assessed functioning of 122 individuals with ASD using the ICF-CY checklist. In total, 139 ICF-CY categories were identified: 64 activities and participation, 40 body functions and 35 environmental factors. The study results reinforce the heterogeneity of ASD, as evidenced by the many functional and contextual domains impacting on ASD from a clinical perspective.
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| 15. |
- Mahdi, Soheil, et al.
(författare)
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An international qualitative study of functioning in autism spectrum disorder using the World Health Organization international classification of functioning, disability and health framework
- 2018
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Ingår i: Autism Research. - : John Wiley & Sons. - 1939-3792 .- 1939-3806. ; 11:3, s. 463-475
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Tidskriftsartikel (refereegranskat)abstract
- This is the third in a series of four empirical studies designed to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Autism Spectrum Disorder (ASD). The present study aimed to describe functioning in ASD (as operationalized by the ICF) derived from the perspectives of diagnosed individuals, family members, and professionals. A qualitative study using focus groups and semi-structured interviews were conducted with 19 stakeholder groups (N = 90) from Canada, India, Saudi Arabia, South Africa, and Sweden. Meaningful concepts from the focus groups and individual interviews were linked to ICF categories using a deductive qualitative approach with standardized linking procedures. The deductive qualitative content analysis yielded meaningful functioning concepts that were linked to 110 ICF categories across all four ICF components. Broad variation of environmental factors and activities and participation categories were identified in this study, while body functions consisted mainly of mental functions. Body structures were sparsely mentioned by the participants. Positive aspects of ASD included honesty, attention to detail, and memory. The experiences provided by international stakeholders support the need to understand individuals with ASD in a broader perspective, extending beyond diagnostic criteria into many areas of functioning and environmental domains. This study is part of a larger systematic effort that will provide the basis to define ICF Core Sets for ASD, from which assessment tools can be generated for use in clinical practice, research, and health care policy making.
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| 16. |
- Mahdi, Soheil, et al.
(författare)
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Short ADHD intervention (SAINT) : Psychological treatment for adults with ADHD
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: SAINT is based on previous research on a CBT manual for adults with ADHD, now shortened to 5 individual-sessions with a follow-up session one month after treatment. It will be compared to an established self-help manual for adults with ADHD, provided through internet. Will SAINT produce an increased everyday function measured with AAQoL compared to control group? If so, is the increased function related to a higher adherence to treatment methods and homework in SAINT?Methods: A randomized controlled study design is applied where SAINT is compared to an active control condition. Asessments are made before treatment, during treatment, immediately after treatment, one month and three months after treatment. Both groups receive treatment during five weeks with a booster session one month after the fifth session. Outcome measures include everyday function, quality of life and ADHD symptoms, among others. The study is conducted in a specialist health care clinic in Stockholm.Results: To date, 71 participants have been randomized to one of two treatment conditions. 20 more participants will be recruited during 2023 and the final results will be analyzed in early 2024. Preliminary data on the outcome measures will be presented at the ADHD World Congress.Conclusions: In case of promising results, SAINT could be offered to patients immediately after diagnosis, thus increasing access to CBT for adults with ADHD.
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| 17. |
- Mahdi, Soheil
(författare)
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Tailoring and standardizing the assessment of ability and disability in ADHD and autism : the development of WHO ICF core sets
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The concept of health has evolved over time and is today considered a multidimensional construct that involves not only absence of impairments or pathologies, but also quality of life and individual functioning. This conceptualization is especially important to individuals with neurodevelopmental disorders (NDD), as these are characterized by early-onset symptoms that tend to persist into adulthood, interfering with individual well-being, daily life activities and engagement in society. The lack of well-established tools for functioning assessment in NDD marks a significant gap, as there is a substantial interindividual variation in severity of functioning and profile of individual limitations and resources. Hence, diagnosis alone is not sufficient enough to understand individual health outcome in NDD. In 2001, the World Health Organization (WHO) launched the International Classification of Functioning, Disability and Health (ICF), a classification system based on a biopsychosocial framework which seeks to describe and understand health-related functioning, allowing all aspects of an individual’s life to be taken into account. However, the ICF in its current form comprises over 1600 categories of health-related functioning aspects, which makes the implementation of the nomenclature rather infeasible and undesirable in clinical and daily practice. To facilitate the implementation, shorter versions of ICF (i.e. Core Sets) have been developed to describe specific condition or condition groups. This thesis is part of the overarching aim to develop ICF Core Sets (ICF-CS) for two common NDD, i.e. Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), to standardize individual assessment of functioning and disability in ADHD and ASD. The development of ICF-CS followed a rigorous and scientific procedure, as established by the World Health Organization (WHO) and the ICF Research Branch, which comprised a series of preparatory studies aiming to investigate relevant aspects of functioning and disability in ADHD and ASD using multiple stakeholder perspective and cross-cultural data sample. In this thesis, two of four preparatory studies are included, of which one explored the client and social environment perspective, whereas the other examined the clinical perspective on functional health in ADHD and ASD. Since the preparatory studies were conducted separately for ADHD and ASD, these resulted in four scientific papers which are included in the thesis. Study I-II consisted of a mixed qualitative-quantitative study design, involving clients with ADHD/ASD (children, adolescents, adults), caregivers and professionals participating in focus group discussions or individual interviews across five countries and WHO-regions (i.e. Africa, Eastern Mediterranean, Europe, South East Asia, The Americas). The participants were divided into different groups based on age group, stakeholder perspective and country. All discussions and interviews were audio-recorded and transcribed verbatim with meaningful concepts extracted from the transcriptions and linked to ICF categories following a meaning condensation procedure. In study III-IV, a cross-sectional study design was employed, with clinical researchers rating the functioning level of individuals with ADHD and ASD using a checklist with ICF categories. Various types of information sources (e.g. interviews with clients/caregivers, clinical observation, test results, rating scales, medical records) were used to complete the rating. Study I (ADHD) included 76 participants, which generated 82 ICF categories (32 activities and participation; 25 environmental factors; 23 body functions; 2 body structures), 243 personal factors (e.g. personality traits, personal attitudes, behavior patterns) and 4 recurring strengths (e.g. creativity, hyper-focus). The categories in the activities and participation component and environmental factors represented all nine (i.e. learning and applying knowledge; general tasks and demands; communication; mobility; self-care; domestic life; interpersonal interactions and relationships; major life areas; community social and civic life) and five chapters (i.e. products and technology; natural environment; support and relationships; attitudes; services, systems and policies), respectively. Body functions comprised mainly of mental functions, but other areas of the body were also identified, including cardiovascular, sensory, digestive and motor functions. Study II (ASD) included 90 participants, which resulted in 110 ICF categories (45 activities and participation; 33 body functions; 29 environmental factors; 3 body structures), 492 personal factors (e.g. life-habits, personal attitudes, behavior patterns) and 6 recurring strengths (e.g. memory, attention, temperament and personality). The activities and participation component and environmental factors included categories from all nine and five chapters, respectively. Body functions consisted mostly of mental and sensory functions, even though other areas of the body also had some coverage (e.g. digestion, exercise tolerance, motor functions). In study III (ADHD), 112 clinical cases were contributed from eight countries and four WHO-regions (i.e. Eastern Mediterranean Europe, South East Asia, Western Pacific). In total, 113 ICF categories (50 activities and participation; 33 environmental factors; 30 body functions), 212 personal factors (e.g. life situation/sociocultural factors, personal attitudes, personality traits) and 22 ADHD-related strengths (e.g. social skills, attention, memory) were identified. Similar to study I, all nine and five chapters were covered in the activities and participation component and environmental factors, respectively. Body functions consisted mainly of mental functions, albeit other areas of body functions were identified in this study which were not covered in study I, such as reproductive and speech functions. No body structures were represented in this study, contrary to study I, which covered 2 body structures. Study IV (ASD) comprised 122 cases from ten countries and four WHO-regions (i.e. Eastern Mediterranean, Europe, The Americas, Western Pacific), generating 139 ICF categories (64 activities and participation; 40 body functions; 35 environmental factors), 148 personal factors (e.g. personal attitudes, personality traits, mental factors) and 3 ASD-related strengths (e.g. memory, attention). Categories were from all chapters in the activities and participation and environmental factors component. Most body functions were mental functions, but still this study identified broader aspects of body functions compared to study II, including reproductive and voice and speech functions. This study did not cover any body structures, unlike study II, which included 3 body structures. The large variety of activities and participation categories identified in the different preparatory studies attest to the complexity of ADHD and ASD and the necessity of having a functioning-oriented perspective on well-being and health. Interestingly, certain areas of activities and participation, which are not extensively covered in research or clinical practice, were highlighted as important areas to explore, such as participation in community and civic life, domestic life, self-care and mobility (i.e. using transportation). The chapter coverage of environmental factors was similar to activities and participation, regardless of study and diagnosis, which shows that factors in the environment are vital to assess in order to understand and optimize individual functioning in daily practice. Given that ADHD and ASD are complex diagnoses with heterogeneous impact on well-being and functioning, it is not surprising that different aspects of the environment are highlighted as important determinants of individual health. Body functions comprised mainly of mental functions, but findings suggest other areas of the body to be affected in ADHD and ASD, hence emphasizing an interdisciplinary service and assessment approach. Although not coded in the ICF, the preparatory studies showed that personal factors could add additional information on functioning which may be essential to intervention planning or goal-setting. In the future, tools will be derived from the ICF-CS for ADHD and ASD and implemented in different settings (e.g. clinics, schools, social services) that play major part in the lives of individuals with ADHD and ASD. The categories in the ICF-CS need to be operationalized into useful items which users (e.g. clinicians, clients, caregivers) can rate with ease and clarity. Users should also be free to add missing ICF categories or add information on strengths, personal factors or other contextual factors which may be pivotal to their everyday life functioning. Qualitative and quantitative outcome measures need to be used to evaluate usefulness of the items as well as administration. Future studies should investigate psychometric properties of ICF-CS based assessment tools and explore how the different ICF components and categories may relate to each other.
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