| 1. |
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| 2. |
- Birgegård, Andreas, et al.
(författare)
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Anorexic self-control and bulimic self-hate : differential outcome prediction from initial self-image
- 2009
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Ingår i: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 42:6, s. 522-530
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:: The study investigated initial self-image (structural analysis of social behavior) and its relation to 36-month outcome, among patients with anorexia nervosa and bulimia nervosa. Hypotheses were that degree of different aspects of self-image would predict outcome in the groups. METHOD:: Participants were 52 patients with anorexia and 91 with bulimia from a longitudinal naturalistic database, and outcome measures included eating disorder and psychiatric symptoms and a general outcome index. Stepwise regression was used to investigate which self-image variables were related to outcome, and multiple regression contrasted the groups directly on each obtained predictor. RESULTS:: Consistent with hypotheses, in bulimia degree of self-hate/self-love moderately predicted outcome, whereas self-control-related variables powerfully predicted outcome in anorexia. CONCLUSION:: It is important to focus on self-image in the treatment of both diagnostic groups, but especially in anorexia nervosa, where control-submission interactions between patient and therapist should be handled with care.
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| 5. |
- Birgegård, Andreas, et al.
(författare)
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Quality assurance of specialised treatment of eating disorders using large-scale Internet-based collection systems : methods, results and lessons learned from designing the Stepwise database.
- 2010
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Ingår i: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 18:4, s. 251-9
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Tidskriftsartikel (refereegranskat)abstract
- Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Björck, Caroline, et al.
(författare)
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Negative self-image and outcome in eating disorders : results at 3-year follow-up.
- 2007
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Ingår i: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 8:3, s. 398-406
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Negative self-image has been hypothesised to be of aetiological significance in eating disorders; however, its relationship to outcome remains unclear. The present study examined the relationship between self-image and follow-up status in a heterogeneous sample of eating disorder patients (N=246). METHODS: Patients were assessed at intake and after 36 months. Self-image was measured using SASB, and a general outcome measure was calculated comprising eating disorder symptoms, occupational status, interpersonal relationships and general psychopathology. RESULTS: SASB self-hate was the most important variable for predicting poor outcome, followed by occupational status, interpersonal relationships, eating disorder symptoms, SASB self-emancipation and general psychiatric symptoms. Together these variables predicted 23% of the variance in outcome. DISCUSSION: High levels of self-hate may increase the risk of poor outcome in eating disorders by adversely affecting interpersonal relationships and making it difficult for patients to engage in treatment.
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| 12. |
- Björck, Caroline
(författare)
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Self-image and eating disorders
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Negative self-image is considered typical of eating disorders. The present thesis aimed to study clinically relevant aspects of self-image in adult patients taking part in a large naturalistic and longitudinal project at specialist units for eating disorders in Sweden. Self-image was measured using the Structural Analysis of Social Behavior (SASB), and examined together with clinical and background variables at initial presentation and at follow-up. Important aspects of treatment, such as diagnosis, treatment satisfaction, outcome and dropout were the focus of four studies. In Study I, eating disorder patients were found to have more negative interpersonal profiles compared to controls. When diagnostic groups were compared, patients with anorexia nervosa were more self-controlling, self-hating and self-blaming, as well as less self-emancipated and self-loving. Patients with binge eating disorder were more self-affirming than patients with anorexia nervosa and bulimia nervosa, as well as less self-controlling than patients with anorexia nervosa and patients with atypical eating disorders. In Study II, patients who became unsatisfied with treatment were characterised by significantly more negative self-image, as well as higher levels of eating disorder and psychiatric symptoms compared to satisfied and highly satisfied patients. Unsatisfied patients expressed higher expectations of treatment interventions focusing on insight and lower expectations of interventions focusing on control. Overall satisfaction with treatment was predicted by interventions focusing on support and control of eating problems. In Study III, high levels of self-hate were significantly related to poor outcome; other variables related to poor outcome included low occupational status, problematic interpersonal relationships, eating disorder symptoms, high levels of self-emancipation, and psychiatric symptoms. In Study IV, patients who dropped out had less negative self-image and fewer psychological problems at intake compared to patients who had completed treatment or who were still in treatment; low levels of self-blame predicted dropout. Results of these studies suggest that eating disorder patients have significant problems with negative self-image. Examining self-image at initial assessment may help to identify patients at risk for negative therapeutic interactions. It may be especially important for therapists to pay attention to underlying interpersonal dynamics, to avoid being drawn into interactions that confirm negative self-image and are detrimental to treatment .
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| 13. |
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| 14. |
- Björck, Caroline, et al.
(författare)
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Self-image and treatment drop-out in eating disorders
- 2008
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Ingår i: Psychology and Psychotherapy. - Leicester, UK : British Psychological Society. - 1476-0835 .- 2044-8341. ; 81:1, s. 95-104
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method: Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results: Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. Discussion: Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.
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| 17. |
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| 19. |
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| 20. |
- Björk, Tabita, et al.
(författare)
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What happened to the ones who dropped out? Outcome in eating disorder patients who complete or prematurely terminate treatment
- 2009
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Ingår i: European eating disorders review. - New York : Wiley. - 1072-4133 .- 1099-0968. ; 17:2, s. 109-119
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake. METHOD: Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored. RESULTS: No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts. DISCUSSION: Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.
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| 21. |
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| 22. |
- Coelho, Vera, et al.
(författare)
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Preschool practices in Sweden, Portugal, and the United States
- 2021
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Ingår i: Early Childhood Research Quarterly. - : Elsevier BV. - 0885-2006 .- 1873-7706. ; 55, s. 79-96
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Tidskriftsartikel (refereegranskat)abstract
- Across countries, there are important differences related to the goals, organization, and educational philosophies of care provided to young children prior to formal schooling. Those differences are likely reflected in the classroom practices and teacher-child interactions within a country's early childhood education and care (ECEC) classrooms. This study aims to evaluate the within-country relevance of two classroom observation measures primarily based on a behavioral count approach focused on teacher and child behaviors; and to examine preschool practices in Sweden, Portugal, and the U.S., as they reflect each country's ECEC goals, organization, and educational philosophies. Participants are 78 preschool settings in Sweden, 42 in Portugal, and 168 in the U.S. Results show that the measures targeted culturally-relevant behaviors and provided inter-rater reliability for the behavior count variables in the three countries. Future collaborations may address additional culturally-specific variables. The behavioral descriptions yielded by combining behavioral counts of the measures are analyzed by researchers from the relevant country for insights to the country's values related to early childhood as well as current debates regarding care for children. Measures that provide comprehensive descriptions of classroom settings and apply minimal external or comparative value judgments on the behaviors observed are of practical utility for collaborative international work.
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| 23. |
- Conley, Daniel, et al.
(författare)
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Hypoxia-Related Processes in the Baltic Sea
- 2009
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 43:10, s. 3412-3420
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Tidskriftsartikel (refereegranskat)abstract
- Hypoxia, a growing worldwide problem, has been intermittently present in the modern Baltic Sea since its formation ca. 8000 cal. yr BP. However, both the spatial extent and intensity of hypoxia have increased with anthropogenic eutrophication due to nutrient inputs. Physical processes, which control stratification and the renewal of oxygen in bottom waters, are important constraints on the formation and maintenance of hypoxia. Climate controlled inflows of saline water from the North Sea through the Danish Straits is a critical controlling factor governing the spatial extent and duration of hypoxia. Hypoxia regulates the biogeochemical cycles of both phosphorus (P) and nitrogen (N) in the water column and sediments. Significant amounts of P are currently released from sediments, an order of magnitude larger than anthropogenic inputs. The Baltic Sea is unique for coastal marine ecosystems experiencing N losses in hypoxic waters below the halocline. Although benthic communities in the Baltic Sea are naturally constrained by salinity gradients, hypoxia has resulted in habitat loss over vast areas and the elimination of benthic fauna, and has severely disrupted benthic food webs. Nutrient load reductions are needed to reduce the extent, severity, and effects of hypoxia.
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| 24. |
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| 25. |
- Forsell, Caroline, et al.
(författare)
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Biomechanical Properties of the Thoracic Aneurysmal Wall : Differences Between Bicuspid Aortic Valve and Tricuspid Aortic Valve Patients
- 2014
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 98:1, s. 65-71
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Tidskriftsartikel (refereegranskat)abstract
- Background. The prevalence for thoracic aortic aneurysms (TAAs) is significantly increased in patients with a bicuspid aortic valve (BAV) compared with patients who have a normal tricuspid aortic valve (TAV). TAA rupture is a life-threatening event, and biomechanics-based simulations of the aorta may help to disentangle the molecular mechanism behind its development and progression. The present study used polarized microscopy and macroscopic in vitro tensile testing to explore collagen organization and mechanical properties of TAA wall specimens from BAV and TAV patients. Methods. Circumferential sections of aneurysmal aortic tissue from BAV and TAV patients were obtained during elective operations. The distribution of collagen orientation was captured by a Bingham distribution, and finite element models were used to estimate constitutive model parameters from experimental load-displacement curves. Results. Collagen orientation was almost identical in BAV and TAV patients, with a highest probability of alignment along the circumferential direction. The strength was almost two times higher in BAV samples (0.834 MPa) than in TAV samples (0.443 MPa; p < 0.001). The collagen-related stiffness (C-f) was significantly increased in BAV compared with TAV patients (C-f = 7.45 MPa vs 3.40 MPa; p = 0.003), whereas the elastin-related stiffness was similar in both groups. A trend toward a decreased wall thickness was seen in BAV patients (p = 0.058). Conclusions. The aneurysmal aortas of BAV patients show a higher macroscopic strength, mainly due to an increased collagen-related stiffness, compared with TAV patients. The increased wall stiffness in BAV patients may contribute to the higher prevalence for TAAs in this group.
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| 26. |
- Hansson, L. M., et al.
(författare)
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How do eating disorder patients eat after treatment? Dietary habits and eating behaviour three years after entering treatment
- 2011
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Ingår i: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 16:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Improvements in psychological symptoms and weight have often been demonstrated following eating disorder (ED) treatment, but it is not clear to what extent eating behaviour itself is normalised. This cross-sectional study aimed to investigate dietary habits and eating behaviour in ED patients three years after entering treatment. METHOD: ED patients (N=70) were divided into those who had recovered (N=36), and those who still suffered from bulimic (N=18) or anorexic (N=16) psychopathology. Patients were compared to a female normal control group of similar age (N=61), and assessments were made on a dietary questionnaire, as well as the BDI, EDI-2, SASB and SCL-90. RESULTS: With some notable exceptions eating patterns in recovered patients resembled those of controls. Dieting was most evident in recovered and current bulimic patients, while restrictive eating and vegetarianism was found in recovered or current anorexic patients. A majority of the patients with ongoing EDs avoided fatty foods. DISCUSSION: Risk behaviours such as restrictive eating, dieting and food avoidance, may have an important impact on relapse rates, and it may therefore be imperative to continue to monitor eating behaviour in ED patients following treatment termination to ensure better long-term outcome.
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| 27. |
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| 28. |
- Hogberg, C., et al.
(författare)
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Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden
- 2019
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Ingår i: Bmc Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMissing diagnostic information often results poor accuracy of the clinical diagnostic decision process. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a short standardized diagnostic interview and covers a rather broad range of diagnoses applicable to children and adolescents. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews and is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatric care. The concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care.MethodsMINI-KID interviews were performed for 101 patients, boys n=50, girls n=51, aged 4 to 18years. The duration of the interview was on average 46min, the child/adolescent participating together with the parent(s) in most cases. The seven most prevalent diagnoses were included in the analyses.ResultsThe average overall percent agreement (OPA) between MINI-KID and LEAD was 79.5%, the average percent positive agreement (PPA) 35.4 and the average percent negative agreement (NPA) 92.7. OPA was highest for Obsessive-Compulsive Disorder (OCD) (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). There were similar results in diagnostic agreement comparing the two versions: the standard MINI-KID and MINI-KID for parents. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment.ConclusionsOverall, there was an acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The standardized interview MINI-KID could be considered as a tool with the possibility to give valuable information in the diagnostic process in child and adolescent care which is similar to the setting in the present study.
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| 29. |
- Högdahl, Louise, et al.
(författare)
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How effective is bibliotherapy-based self-help cognitive behavioral therapy with Internet support in clinical settings? Results from a pilot study.
- 2013
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Ingår i: Eating and Weight Disorders. - : Springer Science and Business Media LLC. - 1124-4909 .- 1590-1262. ; 18:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive behavioral therapy-based guided self-help (CBT-GSH) via the Internet has been shown to be effective in the treatment of bulimia nervosa (BN) and similar eating disorders (EDs), but it is rarely offered, and little is known about the effects, in clinical settings. The present study investigated the effects of a bibliotherapy-based CBT-GSH with Internet support in a clinical setting. Participants were 48 adult outpatients who were recruited without randomization from a specialized ED clinic, diagnosed with BN or similar eating disorder. Forty-eight patients in an intensive day patient program (DPP) were used as comparison group. The Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory 2 measured pre- and post treatment symptoms. Results showed that both groups attained significant improvements in core- as well as related ED symptoms in both instruments. As expected, treatment effects were larger in the more intensive DPP. Nonetheless, bibliotherapy CBT-GSH appears to be a cost-effective treatment that represents a new way to provide more CBT in clinical settings.
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| 30. |
- Högdahl, Louise, et al.
(författare)
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Internet-based cognitive behavioral therapy for bulimic eating disorders in a clinical setting : Results from a randomized trial with one-year follow-up
- 2023
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThose who suffer from eating disorders often experience serious impairment in quality of life and the majority never receive treatment. Treatment availability may be increased by implementing methods that demand less resources and are more easy accessible such as internet-based treatments, but knowledge about their effects is still insufficient. The study evaluated effects of two types of internet-based cognitive behavioral therapy and a structured day patient program, the latter being a standard treatment at an eating disorder clinic at the time for the study.Methods150 participants with bulimic eating disorders randomized to two types of internet based treatments (one pure online treatment and one based on a self-help guide in book-format) or an intensive 16-week day patient program. The number of participants that started treatment was 120 of which 98 in internet treatment and 22 in the day program. Outcome assessments were carried out at baseline, post treatment, and at one-year follow-up.ResultsAll treatments were associated with significantly improved eating disorder pathology, self-image, and clinical impairment. Although the day program generally showed larger effects, only one significant difference found was in diagnostic remission post treatment; 51 % of the participant was in remission in internet treatment and 88 % in the day program. At one-year follow-up, participants in the internet treatments had continued to improve, whereas in the day patient program the effect sustained. Internet treatment had a 36 % drop out rate, there were no dropouts found in the day program.ConclusionsAll treatments were comparable in effect at follow-up, suggesting that internet treatment is a conceivable alternative to standard treatment. Internet treatment in a book-based format was also equally effective as a pure online format. Internet delivered cognitive behavioral treatment forms can make important contributions to achieve increased access to treatment for patients with bulimic eating disorders. Future research and clinical implications for internet delivered treatments in eating disorder services are discussed.
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| 31. |
- Högdahl, Louise, et al.
(författare)
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Personality predicts drop-out from therapist-guided internet-based cognitive behavioural therapy for eating disorders : Results from a randomized controlled trial
- 2016
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 5, s. 44-50
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Tidskriftsartikel (refereegranskat)abstract
- Internet-based guided self-help cognitive behavioural therapy (ICBT) seems a promising way of delivering eating disorder treatment. However, treatment drop-out is a common problem and little is known about the correlates, especially in clinical settings. The study aimed to explore prediction of drop-out in the context of a randomized controlled trial within specialized eating disorder care in terms of eating disorder symptomatology, personality traits, comorbidity, and demographic characteristics. 109 outpatients diagnosed with bulimia nervosa or similar eating disorder were randomized to two types of ICBT. Participants were assessed with several clinical- and self-ratings. The average drop-out rate was 36%. Drop-out was predicted by lower scores in the personality traits Dutifulness and Assertiveness as measured by the NEO Personality Inventory Revised, and by higher scores in Self-affirm as measured by the Structural Analysis of Social Behaviour. Drop-out was also predicted by therapist factors: one therapist had significantly more drop-outs (82%) than the other three (M = 30%). Theoretical and clinical implications of the impact of the predictors are discussed.
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| 32. |
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| 33. |
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| 34. |
- Jansson, Lasse, et al.
(författare)
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Traumatisering bland ungdomar med antisocial problematik : Resultat från en litteraturöversikt
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Att ha blivit traumatiserad betyder att skrämmande upplevelser av till exempel våld har lett till allvarlig psykisk ohälsa hos en individ. Denna rapport är en systematisk kunskapsöversikt över traumatisering bland institutionsvårdade ungdomar. Internationella vetenskapliga studier antyder att mellan 70 och 96 procent av ungdomar som vårdas vid institution kan ha upplevt olika trauman.Av de granskade studierna framkommer att det är vanligt att trauman skett inom familjen i form av till exempel fysisk misshandel och sexuella övergrepp. Men det framkommer även att många institutionsvårdade ungdomar har upplevt våldsbrott "ute på stan". Andra exempel på trauman kan vara att ha bevittnat när andra människor utsätts för skrämmande händelser eller att ha upplevt svåra separationer inom familjen.När barn och ungdomar har utsatts för trauman, särskilt långvariga och upprepade sådana, kan det störa stora delar av deras utveckling. Det kan till exempel synas som en sänkt funktionsförmåga inom många olika livsområden som skolgång, kamratrelationer och identitetsutveckling.Det saknas kunskap om effektiv behandling för traumatiserade ungdomar inom institutionsvård. Det finns dock internationell samstämmighet om att första steget i traumabehandling bör vara insatser som minskar symptom på trauma och verkar stabiliserande på tillvaron. Rapporten ger förslag på hur SiS kan arbeta vidare med att utveckla kunskap om hur ungdomar som visar tecken på traumatisering kan bemötas och erbjudas insatser utifrån sina specifika behov.
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| 35. |
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| 36. |
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| 37. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten
- 2022
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Ingår i: Aftonbladet. - 1103-9000.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
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| 38. |
- Mörner, Sofie, et al.
(författare)
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Används tvångsåtgärder oftare för pojkar än för flickor inom den statliga ungdomsvården? : Resultat från intern statistik och intervjuer med personal
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Personal på SiS särskilda ungdomshem har rätt att använda särskilda befogenheter. Det vill säga tvångsåtgärder som bedöms vara nödvändiga för att vården ska kunna genomföras. Exempel på särskilda befogenheter är avskiljning, urinprovstagning och kroppsvisitation.Bakgrunden till den här studien är en intern kartläggning som visar att särskilda befogenheter används oftare i vården av pojkar än i vården av flickor. De är dessutom kraftfullare och av mer ingripande karaktär. Även extern forskning har visat på skillnader i bemötande beroende på kön.Studien är en del i SiS arbete med jämställd vård och behandling och bygger på klientdata och intervjuer med personal. Resultatet visar på skillnader i användningen av tvångsåtgärder. Vissa av dem hanteras olika beroende på om det är pojkar eller flickor som behandlas.
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| 39. |
- Petersson, Suzanne, 1964-, et al.
(författare)
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Initial self-blame predicts eating disorder remission after 9 years.
- 2021
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Ingår i: Journal of Eating Disorders. - : Springer Science and Business Media LLC. - 2050-2974. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Research into predictors of outcome in eating disorders (ED) has shown conflicting results, with few studies of long-term predictors and the possible importance of psychological variables that may act as risk- and maintenance factors.AIM: To identify baseline predictors of ED remission nine years after initial clinical assessment using self-report measures of ED psychopathology, psychiatric symptoms, and self-image in a sample of adult ED patients (N = 104) treated at specialist units in Stockholm, Sweden. Sixty patients participated in the follow-up, of whom 41 patients (68%) had achieved remission.RESULTS: Results suggested that the only significant predictor of diagnostic remission after nine years was initial levels of self-blame.CONCLUSION: In order to ensure long-term recovery in ED it may be important for clinicians to widen their therapeutic repertoire and utilise techniques that reduce self-blame and increase self-compassion. It is difficult to predict how an eating disorder will develop, and research has found varying factors that affect the outcome of the condition. Recovery rates vary from nearly nil to over 90%. This variation could be explained by different research factors, but are more likely due to varying definitions of 'recovery', with less stringent definitions yielding high recovery rates and more stringent definitions yielding lower rates. The present study investigated whether the severity of eating disorder symptoms and other psychiatric symptoms could predict recovery nine years from first admission to specialised eating disorder care. Sixty patients at three eating disorder treatment units participated, and their scores on self-report measures of symptoms were used as predictor variables. Forty-one participants had no eating disorder diagnosis at nine-year follow-up. Most participants with binge-eating disorder had recovered, while the poorest outcome was found for anorexia nervosa with slightly over half of patients recovered after nine years. The only predictor for the nine-year outcome was a higher initial rating of self-blame, measured with the Structural Analysis of the Social Behavior. It was concluded that it may be important for clinicians to detect and address self-blame early in the treatment of eating disorders in order to enhance the possibility of recovery. Treatment should focus on reducing self-blame and increasing self-acceptance.
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| 40. |
- Welfordsson, Paul, et al.
(författare)
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Feasibility of alcohol interventions in cardiology : a qualitative study of clinician perspectives in Sweden
- 2024
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953.
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study aimed to identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services.Methods and results: This was a qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, and assistant nurses) of varying experience levels and from various clinical settings (high-dependency unit, ward, and outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including 12 related to capability, 9 to opportunity, and 20 to motivation. Four themes were developed: (i) uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; (ii) cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; (iii) alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; and (iv) window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care.Conclusion: Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors, must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services.Registratio:n OSF (osf.io/hx3ts).
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| 41. |
- Welfordsson, Paul, et al.
(författare)
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Mixed messages? Exposure to reports about alcohol’s suggested cardiovascular effects and hazardous alcohol use : a cross-sectional study of patients in cardiology care
- 2024
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. We aimed to explore: (1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; (2) the perceived messages these sources convey, and (3) associations with own level of alcohol use.Methods: We conducted a cross-sectional survey of patients in cardiology services at three hospitals in Sweden. The study outcome was hazardous alcohol use, assessed using the AUDIT-C questionnaire and defined as ≥ 3 in women and ≥ 4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.Results: A total of 330 (66.3%) of 498 patients (mean age 70.5 years, 65% males) who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use (OR = 1.67, 95%CI = 1.02–2.74).Conclusions: This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports that moderate drinking has protective cardiovascular effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol.
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| 42. |
- Welmer, Anna-Karin, et al.
(författare)
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Study protocol for the 'preventing functional decline in acutely hospitalised older patients (PREV_FUNC)' study : effects of two multicomponent exercise programmes on physical function - a three-armed randomised controlled trial
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Acutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however, further research is needed to compare the effect of different types of exercise interventions. In this paper, we report a protocol for a trial that aims to examine (1) if multicomponent exercise interventions (interventions that include both mobility and strengthening exercises) have effects on physical function compared with usual care in older adults and (2) if a comprehensive multicomponent exercise programme is more effective than a simple multicomponent exercise programme that only include walking and sit-to-stand exercises.Methods and analysis: This is a three-armed randomised controlled trial, with two intervention groups (comprehensive and simple exercise programme) and a control group receiving usual care. We will include 320 participants aged >= 75 years from geriatric medical departments of four hospitals in Stockholm, Sweden. Assessments will be conducted at hospital admission, discharge and 3 months thereafter concerning physical function (primary outcome), activities of daily living, health-related quality of life, sarcopenia and falls. The number of readmissions will be registered up to 1 year after discharge. Data will be analysed with linear mixed effects models, according to the intention-to-treat approach.Ethics and dissemination: Ethical approval for this trial has been granted by the Swedish Ethical Review Authority (approval number 2022-03032-01). Data collection will consider the information requirement, the requirement of consent, confidentiality obligations and the utilisation requirement. Trial findings will be disseminated through multiple channels, including scientific publications and conferences, and workshops with healthcare professionals and the public.
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| 43. |
- Wennerholm, Pia
(författare)
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En systematisk översikt av insatser i syfte att minska avskiljningar och andra tvångsingripande åtgärder inom ungdomsvården
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Avskiljning är en särskild befogenhet som Statens institutionsstyrelse, SiS, har rätt att använda om en intagen ungdom är så våldsam eller utagerande att han eller hon riskerar att skada sig själv eller andra. Den är ett exempel på en så kallad akut tvångsingripande åtgärd och den unge får som längst vara avskild från övriga intagna under 24 timmar i följd.I juni 2009 fick SiS regeringens uppdrag att se över hur avskiljningen på de särskilda ungdomshemmen tillämpas. I december samma år presenterade SiS sin slutredovisning där vikten av att fortsätta forsknings- och utvecklingsarbetet var en av metoderna för att vården inom SiS ska utvecklas och kvalitetssäkras.Syftet med den här rapporten är att redovisa resultatet från en systematisk översikt av insatser som syftar till att att minska avskiljningar och andra akuta tvångsingripande åtgärder som kan vara relevanta för SiS ungdomsvård.Resultatet visar att det finns en rad lovande försök att förebygga avskiljningar och andra akuta tvångsingripande åtgärder inom vård av unga med utagerandeproblematik. Rapporten ger även förslag på hur SiS kan gå vidare med frågan i ett fortsatt forsknings- och utvecklingsarbete.
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