| 1. |
- Allentoft, Morten E., et al.
(author)
-
Population genomics of post-glacial western Eurasia
- 2024
-
In: Nature. - 0028-0836 .- 1476-4687. ; 625:7994, s. 301-311
-
Journal article (peer-reviewed)abstract
- Western Eurasia witnessed several large-scale human migrations during the Holocene1–5. Here, to investigate the cross-continental effects of these migrations, we shotgun-sequenced 317 genomes—mainly from the Mesolithic and Neolithic periods—from across northern and western Eurasia. These were imputed alongside published data to obtain diploid genotypes from more than 1,600 ancient humans. Our analyses revealed a ‘great divide’ genomic boundary extending from the Black Sea to the Baltic. Mesolithic hunter-gatherers were highly genetically differentiated east and west of this zone, and the effect of the neolithization was equally disparate. Large-scale ancestry shifts occurred in the west as farming was introduced, including near-total replacement of hunter-gatherers in many areas, whereas no substantial ancestry shifts happened east of the zone during the same period. Similarly, relatedness decreased in the west from the Neolithic transition onwards, whereas, east of the Urals, relatedness remained high until around 4,000 bp, consistent with the persistence of localized groups of hunter-gatherers. The boundary dissolved when Yamnaya-related ancestry spread across western Eurasia around 5,000 bp, resulting in a second major turnover that reached most parts of Europe within a 1,000-year span. The genetic origin and fate of the Yamnaya have remained elusive, but we show that hunter-gatherers from the Middle Don region contributed ancestry to them. Yamnaya groups later admixed with individuals associated with the Globular Amphora culture before expanding into Europe. Similar turnovers occurred in western Siberia, where we report new genomic data from a ‘Neolithic steppe’ cline spanning the Siberian forest steppe to Lake Baikal. These prehistoric migrations had profound and lasting effects on the genetic diversity of Eurasian populations.
|
|
| 2. |
- Böttcher, Johanna, et al.
(author)
-
Adding a smartphone app to internet-based self-help for social anxiety : A randomized controlled trial
- 2018
-
In: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 87, s. 98-108
-
Journal article (peer-reviewed)abstract
- Background: Increasing access to treatment via smartphone apps is an important topic in Social Anxiety Disorder (SAD). ‘Challenger’ is an app promoting exposure exercises in daily life. The present study evaluated the additional benefit of using the app as adjunct to Internet-based unguided self-help for SAD. In a second step, we also tested how the app and the self-help programme (SH) should best be combined.Method: 209 patients diagnosed with SAD were randomly allocated to three groups. Group 1 received the app and the self-help programme for six weeks (parallel treatment), group 2 first received SH for six weeks and then the app for six weeks (sequential treatment). Group 3 was a wait-list group. Comparisons were made at week 7 evaluating the potential add-on effect of the app (SH plus app versus SH only) and at week 14 comparing the parallel to the sequential treatment. Participants filled in questionnaires prior, during, and post treatment, and at 4- and 12- months follow-up.Results: Intention-to-treat analyses showed no significant effect of adding the app to Internet-based self-help. However, among participants actively using the app, adding Challenger to self-help resulted in significantly less social anxiety (d = 0.30). At week 14, decreases in social anxiety were large for both the parallel and the sequential group with no differences between the active groups (dwithin = 1.12–1.19). Changes were maintained throughout the follow-up period.Conclusion: Results of the current study cautiously support the notion of adding a smartphone app to unguided self-help for SAD. Future studies should investigate how patients can be motivated to use the app more frequently.
|
|
| 3. |
- Böttcher, Johanna, et al.
(author)
-
Challenger : eine, 'smarte' Erweiterung der internet-basierten Behandlung sozialer Ängste
- 2017
-
Conference paper (peer-reviewed)abstract
- Hintergrund: Online-Behandlungen für soziale Angststörungen (SAS) sind bereits gut untersucht. Ein nächster Schritt ist die Erprobung von Smartphone Anwendungen. Diese bieten zahlreiche Möglichkeiten, die Umsetzung einzelner Behandlungselemente im Alltag zu vereinfachen. „Challenger“ ist eine jüngst entwickelte App, die die Durchführung von Expositionsübungen unterstützt. Spielerisch bietet sie den Nutzer*innen Übungen an, die auf die individuellen Bedürfnisse der Betroffenen, sowie auf aktuelle räumliche und situationale Merkmale abgestimmt sind. Die vorliegende Studie untersucht, welchen zusätzlichen Nutzen Challenger zur internet-basierten Behandlung sozialer Ängste beiträgt.Methode: 209 Patient*innen mit SAS wurden zufällig drei Gruppen zugeteilt. Die erste Gruppe erhielt ein unbegleitetes Selbsthilfeprogramm mit zusätzlichem Zugang zur App, die zweite Gruppe erhielt ausschließlich das Selbsthilfeprogramm und die dritte Gruppe war eine Warteliste-Kontrollgruppe. Die Teilnehmer*innen füllten vor, nach und 12 Monate nach Ende der Behandlung Fragebögen zu sozialen Ängsten und sekundären Maßen aus.Ergebnisse: Beide aktive Gruppen zeigten bedeutsame Verbesserungen der sozialen Ängste. Patient*innen, die zusätzlich mit der App trainierten, waren der aktiven Vergleichsgruppe leicht überlegen (kontrolliertes d=0,25). Die Therapieerfolge waren über 12 Monate stabil. Diskussion: Die untersuchte Kombination der Challenger App mit internet-basierter Selbsthilfe war für Patient*innen mit SAS wirksam. Da die ungeleitete App keine personellen Ressourcen fordert und gleichzeitig einen neuartigen, spielerischen Zugang zu Expositionsübungen bietet, empfiehlt sich ihre weitere Erforschung in anderen Behandlungskontexten.
|
|
| 4. |
- Carlbring, Per, et al.
(author)
-
Adding a Smartphone App to Bibliotherapy for Social Anxiety : A Randomized Controlled Comparison
- 2017
-
In: Applying CBT in Diverse Contexts: 51st Annual Convention. ; , s. 394-394
-
Conference paper (peer-reviewed)abstract
- The efficacy of Internet-based treatments and bibliotherapy for Social Anxiety Disorder is well established. The next step is to evaluate smartphone supported interventions. ‘Challenger’ is a recently developed facilitating the implementation of exposure exercises in daily life. The present study evaluates the efficacy of the combination of Challenger and bibliotherapy for Social Anxiety Disorder. A total of 209 patients with Social Anxiety Disorder were randomly allocated to three groups. The first group received app and bibliotherapy for six weeks (parallel design) and the second group received first bibliotherapy for six weeks and then the app for another six weeks (sequential design). The third group was a wait-list control group. Participants filled in questionnaires on primary and secondary outcomes post treatment as well as at 4 and 12 months follow-up. Participants using both app and bibliotherapy showed somewhat larger reductions in social fears after six weeks of treatment compared to participants using only bibliotherapy (d=0.25). Decreases in social anxiety were large for both groups after 12 weeks of treatment (d= 1.11-1.20) and were maintained throughout the follow-up period. Results of the current study support the notion of adding a smartphone app to bibliotherapy for Social Anxiety Disorder. Future study should investigate the potential of the app in different treatment settings.
|
|
| 5. |
- Carlbring, Per, et al.
(author)
-
Deposit-limits and online gambling intensity : A randomised controlled trial
- 2019
-
Conference paper (peer-reviewed)abstract
- Context: Pathological gambling is recognized as a public health issue in a many countries. Consequently, helping individuals control their gambling behaviors is critical. One strategy is setting a pre-committed limit for how much money one can lose, deposit or win. The aim of the study was to compare gambling intensity between online gamblers prompted to set a deposit limit and non-prompted customers.Methods: All customers of the gambling service having registered an account during the study recruitment period were included. Gambling intensity was measured with aggregated net loss, with proportions of limit-setters, sum of deposits and number of gambling days used as secondary outcomes.Intervention: A total of 4328 customers of a gambling operator from Finland were randomized to receive a prompt to set a voluntary deposit limit of optional size either 1) at registration, 2) before or 3) after their first deposit, or 4) to an unprompted control condition.Results: The intervention groups did not differ in either proportion of participants with positive net loss or size of positive net loss. The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive net loss or size of net loss. The intervention groups had higher rates of limit-setters and net loss was highest among participants who had increased/removed a deposit-limit. Conclusions: Prompting online gamblers to set a voluntary deposit limit of optional size did not affect subsequent net loss.
|
|
| 6. |
- Carlbring, Per, et al.
(author)
-
The consequences of ignoring therapist effects in trials with longitudinal data : A simulation study
- 2019
-
Conference paper (other academic/artistic)abstract
- Background: Psychotherapy trials frequently generate multilevel longitudinal data with 3 levels. This type of hierarchy exists in all trials in which therapists deliver the treatment and patients are repeatedly measured. Unfortunately, researchers often ignore the possibility that therapists could differ in their performance and instead assume there is no difference between therapists in their average impact on patients' rate of change. In this poster, we focus on scenarios in which therapists are fully and partially nested within treatments and investigate the consequences of ignoring even small therapist effects in longitudinal data. Method: We first derived the factors leading to increased Type I errors for the Time * Treatment effect in a balanced study. Scenarios with an unbalanced allocation of patients to therapists and studies with missing data were then investigated in a comprehensive simulation study, in which the correct 3-level linear mixed-effects model, which modeled therapist effects using a random slope at the therapist level, was compared with a misspecified 2-level model. Results: Type I errors were strongly influenced by several interacting factors. Estimates of the therapist-level random slope suffer from bias when there are very few therapists per treatment. Conclusion: Researchers should account for therapist effects in the rate of change in longitudinal studies. To facilitate this, we developed an open source R package powerlmm, which makes it easy to investigate model misspecification and conduct power analysis for these designs.
|
|
| 7. |
- Dahlin, Mats, et al.
(author)
-
Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder : A randomized controlled trial
- 2016
-
In: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 77, s. 86-95
-
Journal article (peer-reviewed)abstract
- Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD.
|
|
| 8. |
- Döllinger, Lillian, et al.
(author)
-
Effectively training emotion recognition accuracy : The evaluation of two systematic training programs
- 2019
-
Conference paper (other academic/artistic)abstract
- This study presents findings about the effectiveness of two computerized training-programs for emotion recognition accuracy that were evaluated in a double-blind randomized controlled study with repeated measures design. Both trainings are effective in training emotion recognition accuracy. The trainings and results are presented in detail and practical implications are discussed.
|
|
| 9. |
- Herlitz, Johan, 1949-, et al.
(author)
-
Över 100 doktorsavhandlingar inom den prehospitala akutsjukvården i Sverige
- 2023
-
In: Läkartidningen. - : Läkartidningen Förlag AB. - 1652-7518. ; 120
-
Research review (peer-reviewed)abstract
- HUVUDBUDSKAPÖver 100 avhandlingar har i dagsläget skrivits om den prehospitala akutsjukvården i Sverige.Dessa täcker ett omfattande kunskapsfält, allt ifrån prognostiska faktorer vid akut sjukdom till ambulans personalens psykiska och fysiska hälsa.Endast ett kunskapsområde har belysts mera om fattande, och det är hjärt–lungräddning vid plötsligt hjärtstopp.Vården av patienter med psykisk ohälsa har inte belysts i någon avhandling.Det finns stora kunskapsluckor, och vidare forskning inom området behövs.
|
|
| 10. |
- Ivanova, Ekaterina, et al.
(author)
-
Deposit Limit Prompt in Online Gambling for Reducing Gambling Intensity : A Randomized Controlled Trial
- 2019
-
In: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 10
-
Journal article (peer-reviewed)abstract
- Pre-commitment tools – allowing users of gambling services to pre-set a limit for how much money they may spend – are relatively common. However, there exist no clear evidence of their effectiveness in preventing gamblers from spending more money than they otherwise planned. The aim of the study was to compare gambling intensity between users of an online gambling service prompted to set a deposit limit and non-prompted customers, both in the whole sample and among most active users based on the total number of gambling days. Prospective customers of a publicly governed gambling operator from Finland were randomized to receive a prompt to set a voluntary deposit limit of optional size either (1) at registration, (2) before or (3) after their first deposit, or (4) to an unprompted control condition. Data on customers from Finland with online slots as a preferred gambling category (N = 4328) were tracked in the platform for 90 days starting at account registration, gambling intensity being measured with aggregated net loss. The intervention groups did not differ from each other in either proportion of participants with positive net loss or size of positive net loss. The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive net loss (OR = 1.0; p = 0.921) or size of net loss (B = -0.1; p = 0.291). The intervention groups had higher rates of limit-setters compared to the control condition (ORat-registration/pre-deposit/post-deposit = 11.9/9.2/4.1). Customers who have increased/removed a previously set deposit limit had higher net loss than the limit-setters who have not increased/removed their limit (Bat-registration/pre-deposit/post-deposit/control = 0.7/0.6/1.0/1.3), and unprompted limit-setters lost more than unprompted non-setters (B = 1.0). Prompting online gamblers to set a voluntary deposit limit of optional size did not affect subsequent net loss compared to unprompted customers, motivating design and evaluation of alternative pre-commitment tools. Setting a deposit limit without a prompt or increasing/removing a previously set limit may be a marker of gambling problems and may be used to identify customers in need of help.
|
|
| 11. |
- Magnusson, Kristoffer, et al.
(author)
-
For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2016
-
In: EABCT 2016 Abstract Book. ; , s. 285-285
-
Conference paper (peer-reviewed)abstract
- Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidencebased methods is believed to aid patients in gaining access to the right type of help. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each of the primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were subsequently conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions, yielding a total of 252 (8.8%). Patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to treatment. Conclusion: Deterioration among patients receiving ICBT is not uncommon and should be monitored by researchers in order to reverse a negative treatment trend.
|
|
| 12. |
|
|
| 13. |
- Magnusson, Kristoffer, et al.
(author)
-
Harmful compared to what? : The problem of gaming and ambiguous causal questions
- 2024
-
In: Addiction. - 0965-2140 .- 1360-0443.
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: There has been much concern regarding potential harmful effects of video game-play in the past 40 years, but limited progress in understanding its causal role. This paper discusses the basic requirements for identifying causal effects of video game-play and argues that most research to date has focused upon ambiguous causal questions.METHODS: Video games and mental health are discussed from the perspective of causal inference with compound exposures; that is, exposures with multiple relevant variants that affect outcomes in different ways.RESULTS: Not only does exposure to video games encompass multiple different factors, but also not playing video games is equally ambiguous. Estimating causal effects of a compound exposure introduces the additional challenge of exposure-version confounding.CONCLUSIONS: Without a comparison of well-defined interventions, research investigating the effects of video game-play will be difficult to translate into actionable health interventions. Interventions that target games should be compared with other interventions aimed at improving the same outcomes.
|
|
| 14. |
- Magnusson, Kristoffer, et al.
(author)
-
Internet-Delivered Cognitive-Behavioral Therapy for Significant Others of Treatment-Refusing Problem Gamblers : A Randomized Wait-List Controlled Trial
- 2019
-
In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 87:9, s. 802-814
-
Journal article (peer-reviewed)abstract
- Objective: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers' treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. Method: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive-behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. Results: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO's emotional consequences: d = -0.90, 95% CI [-1.47, -0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = -0.45, 95% CI [-0.81, -0.09]; depression: d = -0.49, 95% CI [-0.82, -0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect -0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). Conclusion: The results confirm earlier studies' findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO's coping and well-being. The trial's outcome data and scripts are available for download (https://osf. io/awtg7/).
|
|
| 15. |
- Magnusson, Kristoffer, et al.
(author)
-
Internet-delivered cognitive-behavioural therapy for concerned significant others of people with problem gambling : Study protocol for a randomised wait-list controlled trial
- 2015
-
In: BMJ Open. - : BMJ. - 2044-6055. ; 5
-
Journal article (peer-reviewed)abstract
- Introduction: About 2.3% of the adult population in Sweden are considered to suffer from problem gambling, and it is estimated that only 5% of those seek treatment. Problem gambling can have devastating effects on the economy, health and relationship, both for the individual who gambles and their concerned significant other (CSO). No empirically supported treatment exists for the CSOs of people with problem gambling. Consequently, the aim of this study is to develop and evaluate a programme aimed at CSOs of treatment-refusing problem gamblers. The programme will be based on principles from cognitive behavioural therapy (CBT) and motivational interviewing. To benefit as many CSOs as possible, the programme will be delivered via the internet with therapist support via encrypted email and short weekly conversations via telephone.Methods and analysis: This will be a randomised wait-list controlled internet-delivered treatment trial. A CBT programme for the CSOs of people with problem gambling will be developed and evaluated. The participants will work through nine modules over 10 weeks in a secure online environment, and receive support via secure emails and over the telephone. A total of 150 CSOs over 18 years of age will be included. Measures will be taken at baseline and at 3, 6 and 12 months. Primary outcomes concern gambling-related harm. Secondary outcomes include the treatment entry of the individual who gambles, the CSO's levels of depression, anxiety, as well as relationship satisfaction and quality of life.Ethics and dissemination: The protocol has been approved by the regional ethics board of Stockholm, Sweden. This study will add to the body of knowledge on how to protect CSOs from gambling-related harm, and how to motivate treatment-refusing individuals to seek professional help for problem gambling.Trial registration number: NCT02250586.
|
|
| 16. |
- Magnusson, Kristoffer, et al.
(author)
-
Level of Agreement Between Problem Gamblers’ and Collaterals’ Reports : A Bayesian Random-Effects Two-Part Model
- 2019
-
In: Journal of Gambling Studies. - : Springer Science and Business Media LLC. - 1050-5350 .- 1573-3602. ; 35:4, s. 1127-1145
-
Journal article (peer-reviewed)abstract
- This study investigates the level of agreement between problem gamblers and their concerned significant others (CSOs) regarding the amount of money lost when gambling. Reported losses were analyzed from 266 participants (133 dyads) seeking treatment, which included different types of CSO–gambler dyads. The intraclass correlation coefficients (ICCs) concerning the money lost when gambling during the last 30 days were calculated based on the timeline followback. In order to model reports that were highly skewed and included zeros, a two-part generalized linear mixed-effects model was used. The results were compared from models assuming either a Gaussian, two-part gamma, or two-part lognormal response distribution. Overall, the results indicated a fair level of agreement, ICC = .57, 95% CI (.48, .64), between the gamblers and their CSOs. The partner CSOs tended to exhibit better agreement than the parent CSOs with regard to the amount of money lost, ICCdiff = .20, 95% CI (.03, .39). The difference became smaller and inconclusive when reports of no losses (zeros) were included, ICCdiff = .16, 95% CI (− .05, .36). A small simulation investigation indicated that the two-part model worked well under assumptions related to this study, and further, that calculating the ICCs under normal assumptions led to incorrect conclusions regarding the level of agreement for skewed reports (such as gambling losses). For gambling losses, the normal assumption is unlikely to hold and ICCs based on this assumption are likely to be highly unreliable.
|
|
| 17. |
- Magnusson, Kristoffer
(author)
-
Methodological issues in psychological treatment research : applications to gambling research and therapist effects
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- Over the last couple of decades evidence-based psychotherapies have flourished, and there are now therapies that are well-established for a wide range of problems. At the same time the mental-health burden is still enormous, and challenges to the dissemination of treatments are substantial. Despite the considerable gains in knowledge that have been made, many issues remain unsolved, and there are many reasons to be skeptical of the current quality of the evidence. The aim of this thesis was to explore methodological challenges that impact the evaluation of psychological treatments in general but also gambling treatment trials specifically. In the first part, I present a broader overview of some of the contemporary issues that concern the scientific investigation of psychotherapies. Two issues are then explored in more detail, 1) the broader issue of therapist effects in longitudinal studies, and 2) the more specific issue of analyzing semicontinuous data as a treatment outcome. After expanding on these issues, the findings are then used in two clinical gambling studies. In Study I, we investigated the consequences of ignoring therapist effects in longitudinal data. We derived what factors impact the type I errors, and performed an extensive simulation study. The empirical simulation results validated the analytical results and showed that even when 5% of the variance in slopes is at the therapist level, the type I errors can be substantially inflated. When analyzing data from longitudinal studies, investigators should account for the possibility that therapists might have different overall slopes. In an LMM, this can be accounted for by including a random slope at the therapist level. In order to help investigators plan multilevel longitudinal studies, an R package (powerlmm) was developed. In Study II, we investigated the challenges of estimating treatment effects in gambling studies using gambling expenditure as an outcome. Gambling outcomes are typically very skewed and can include a large number of zeros. Investigators typically try to analyze such data mostly by log transforming the outcome, or continue with a standard analysis based on normally distributed residuals. In this paper, we propose that a marginalized two-part model can be a more attractive option. We compared the performance of the proposed two-part model to the typical methods used by investigators. The performance of these models were compared using real data and via different Monte Carlo simulation scenarios. The choice of an appropriate estimand for treatment effects was also discussed, and we argue that gambling researchers should primarily be concerned with the overall reduction in gambling losses. In Study III, we applied and extended the work in Study II to investigate how concordant gamblers and their concerned significant others (CSOs) were in their reports of gambling losses. The sample consisted of problem gamblers and their CSOs participating in a trial comparing individual CBT versus behavioral couples therapy. A total of 133 dyads were included, and we used their baseline reports of gambling losses using the timeline followback covering the last 30 days. Overall we found that there was a fair level of agreement, ICC = .57, 95% CI [.48, .64]. There were some evidence that partner CSOs had a higher level of agreement compared to parent CSOs, ICCdiff = .20, 95% CI [.03, .39]. In Study IV, we applied the results from Study I, II, and III to investigate the effects of an internet-delivered program aimed at the CSOs of treatment refusing problem gamblers. In total, 100 CSOs of treatment-refusing problem gamblers were randomized to either ten weeks of ICBT or a waitlist control. At posttest the intervention group reported an improvement on the CSO’s emotional consequences (d = -0.90, 95% CI [-1.47, -0.33]), relationship satisfaction (d = 0.41, 95% [0.05, 0.76]), anxiety (d = -0.45, 95% [-0.81, -0.09]), depression (d = -0.49, 95% [-0.82, -0.16]). Any effects on the CSO’s reports on gambling losses and on treatment-seeking were inconclusive. Problem gamblers are hard to influence via their CSO proxies; however, the intervention had a clinically meaningful effect on the CSO’s coping as measured by their emotional consequences, anxiety, depression, and relationship satisfaction. Several methodological issues are discussed in relation to this RCT. For transparency and for better pooling of data, we also published the raw data, including all measured outcomes together with the R scripts used to analyze the trial. The data and scripts can be downloaded from https://osf.io/awtg7. Psychotherapy researchers face significant challenges, and there is a great need for high-quality psychotherapy trials, a better appreciation of the methodological issues, and more transparent reporting practices. Hopefully, improvements to psychotherapy research will follow, and that these improvements will improve clinical practice and reduce the mental health burden in general.
|
|
| 18. |
- Magnusson, Kristoffer, et al.
(author)
-
Modeling Longitudinal Gambling Data : Challenges and Opportunities
- 2019
-
Other publication (other academic/artistic)abstract
- Clinical studies investigating treatments for problem gambling or gambling disorder frequently use gambling expenditure, such as gambling losses, as a treatment outcome. Gambling losses frequently vary substantially between participants; some report no losses, and some report substantial losses. In this article, we review how gambling losses are commonly analyzed in treatment studies, and show that frequently used methods, such as a log(y+1) transformation or assuming a normal distribution, often perform poorly for these types of data. We propose that a marginalized longitudinal two-part model is a more attractive option. The models are compared using real data from a trial including 136 persons with gambling disorder. Additionally, different performance metrics are further evaluated in a Monte Carlo simulation study. We conclude that gambling researchers should consider using the longitudinal two-part model as it offers a flexible and powerful way of modeling gambling outcomes. The log(y + 1) transformation can be highly misleading in typical gambling data, as a difference in the number of zeros leads to biased estimates of the treatment effects.
|
|
| 19. |
- Magnusson, Kristoffer, et al.
(author)
-
The Consequences of Ignoring Therapist Effects in Trials With Longitudinal Data : A Simulation Study
- 2018
-
In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 86:9, s. 711-725
-
Journal article (peer-reviewed)abstract
- Objective: Psychotherapy trials frequently generate multilevel longitudinal data with 3 levels. This type of hierarchy exists in all trials in which therapists deliver the treatment and patients are repeatedly measured. Unfortunately, researchers often ignore the possibility that therapists could differ in their performance and instead assume there is no difference between therapists in their average impact on patients' rate of change. In this article, we focus on scenarios in which therapists are fully and partially nested within treatments and investigate the consequences of ignoring even small therapist effects in longitudinal data.Method: We first derived the factors leading to increased Type I errors for the Time x Treatment effect in a balanced study. Scenarios with an unbalanced allocation of patients to therapists and studies with missing data were then investigated in a comprehensive simulation study, in which the correct 3-level linear mixed-effects model, which modeled therapist effects using a random slope at the therapist level, was compared with a misspecified 2-level model.Results: Type I errors were strongly influenced by several interacting factors. Estimates of the therapist-level random slope suffer from bias when there are very few therapists per treatment.Conclusion: Researchers should account for therapist effects in the rate of change in longitudinal studies. To facilitate this, we developed an open source R package powerlmm, which makes it easy to investigate model misspecification and conduct power analysis for these designs.
|
|
| 20. |
- Mechler, Jakob, et al.
(author)
-
Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder : A randomized controlled trial
- 2024
-
In: npj Mental Health Research. - 2731-4251. ; 3:1
-
Journal article (peer-reviewed)abstract
- Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD.In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60).The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively.Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT.In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD.The study was prospectively registered at ClinicalTrials (NCT05015166).
|
|
| 21. |
- Mechler, Jakob, et al.
(author)
-
Guided and Unguided Internet - delivered Psychodynamic Therapy for Social Anxiety Disorder : A Randomized Controlled Trial
- 2024
-
In: SweSRII 2024. - : Linköping University Electronic Press. ; , s. 13-13
-
Conference paper (peer-reviewed)abstract
- INTRODUCTION: Social Anxiety Disorder (SAD) is a highly prevalent and debilitating disorder. While effective treatments exist, they are not always easily accessible or helpful for all patients. This highlights the need for accessible treatment alternatives. The aim of the STePS study was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist support, compared to a waitlist control condition, in the treatment of adults with SAD. METHODS: In this randomized clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old, scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) without meeting any exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n=60), IPDT without guidance (n=61), or waitlist (n=60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptom severity measured weekly by the LSAS-SR. Primary analyses were conducted on an intention-to-treat sample, including all randomly assigned participants. Secondary outcomes included depressive symptoms, generalized anxiety, quality of life, emotion regulation, and defensive functioning. RESULTS: During the conference, results obtained from the study at post-treatment, as well as at 6- and 12-month follow-ups will be presented. CONCLUSION: This is the second RCT to investigate the efficacy of IPDT in the treatment of SAD. If found efficacious, IPDT should be compared to existing evidence-based internet-delivered treatments.
|
|
| 22. |
- Mellqvist Fässberg, Madeleine, et al.
(author)
-
Functional disability and death wishes in older Europeans: results from the EURODEP concerted action.
- 2014
-
In: Social psychiatry and psychiatric epidemiology. - : Springer Science and Business Media LLC. - 1433-9285 .- 0933-7954. ; 49:9, s. 1475-1482
-
Journal article (peer-reviewed)abstract
- Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life.
|
|
| 23. |
- Nilsson, Anders, et al.
(author)
-
Behavioral couples therapy versus cognitive behavioral therapy for problem gambling : a randomized controlled trial
- 2020
-
In: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 115:7, s. 1330-1342
-
Journal article (peer-reviewed)abstract
- Background and aims There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design Two parallel-group randomized controlled study comparing two different internet-based treatments for PG. Follow-up measures were conducted at treatment finish, and at 3-, 6- and 12-month post-treatment. Setting Stockholm, Sweden. Participants A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions A treatment based on BCT was compared with a CBT intervention. Both treatments were internet-based, with 10 therapist-guided self-help modules accompanied by weekly telephone and e-mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements The primary outcome measures were time-line follow-back for gambling (TLFB-G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM-IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder seven-item scale (GAD-7), the Relation Assessment Scale Generic (RAS-G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO. Findings The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB-G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002. Conclusions Differences in the efficacy of internet-based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group.
|
|
| 24. |
- Nilsson, Anders, et al.
(author)
-
Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling : Study protocol for a randomised controlled trial
- 2016
-
In: BMJ Open. - : BMJ. - 2044-6055. ; 6:9
-
Journal article (peer-reviewed)abstract
- Introduction: Problem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive–behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support.Methods and analysis: A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling.Ethics and dissemination: This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences.
|
|
| 25. |
- Nilsson, Anders, et al.
(author)
-
The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others : A Pilot Randomized Controlled Trial
- 2018
-
In: Journal of Gambling Studies. - : Springer Science and Business Media LLC. - 1050-5350 .- 1573-3602. ; 34:2, s. 539-559
-
Journal article (peer-reviewed)abstract
- Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.
|
|
| 26. |
- Packendorff, Niclas, et al.
(author)
-
Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care
- 2024
-
In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - 1757-7241. ; 32:1
-
Journal article (peer-reviewed)abstract
- BackgroundEmergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records.MethodsThe ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers.ResultsFrom the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions.ConclusionThis study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.
|
|
| 27. |
- Roswall, Nina, et al.
(author)
-
Long-Term Exposure to Transportation Noise and Risk of Incident Stroke : A Pooled Study of Nine Scandinavian Cohorts
- 2021
-
In: Journal of Environmental Health Perspectives. - : National Institute of Environmental Health Sciences (NIEHS). - 0091-6765 .- 1552-9924. ; 129:10
-
Journal article (peer-reviewed)abstract
- Background: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse.Objective: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population.Methods: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through linkage to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle confounders, and air pollution.Results: During follow-up (median=19.5y), 11,056 stroke cases were identified. Road traffic noise (Lden) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for individual- and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of ≤2.5μm (PM2.5) and NO2]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40–50 vs. ≤40 dB) (HR=1.12; 95% CI: 0.99, 1.27), but not with higher exposure (≥50 dB, HR=0.94HR; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke.Discussion: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise.
|
|
| 28. |
- Rozental, Alexander, et al.
(author)
-
For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2017
-
In: BABCP Manchester 2017. ; , s. 119-120
-
Conference paper (peer-reviewed)abstract
- Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation.Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition.Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers in order to reverse and prevent a negative treatment trend.Negative effects of psychological treatments is largely unknown for many researchers and clinicians. However, evidence suggest that 5-10% of all patients deteriorate during treatment and that some also experience other adverse and unwanted events. The results from the current study indicate that deterioration occurs among some patients receiving cognitive behaviour therapy via the Internet. Furthermore, certain sociodemographic variables seem to be associated with lower odds of deterioration; older age, higher educational level, being in a relationship, and having higher symptom severity at pre treatment assessment. In addition, proportionally more patients deteriorated while in wait- list control, suggesting that a better match between patient and treatment format may be required, and that there are ethical and methodological issues surrounding the use of waitings periods in randomised controlled trials.
|
|
| 29. |
- Rozental, Alexander, et al.
(author)
-
For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2016
-
Conference paper (other academic/artistic)abstract
- Aim: During the last couple of decades research on the efficacy and effectiveness of psychological treatments has provided evidence for its use in alleviating mental distress and enhancing well-being. Meanwhile, novel ways of delivering evidence-based methods, such as, via the Internet or smartphone applications, have received increasing support, with the potential of becoming an important and widely used addition to the health care system. Internet-based cognitive behavior therapy (ICBT) has for instance been shown to be beneficial in relation to a number of psychiatric and somatic disorders. However, research has almost solely focused on the positive results, neglecting the fact that psychological treatments also might have negative effects. Investigations from face-to-face settings have found that 5-10% of all patients deteriorate, but whether this is true for ICBT has been unclear. Hence, in order to examine deterioration in cognitive behavior therapy delivered via the Internet, an individual patient data meta-analysis was performed.Method: Patient-level data from 29 clinical trials of ICBT for depression, anxiety disorders, and other problems, e.g., pathological gambling and erectile dysfunction, were aggregated, totaling 2866 participants receiving either a treatment or control condition. Deterioration was assessed using the Reliable Change Index on each of the primary outcome measures. Participants identified as having deteriorated were subsequently analyzed using logistic regression to find potential predictors of a negative treatment outcome.Results: Using only available data, a total of 89 participants (3.1%) were recognized as having reliably deteriorated from pre to post treatment assessment, with an additional 17 participants (0.6%) from pre treatment to follow-up assessment. In general, more participants (N = 56) diagnosed with an anxiety disorder deteriorated, compared to depression (N = 16), and other problems (N = 30). Results using imputed values for missing data and an exploration of predictors of deterioration will be available at the time of the conference.Conclusion: Preliminary evidence indicates that deterioration among participants receiving ICBT afflicts approximately 3.1%, with higher rates for anxiety disorders than depression and other problems. A closer inspection could reveal potential predictors for deterioration, which, in turn, might be used to prevent or reverse a negative treatment outcome.
|
|
| 30. |
- Rozental, Alexander, et al.
(author)
-
For Better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2017
-
In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 85:2, s. 160-177
-
Journal article (peer-reviewed)abstract
- Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive–behavioral therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2,866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, odds ratios (ORs) = 3.10, 95% confidence interval (CI) [2.21, 4.34]. Clinical severity at pretreatment was related to lower odds, OR = 0.62, 95% CI [0.50, 0.77], and OR = 0.51, 95% CI [0.51, 0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, OR = 0.58, 95% CI [0.35, 0.95], having at least a university degree, OR = 0.54, 95% CI [0.33, 0.88], and being older, OR = 0.78, 95% CI, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Conclusion: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend.
|
|
| 31. |
- Uhlén, Mathias, et al.
(author)
-
A human protein atlas for normal and cancer tissues based on antibody proteomics
- 2005
-
In: Molecular & Cellular Proteomics. - 1535-9476 .- 1535-9484. ; 4:12, s. 1920-1932
-
Journal article (peer-reviewed)abstract
- Antibody-based proteomics provides a powerful approach for the functional study of the human proteome involving the systematic generation of protein-specific affinity reagents. We used this strategy to construct a comprehensive, antibody-based protein atlas for expression and localization profiles in 48 normal human tissues and 20 different cancers. Here we report a new publicly available database containing, in the first version, similar to 400,000 high resolution images corresponding to more than 700 antibodies toward human proteins. Each image has been annotated by a certified pathologist to provide a knowledge base for functional studies and to allow queries about protein profiles in normal and disease tissues. Our results suggest it should be possible to extend this analysis to the majority of all human proteins thus providing a valuable tool for medical and biological research.
|
|
| 32. |
- Wall, Håkan, et al.
(author)
-
Evaluation of a Brief Online Self-help Program for Concerned Gamblers
- 2021
-
In: Journal of Gambling Studies. - : Springer Nature. - 1050-5350 .- 1573-3602. ; 37, s. 1277-1290
-
Journal article (peer-reviewed)abstract
- The purpose of this study was to evaluate the feasibility and module content of a brief online self-help program for concerned gamblers, i.e., gamblers who perceived a need to change their gambling habits, in the context of a gambling helpline. The program consisted of four modules based on Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT), covering motivation to change, logging gambling behaviors, planning and implementing gambling-free activities, and managing risk situations. Gambling expenditures were also logged in the program, and their development over time were analyzed as longitudinal data using marginalized two-part models. Out of 4655 gamblers recruited via the helpline's webpage, 92% completed content in at least one module, and 23% were active in all four modules. Attrition was in general high, with only 10% retention in the gambling log for longer than 14 days. Gambling expenditures decreased for those who logged them for a shorter time period, whereas it increased for those who logged expenditures for a longer time period. This study shows that it is relatively easy to recruit participants to an online program for concerned gamblers in the context of a gambling helpline. However, since few users logged in to the program more than once, we suggest future online programs to have open modules with all content accessible at once.
|
|
| 33. |
- Wall, Hakan, et al.
(author)
-
The evaluation of a brief ICBT program with therapist support for individuals with gambling problems in the context of a gambling helpline: a randomized pilot trial
- 2023
-
In: Pilot and Feasibility Studies. - : BMC. - 2055-5784. ; 9:1
-
Journal article (peer-reviewed)abstract
- Background and aims Gambling helplines are a natural way of first contact for individuals with gambling problems. However, few studies have evaluated the feasibility and effectiveness of brief interventions in a gambling helpline. To reduce this knowledge gap, this study evaluated the feasibility of an online cognitive behavioral therapy (ICBT) program in the context of a gambling helpline as a first step towards a full-scale RCT. Design This is a two-group parallel randomized controlled pilot trial where the participants were randomized to either a brief four-module ICBT program (n = 22) or a control group (n = 21). Participants were followed up weekly during the intervention, post intervention, and 6 weeks upon completion of intervention. Participants A total of 43 self-identified individuals with gambling problems (scoring 3 or more on the Problem Gambling Severity Index) were recruited via the Swedish national gambling helpline, 59% females, mean age 43.7 years. Measurements Feasibility of the procedure and intervention (i.e., recruitment pace, attrition, program engagement, and satisfaction) were the primary outcomes; treatment effect (net gambling losses) was the secondary outcome. Results Approximately 2 participants per week were randomized, and retention was low, with 47% lost to follow-up at the 6-week follow-up time-point. Most participants engaged in the online modules (86%) and rated their overall satisfaction with the program as high (7.5 out of 10). Both groups decreased their weekly gambling losses at both follow-up time-points, but the between-group comparisons were inconclusive. Conclusion It is not advisable to conduct a full-scale RCT based on the results from this pilot study. Future studies in a gambling helpline should consider interventions that are more suited to be incorporated in a gambling helpline and identify ways to increase participant engagement.
|
|
| 34. |
- Wibring, Kristoffer, et al.
(author)
-
Towards definitions of time-sensitive conditions in prehospital care
- 2020
-
In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 28:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND:Prehospital care has changed in recent decades. Advanced assessments and decisions are made early in the care chain. Patient assessments form the basis of a decision relating to prehospital treatment and the level of care. This development imposes heavy demands on the ability of emergency medical service (EMS) clinicians properly to assess the patient. EMS clinicians have a number of assessment instruments and triage systems available to support their decisions. Many of these instruments are based on vital signs and can sometimes miss time-sensitive conditions. With this commentary, we would like to start a discussion to agree on definitions of temporal states in the prehospital setting and ways of recognising patients with time-sensitive conditions in the most optimal way.MAIN BODY:There are several articles discussing the identification and management of time-sensitive conditions. In these articles, neither definitions nor terminology have been uniform. There are a number of problems associated with the definition of time-sensitive conditions. For example, intoxication can be minor but also life threatening, depending on the type of poison and dose. Similarly, diseases like stroke and myocardial infarction can differ markedly in terms of severity and the risk of life-threatening complications. Another problem is how to support EMS clinicians in the early recognition of these conditions. It is well known that many of them can present without a deviation from normal in vital signs. It will most probably be impossible to introduce specific decision support tools for every individual time-sensitive condition. However, there may be information in the type and intensity of the symptoms patients present. In future, biochemical markers and machine learning support tools may help to identify patients with time-sensitive conditions and predict mortality at an earlier stage.CONCLUSION:It may be of great value for prehospital clinicians to be able to describe time-sensitive conditions. Today, neither definitions nor terminology are uniform. Our hope is that this commentary will initiate a discussion on the issue aiming at definitions of time-sensitive conditions in prehospital care and how they should be recognised in the most optimal fashion.
|
|
