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1.
  • Almgren, Johanna, et al. (författare)
  • Patients' Health Experiences of Post COVID-19 Condition – A Qualitative Study
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 19:21
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients who suffer from long-term symptoms of COVID-19, described as post COVID-19 condition, are a new and large group of patients. There is a lack of knowledge concerning health experiences in this patient group. The aim of this study was to explore patients' health experiences of post COVID-19 condition. Data collection was performed through 14 semi-structured interviews. The qualitative content analysis resulted in six sub-categories, three categories, and an overall theme. Patients experienced symptoms of varying duration-ranging from 5-21 months. The results showed that patients' health experiences of post COVID-19 condition moved between uncertainty and new insights. This was shown by patients experiencing: (1) loss of abilities, including losing smell and taste and lacking energy, (2) loss of control, including being foreign to oneself and seeking answers, and (3) revaluation of life, including accepting the transformed body and prioritizing health. This study illustrates that patients living with post COVID-19 condition need to be treated with flexibility, based on each individual's unique challenges and experiences of the symptoms and the consequences for their health. © 2022 by the authors.
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2.
  • Carlsson, Ing-Marie, 1961-, et al. (författare)
  • Creating a communication space in the healthcare context : Children’s perspective of using the eHealth service, Sisom
  • 2021
  • Ingår i: Journal of Child Health Care. - London : Sage Publications. - 1367-4935 .- 1741-2889. ; 25:1, s. 31-43
  • Tidskriftsartikel (refereegranskat)abstract
    • According to the United Nation’s Convention of the Rights of the Child, children have the right to participate in their own healthcare and make their opinions heard. The aim of this study was thus to explore the impact of using an eHealth service, Sisom, to gain the children’s perspectives during their healthcare appointments. Data were gathered through individual interviews with a purposeful sample of 16 children, aged 6–13 years old, treated for different diseases and using the eHealth service, Sisom, during their healthcare appointments. The interviews were analysed using a constructivist grounded theory. The results showed that using Sisom made children’s voice heard by creating a communication space in the healthcare setting. This meant that the children got involved in the communication, were acknowledged as an important person who could give the answers to questions and were given time. Implementing the use of Sisom is a way to make children’s needs and preferences explicitly visible for decision-making in practice and thereby supporting the further development of child-centred care in practice. © The Author(s) 2020.
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3.
  • Demmelmaier, Ingrid, 1960-, et al. (författare)
  • Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial
  • 2021
  • Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 31:5, s. 1144-1159
  • Tidskriftsartikel (refereegranskat)abstract
    • Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference −1.05 [95% CI: −1.85, −0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.
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4.
  • Fretland, Asmund Avdem, et al. (författare)
  • Inflammatory Response After Laparoscopic Versus Open Resection of Colorectal Liver Metastases : Data From the Oslo-CoMet Trial.
  • 2015
  • Ingår i: Medicine. - 0025-7974 .- 1536-5964. ; 94:42, s. 1-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Laparoscopic and open liver resection have not been compared in randomized trials. The aim of the current study was to compare the inflammatory response after laparoscopic and open resection of colorectal liver metastases (CLM) in a randomized controlled trial.This was a predefined exploratory substudy within the Oslo CoMet-study. Forty-five patients with CLM were randomized to laparoscopic (n = 23) or open (n = 22) resection. Ethylenediaminetetraacetic acid-plasma samples were collected preoperatively and at defined time points during and after surgery and snap frozen at -80 C. A total of 25 markers were examined using luminex and enzyme-linked immunosorbent assay techniques: high-mobility box group 1(HMGB-1), cell-free DNA (cfDNA), cytokines, and terminal C5b-9 complement complex complement activation.Eight inflammatory markers increased significantly from baseline: HMGB-1, cfDNA, interleukin (IL)-6, C-reactive protein, macrophage inflammatory protein -1β, monocyte chemotactic protein -1, IL-10, and terminal C5b-9 complement complex. Peak levels were reached at the end of or shortly after surgery. Five markers, HMGB-1, cfDNA, IL-6, C-reactive protein, and macrophage inflammatory protein -1β, showed significantly higher levels in the open surgery group compared with the laparoscopic surgery group.Laparoscopic resection of CLM reduced the inflammatory response compared with open resection. The lower level of HMGB-1 is interesting because of the known association with oncogenesis.
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5.
  • Fölster, Jens, et al. (författare)
  • Sjöar och vattendrag i Norrbotten : Utvärdering av vattenkemidata från miljöövervakningen 1984-2012
  • 2014
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Rapporten omfattar en utvärdering av flera decenniers mätningar av vattenkemi i 17 sjöar och 15vattendrag inom den nationella och regionala miljöövervakningen i Norrbottens län. Utvärderingenomfattar beskrivningen av tillståndet utifrån de senaste tre åren och en trendanalys påtidsserierna. Vattenförekomsterna har också klassats med avseende på ekologisk status enligtNaturvårdsverkets bedömningsgrunder.Resultaten visar på generellt hög eller god status med avseende på vattenkemi för alla sjöar utomBergträsket som hade höga klorofyllhalter och lågt siktdjup jämfört med referensvärdena. Halternatotalfosfor i Bergträsket liksom i Pahajärvi var så nära gränsvärdet för god status att detinte gick att ge en entydig klassning utifrån totalfosfor. Även vattendragen hade generellt högeller god status med undantag för Kitkiöjoki och Övre Lansjärv som hade totalfosforhalter straxöver gränsvärdet för god status, men inom felmarginalen för klassning.I de flesta vattenförekomsterna var fosfor det begränsande näringsämnet, men i två av vattendragetvar kväve begränsande och i fem vattendrag och sju sjöar var förhållandet mellan fosfor ochkväve inom området då båda ämnena kan vara begränsande. Många sjöar och vattendrag uppvisadetecken på minskande halter av näringsämnen.Sjöarna och vattendragen har generellt neutrala pH-värden och surhetstillståndet har ringa betydelseför de levande organismerna. Undantaget är Rokån som har pH-värden under fem orsakatav naturligt höga järnhalter. Den minskande försurningspåverkan från luftdeposition avspeglarsig i minskande halter av sulfat, men eftersom depositionsnivåerna är så låga har det ingen betydelsetillståndet i vattnet.Resultaten för vattnets färg, innehåll av baskatjoner och organsikt kol visar inte på några tydligatrender utan varierar som svar på förändringar i nederbörd mellan olika år.De uppmätta tungmetallhalterna i sjöar och vattendrag ligger i de flesta fall långt under gränsvärdena.Undantaget är zink i Latnjajaure och Hornavan där medelvärdet för perioden ligger liteöver respektive nära det dubbla gränsvärdet. För tungmetaller utan gränsvärden ligger halternanära bakgrundsvärdena, med några undantag där berggrunden ger ovanligt höga halter.
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6.
  • Fölster, Jens, et al. (författare)
  • Sjöar och vattendrag i Västernorrland : Utvärdering av vattenkemidata från miljöövervakningen 1983-2011
  • 2012
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Resultat från tre decenniers miljöövervakning av vattenkemi i 10 sjöar och 13 vattendrag i Västernorrland har utvärderats. Utvärderingen omfattar beskrivningen av tillståndet utifrån de senaste tre åren och en trendanalys på tidsserierna. Vattenförekomsterna har också klassats med avseende på ekologisk status enligt Naturvårdsverkets bedömningsgrunder.Resultaten visar generellt på hög eller god ekologisk status utifrån vattenkemin för samtliga sjöar och vattendrag som ingick i studien med undantag för Västersel som hade en halt av Totalfosfor som var mer än det dubbla referensvärdet enligt bedömningsgrunder.Ingen av sjöarna eller vattendragen klassades som försurade enligt bedömningsgrunder, men Viksbäcken klassas som försurningspåverkad genom en expertbedömning mot bakgrund av höga halter oorganiskt aluminium och att vattendraget bedöms varit försurat 1980 enligt bedömningsgrunder. Trenderna i surhetsrelaterade parametrar avspeglar delvis det minskande försurningstrycket, men att förändringarna under perioden är så små att de troligen inte lett till förändringar i artsammansättningen. De största statistiskt signifikanta pH-ökningarna är kring 0,2 enheter på 22 år.Ingen av sjöarna klassades som övergödda utifrån fosforhalten och bara ett vattendrag, Västersel, klassade som övergött enligt bedömningsgrunder. Medelhalten av tot-P var 45 μg/l jämfört med referensvärdet 12 μg/l.S. Bergsjön hade ett siktdjup som var strax under hälften av det beräknade referensvärdet och får därför bara måttlig status. De övriga sjöarna uppnår hög eller god status med avseende på siktdjup.I fyra sjöar med metallanalyser var halterna långt under gränsvärdena för Cd, Pb, Ni och Cr. För Cu och Zn däremot låg halterna nära eller på gränsvärden satta av Naturvårdsverket och för Zn i Valasjön till och med över. I vattendragen var halterna långt under gränsvärdena med undantag för Västersel där medelvärdet för Zn låg nära gränsvärdet. Man kan inte utesluta att de höga halterna är naturliga och t. ex. beror på lokal variation i berggrunden.
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7.
  • Glimelius, Bengt, et al. (författare)
  • U-CAN : a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden.
  • 2018
  • Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 57:2, s. 187-194
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population.Material and Methods: Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data.Results: In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort.Conclusions: Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.
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8.
  • Hamreby, Kerstin, 1950- (författare)
  • Flickor och pojkar i den sociala barnavården : Föreställningar om kön och sociala problem under 1900-talet
  • 2004
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The topic of this study is girls and boys in the field of child welfare. The aim has been to trace and describe conceptions of gender, delinquency and social problems in child welfare from the end of the nineteenth century until the middle of the twentieth century. The sources of data in the study consist of legislative documents, journals and other historical literature representing the professional discourse. Two analytical approaches have been used. First, the sources were employed for descriptions of legislation and the legislative processes in child welfare. Second, the material was analyzed with a discursive approach to elucidate conceptions of gender and their importance in the legislative process and thus in the construction of social problems. Three main periods with different currants of ideas have been identified. In the first period moralism dominated. Thoughts about social problems were based in normative assumptions and scientific influences were rare. Child welfare legislation was deeply influenced by ideas of social control. Young people were to be controlled and disciplined especially through work: Girls through household work and care and boys through paid work. In the second period hygienism, ideas based in hygiene discourses, were the main trend. Genetically based arguments together with discussions about morality and poverty were used to explain social problems, and scientific methods were to be used to discipline and control young people. Proposals for measures take against social problems corresponded to two main lines, a hygienic-medical line and a social pedagogic line. The hygienic-medical line had a considerable influence on actions taken to prevent and deal with social problems. One example was the compulsory care and sterilization of certain young women to prevent them from reproducing. The social pedagogic line comprised parents’ education, the role of the family and sexual education. An increased use of psychological explanations for experiences and behaviour among individuals and groups was seen in the 1930’s; this marked the beginning of the third period, psychologism. During the period of psychologism, science, mainly represented by psychology and psychiatry, gradually achieved a greater impact in those processes where young people were categorized as social problems. If in the previous period external discipline was the means of control, in this period internalized self-discipline was to be the means of adjustment. The study showed that conceptions of girls and boys in child welfare were gendered throughout the first half of the twentieth century. This bias has had an impact on how girls and boys were treated in child welfare services. Discussions about social problems concerning girls were often about sexuality and sexual actions, and discussions concerning boys were about violence and criminality. Social problems among girls were seen above all as moral transgressions and social problems among boys as juridical transgressions. These differing conceptions are of great importance when considering how girls and boys were judged and treated according to the child welfare Acts in existence during the first part of the twentieth century.
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9.
  • Harris, Ulrika, et al. (författare)
  • Parents’ Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD : A Qualitative Study
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 19:22
  • Tidskriftsartikel (refereegranskat)abstract
    • Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents’ experiences of direct and indirect implications of sleep quality onthe health of children with ADHD. The study used an abductive qualitative design, with Tengland’s two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6–13 with ADHD and sleep problems. The parents experienced that sleep influenced their children’s abilities to control emotional behaviour relatedto ADHD and to manage everyday life. Sleep also had an impact on the children’s well-being,in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need forgreater focus on sleep, to target both abilities and well-being in promoting health among childrenwith ADHD. © 2022 by the authors
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10.
  • Kronsell, Lisa, et al. (författare)
  • Parents’ Perceptions of the Value of Children’s Participation in Pediatric Rehabilitation Services : A Phenomenographic Study
  • 2021
  • Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 18:20
  • Tidskriftsartikel (refereegranskat)abstract
    • Ensuring that children have opportunities to be involved in decision-making regarding their own care is associated with quality improvement in pediatric rehabilitation. The aim of the study was to explore parents’ perceptions of the value of children’s participation in pediatric rehabilitation services. Semi-structured interviews were conducted with 17 parents of children with disabilities who visited pediatric rehabilitation services. A phenomenographic analysis method was used. Three categories developed from the analysis describing how participation generated value in terms of empowerment, self-awareness, and independence. The outcome space describes a hierarchical relationship between the categories and their influence on each other. Independence achieved through participation was a core aspect and is at the highest level in the hierarchy since it includes and depends on the outcomes from both empowerment and self-awareness. Parents’ perceptions of the value of children’s participation in pediatric rehabilitation services include the possibility for the child to use their entire capacity through values created in terms of empowerment, self-awareness, and independence, in order to live the best life possible. Children with disabilities are diverse as a group, and further research to identify barriers and facilitators of participation is needed to adjust interventions within pediatric rehabilitation services to ensure that children with disabilities can be increasingly empowered, self-aware, and independent. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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11.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • Children and young people’s participation in developing interventions in health and well-being : a scoping review
  • 2018
  • Ingår i: BMC Health Services Research. - London : BioMed Central. - 1472-6963. ; 18:507
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people'shealth and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. Methods: An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. Results: The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and youngpeople becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. Conclusions: This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted. © 2018 The Author(s).
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12.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • Parents’ experiences of an e-health intervention implemented in pediatric healthcare : a qualitative study
  • 2019
  • Ingår i: BMC Health Services Research. - London, UK : BioMed Central. - 1472-6963. ; 19
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children’s opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents’ ability to communicate and include children. E-health solutions can remove barriers to children’s communication with healthcare professionals. The aim of this study was to explore parents’ perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments.Methods: The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method.Results: The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness.Conclusions: We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child’s participation and human rights. © 2019 The Author(s)
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13.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • Parents’ Experiences of Weighted Blankets’ Impact on Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Problems—A Qualitative Study
  • 2021
  • Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 18:24
  • Tidskriftsartikel (refereegranskat)abstract
    • Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents’ experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children’s sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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14.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • SLEEP : intervention with weighted blankets for children with attention deficit hyperactivity disorder (ADHD) and sleep problems
  • 2022
  • Ingår i: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION AND OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets.METHODS AND ANALYSIS: This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention.ETHICS AND DISSEMINATION: Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019--2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers.TRIAL REGISTRATION NUMBER: NCT04180189. © Author(s) (or their employer(s)) 2022.
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15.
  • Larsson, Ingrid, et al. (författare)
  • SLEEP : Intervention with weighted blankets for children with attention deficit hyperactivity disorder (ADHD) and sleep problems: Study protocol for a randomised control trial
  • 2022
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction and objectives Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets. Methods and analysis This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention. Ethics and dissemination Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019 - 2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers. Trial registration number NCT04180189.
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16.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • Sleep interventions for children with attention deficit hyperactivity disorder (ADHD) : A systematic literature review
  • 2023
  • Ingår i: Sleep Medicine. - Amsterdam : Elsevier. - 1389-9457 .- 1878-5506. ; 102, s. 64-75
  • Forskningsöversikt (refereegranskat)abstract
    • Objective/background: Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. Patients/methods: The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6–18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. Results: The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate −0.49 standardized mean differences (95% confidence interval −0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5–13 years with ADHD. Conclusions: This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD. © 2022 The Authors
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17.
  • Larsson, Ingrid, 1968-, et al. (författare)
  • Validity and reliability of the Swedish version of the Children’s Sleep Habits Questionnaire (CSHQ-SWE)
  • 2024
  • Ingår i: BMC Pediatrics. - London : BioMed Central (BMC). - 1471-2431. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To translate and culturally adapt the Children’s Sleep Habits Questionnaire (CSHQ) to a Swedish version, CSHQ-SWE, and to assess its validity and reliability for use with children with attention deficit hyperactivity disorder (ADHD). Methods: A total of 84 children with ADHD (51 boys and 33 girls; 6–12 years) and parents (7 men and 77 women; 28–51 years) were included in the study. CSHQ was translated and culturally adapted to Swedish, and assessed for concurrent validity with sleep actigraphy (analyzed by Kendall’s Tau) and for reliability by internal consistency (analyzed by McDonald’s Omega H). Face and content validity was evaluated by parents (n = 4) and healthcare professionals (n = 6) qualitatively (comprehensiveness, relevance, and comprehensibility assessed by interviews and analyzed by thematic analysis) and quantitatively (analyzed by content validity ratio and content validity index for 33 items and four non-scored inquiries). Results: Parent-reported sleep problems (CSHQ-SWE total score) were moderately correlated with less “Sleep Efficiency” (Tau = −0.305; p < 0.001) measured by sleep actigraphy. Parent-reported problems with “Sleep Onset Delay” was moderately correlated with measured time for ”Sleep Onset Latency” (Tau = 0.433; p < 0.001). Parent-reported problems with “Night Wakings” were weakly correlated with measured time for “Wake After Sleep Onset” (Tau = 0.282; p < 0.001). Parents estimation of “Total daily sleep duration” was moderately correlated with measured “Total Sleep Time” (Tau = 0.386; p < 0.001). Five of the seven subscales reached an acceptable level for internal consistency (McDonald’s Omega H > 0.700). Comprehensiveness, relevance, and comprehensibility of CSHQ-SWE were satisfactory overall. Content validity ratio was 0.80 to 1.00 for six items, 0.00 to 0.60 for 22 items, and < 0.00 for nine items. Content validity index was 0.22. Conclusions: CSHQ-SWE demonstrated acceptable concurrent validity with objectively measured sleep and internal consistency, whereas the overall results of face and content validity assessment varied. The instrument needs to be further evaluated regarding construct validity, responsiveness, test-retest reliability, and its generalization to other populations. © The Author(s) 2024
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18.
  • Linblad, Inger, 1963- (författare)
  • Problembilder av barn : Representationer, föreställningar och strategier i BRIS stödtelefon 1996-98
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A number of countries including Sweden have developed children’s helplines as free and anonymous counseling services for children and youth. The aim of this study was to deepen knowledge about how the problems of children and youth are represented and constructed in Sweden’s BRIS (Children’s Rights in Society) Children’s Helpline, telephone support between the years 1996 and 1998. The work was social constructivistic, examining how helpline responders understand and interpret information received during support calls. The concept of “the concern” is highlighted as a point of study of problem constructions within micro-counselling. The empirical material consisted primarily of interviews with persons who worked at BRIS either as employed ombudspersons or as volunteer telephone responders. Eleven ombudspersons replied to questions about the Children’s Helpline and how support services are organized. Thirty eight interviews were carried out with helpline responders at two separate occasions during the study period. Fifteen of these interviews provided material for an in depth investigation of responders preconceptions of children and youth’s everyday life, as well as the themes of gender, problematic relationships and assault as well as the strategies that responders used in their supportive calls. Statistical information was collected from BRIS reports. Fifteen completed questionnaires from support calls were included in this study. Analytical processes resulted in the development of the two theoretical concepts of familiarity and micro-understanding. General representations of children and youth situations are put forth via descriptions of misery. The responders’ concepts of children’s everyday life appear fragmentary because of the limited information available about the caller. Gender issues are constructed around questions of feminity and sexuality. The theme of assault contains calls from both girls and boys. Boys’ calls about assault are constructed around bullying and physical assault. Girls’ call are also constructed around violence but also include sexual abuse and molestation. This study contributes to the growing field of knowledge about the problem images of children and youth that emanate from support calls made to telephone helplines.
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19.
  • Lindholm, Annelie, 1975-, et al. (författare)
  • Sex Differences in Children with Uncomplicated Attention Deficit/Hyperactivity Disorder and Sleep Problems
  • 2024
  • Ingår i: Children. - Basel : MDPI. - 2227-9067. ; 11:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. © 2024 by the authors. Licensee MDPI, Basel, Switzerland.
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20.
  • Lönn, Maria, Doktorand, 1981-, et al. (författare)
  • Changed sleep according to weighted blanket adherence in a 16-week sleep intervention among children with attention-deficit/hyperactivity disorder
  • 2024
  • Ingår i: Journal of Clinical Sleep Medicine (JCSM). - Darien : The American Academy of Sleep Medicine. - 1550-9389 .- 1550-9397.
  • Tidskriftsartikel (refereegranskat)abstract
    • Study objectives: To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket adherence.Methods: Children with attention-deficit/hyperactivity disorder (ADHD) (n =94), mean age 9.0 (sd 2.2, range 6-14) participated in a 16-week sleep intervention with weighted blankets (WB). Children were classified as WB adherent (use of WB ≥ 4 nights/week) or non-adherent (use of WB ≤ 3 nights/week). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire (CSHQ)) and child-reported Insomnia Severity Index (ISI) were evaluated according to adherence with mixed effect models. Gender, age, and ADHD subtype were examined as potential moderators.Results: Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after four weeks of use as well as a decrease in parent- (CSHQ) (-5.73, P = .000) and child-reported sleep problems (ISI) (-4.29, P = .005) after 16 weeks. The improvement in sleep was larger among WB adherent vs. non-adherent (between-group difference: CSHQ: -2.09, P = .038; ISI: -2.58, P =.007). Total sleep time was stable for children adherent to WB but decreased for non-adherent (between-group difference: +16.90, P = .019).Conclusions: An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs. non-adherents. Children with ADHD may thus benefit from using WBs to handle their sleep problems.© 2024 American Academy of Sleep Medicine
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21.
  • Lönn, Maria, Doktorand, 1981-, et al. (författare)
  • Experiences of Using Weighted Blankets among Children with ADHD and Sleeping Difficulties
  • 2023
  • Ingår i: Occupational Therapy International. - Oxford : John Wiley & Sons. - 0966-7903 .- 1557-0703. ; 2023, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction. Sleeping difficulties are common in children with attention deficit hyperactivity disorder (ADHD). A sleep intervention with weighted blankets was designed to increase current understanding of using weighted blankets to target children’s individual needs in connection with sleep and daytime functioning. Aim. To explore how children with ADHD and sleeping difficulties experience the use of weighted blankets. Methods. An explorative qualitative design in which 26 children with ADHD and sleeping difficulties, 6-15 years old, were interviewed about a sleep intervention with weighted blankets. Four categories emerged from qualitative content analysis. Results. Children’s experiences revealed that the use of weighted blankets 1) requires a commitment, by adjusting according to needs and preferences and adapting to the environment; 2) improves emotional regulation by feeling calm and feeling safe; 3) changes sleeping patterns by creating new routines for sleep and improving sleep quality; and 4) promotes everyday participation by promoting daily function and balancing activity and sleep. Conclusions. Using weighted blankets promoted children’s management of daily life with ADHD and sleeping difficulties. Occupational therapists can improve the assessment and delivery of weighted blankets tailored to individual needs based on increased knowledge from the children themselves. Copyright © 2023 Maria Lönn et al.
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22.
  • Lönn, Maria, Doktorand, 1981-, et al. (författare)
  • The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder—A randomized controlled crossover trial
  • 2024
  • Ingår i: Journal of Sleep Research. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1105 .- 1365-2869.
  • Tidskriftsartikel (refereegranskat)abstract
    • Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. −2.79 min, p = 0.015, Cohen's d = −0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11–14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions. © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.
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23.
  • Malmborg, Julia S., PhD, 1988-, et al. (författare)
  • Parents' health experiences after their child with ADHD and sleep problems underwent a sleep intervention with a weighted blanket
  • 2023
  • Konferensbidrag (refereegranskat)abstract
    • Background: Being a parent of a child with attention deficit hyperactivity disorder (ADHD) and sleep problems can be challenging and stressful. Weighted blankets have the potential to improve sleep and health in these children, but less is known about the potential effects the child's use of a weighted blanket may have on parents' health.Purpose of the study: To explore parents' health experiences after their child with ADHD and sleep problems underwent a sleep intervention with a weighted blanket.Methods: This study is a part of a randomized, controlled crossover trial with a 16-week sleep intervention with weighted blankets for children with ADHD and sleep problems. A total of 24 parents of children who preferred sleeping with a weighted blanket were interviewed about how the sleep intervention influenced their health. An inductive qualitative content analysis resulted in seven subcategories and two categories.Findings: Children's sleep with weighted blankets influenced parents experienced health in terms of 1) coping with everyday life, including finding harmony, nurturing family relationships, and maintaining a sustainable structure, and 2) feeling well-being, including being well rested, sustaining energy, reaching calm, and achieving meaningful leisure time.Conclusion: A sleep intervention with weighted blankets in children with ADHD and sleep problems influenced parents' health positively by improving management of life and well-being. For parents who struggle to meet the everyday challenges of their child's ADHD, this sleep intervention may contribute to a sustainable health. 
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24.
  • Mattsson, Peter, et al. (författare)
  • Physical fitness, but not muscle strength, is a risk factor for death in amyotrophic lateral sclerosis at an early age
  • 2012
  • Ingår i: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ. - 0022-3050 .- 1468-330X. ; 83:4, s. 390-394
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disorder mainly characterised by motor symptoms. Extensive physical activity has been implicated in the aetiology of ALS. Differences in anthropometrics, physical fitness and isometric strength measured at 18-19 years were assessed to determine if they are associated with subsequent death in ALS. Method Data on body weight and height, physical fitness, resting heart rate and isometric strength measured at conscription were linked with data on death certificates in men born in 1951-1965 in Sweden (n=809 789). Physical fitness was assessed as a maximal test on an electrically braked bicycle ergometer. Muscle strength was measured as the maximal isometric strength in handgrip, elbow flexion and knee extension in standardised positions, using a dynamometer. Analyses were based on 684 459 (84.5%) men because of missing data. A matched case control study within this sample was performed. The population was followed until 31 December 2006, and 85 men died from ALS during this period. Results Weight adjusted physical fitness (W/kg), but not physical fitness per se, was a risk factor for ALS (OR 1.98, 95% CI 1.32 to 2.97), whereas resting pulse rate, muscle strength and other variables were not. Conclusions Physical fitness, but not muscle strength, is a risk factor for death at early age in ALS. This may indicate that a common factor underlies both fitness (W/kg) and risk of ALS.
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25.
  • Neher, Margit, 1959-, et al. (författare)
  • Innovation in healthcare : leadership perceptions about the innovation characteristics of artificial intelligence—a qualitative interview study with healthcare leaders in Sweden
  • 2023
  • Ingår i: Implementation Science Communications. - London : BioMed Central (BMC). - 2662-2211. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation.Methods: The study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare.Results: Participants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation.Conclusion: Healthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI’s opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare. © 2023, The Author(s).
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26.
  • Nilsen, Per, 1960-, et al. (författare)
  • A Framework to Guide Implementation of AI in Health Care : Protocol for a Cocreation Research Project
  • 2023
  • Ingår i: JMIR Research Protocols. - Toronto : JMIR Publications. - 1929-0748. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care.Objective: The aim of this protocol is to describe the development, testing, and evaluation of a framework, “Artificial Intelligence-Quality Implementation Framework” (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care.Methods: The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge.Results: The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement.Conclusions: The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. © 2023 The Author(s).
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27.
  • Nilsen, Per, 1960-, et al. (författare)
  • Realizing the potential of artificial intelligence in healthcare : Learning from intervention, innovation, implementation and improvement sciences
  • 2022
  • Ingår i: Frontiers in Health Services. - Lausanne : Frontiers Media S.A.. - 2813-0146. ; 2
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare. © 2022 Nilsen, Reed, Nair, Savage, Macrae, Barlow, Svedberg, Larsson, Lundgren and Nygren. 
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28.
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29.
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30.
  • Nygren, Ingrid, et al. (författare)
  • Arbogaåns avrinningsområde : Recipientkontroll 2015
  • 2016
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Institutionen för vatten och miljö vid SLU har på uppdrag av Arbogaåns vattenförbund varit utförare av recipientkontrollprogrammet för Arbogaåns avrinningsområde under 2015. Prov för vattenkemiska och biologiska analyser har tagits på 27 platser i rinnande vattendrag, samt i 16 sjöar inom Arbogaaåns vattensystem. Denna rapport redovisar resultaten från dessa undersökningar och klassning av ekologisk status, avseende analyserade parametrar vid stationerna, enligt Naturvårdsverkets bedömningsgrunder 2007 (NV 2007:4, Bilaga A: Bedömningsgrunder för sjöar och vattendrag) och Havs- och vattenmyndighetens föreskrifter om klassificering och miljökvalitetsnormer avseende ytvatten (HVMFS 2013:19).  Väder och vattenföring Året 2015 hamnade på tredje plats bland de varmaste åren i Sverige. Det var framförallt i början och slutet av året som man hade de största temeraturöverskotten medan för årstiden ovanligt kyligt väder under maj, juni och delar av juli drog ner årsmedeltemperaturen. När det gäller nederbörd så var det stora variationer så att i princip varannan månad gav nederbörd över eller mycket över det normala medan övriga månader låg under eller mycket under. Vattenföringen vid pegelstationerna i området låg mestadels nära medel för perioden 1978-2015.  Vattenkemi De lägsta halterna av näringsämnen i både sjöar och vattendrag uppmättes liksom tidigare år i de norra och västra delarna av Arbogaåns avrinningsområde där andelen skog är stor. Halten av fosfor i sjöarna var 2015 högst i Väringen (6070) medan den högsta kvävehalten uppmättes i Vikern (6310). Transporten av näringsämnen i vattendragen ökar successivt mot Arbogåns mynning. Anledningen är att vattenföringen ökar nedåt i systemet samt att halterna av kväve och fosfor också ökar i och med att andelen jordbruksmark är större i den nedre delen. Det tillkommer också punktkällor från ett antal avloppsreningsverk vilket ökar belastningen nedåt i systemet. Belastningen av kväve och fosfor på Mälaren från Arbogaån varierar mellan åren, till stor del beroende på variationer i vattenföringen (figur A). En viss trend kan dock anas att efter en nedgång runt år 2000 så ökar transporten av näringsämnen åter långsamt. Efter 2012 och 2014 års toppnoteringar är 2015 års transport åter lägre men fortfarande den femte högsta noteringen sedan 1997. De högsta siktdjupen och lägsta klorofyllhalterna återfanns i de norra och västra delarna av avrinningsområdet (område E och D) medan de lägsta siktdjupen uppmättes i de södra och östra delarna (område A, B och C). De högsta klorofyllhalterna var inte lika tydligt associerade till delområde utan återfanns i princip spridda över alla områden.  Biologi De biologiska provtagningarna fokuserade i år helt på bottenfauna i vattendrag. Den ekologiska statu-sen bedömd med hjälp av bottenfauna var vid alla provpunkter utom Hagbyåns inflöde till Norasjön (6330) och Arbogaåns inflöde i Väringen (6065) oförändrat hög eller god 2015 (figur B). Stationen vid inflödet till Norasjön visar en fortsatt sjunkande trend men bibehåller måttlig ekologisk status. Även status vid inflödet till Väringen har försämrats till måttlig.  Sammanställning av statusklassningVi sammanvägning av alla analyserade kvalitetselement är statusen generellt hög eller god i merparten av sjöarna och vattendragen i norra och västra delen av avrinningsområdet med några undantag (figur B). Statusklassningarna kring och nedströms Väringen visar mestadels på måttlig till god status.
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31.
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32.
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33.
  • Nygren, Ingrid, et al. (författare)
  • Eskilstunaåns avrinningsområde : Recipientkontroll 2015
  • 2016
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • -Institutionen för vatten och miljö vid SLU har på uppdrag av Hjälmarens vattenvårdsförbund varit utförare av recipientkontrollprogrammet för Eskilstunaåns avrinningsområde under 2015. Prov för vattenkemiska och biologiska analyser har tagits på 29 platser i rinnande vattendrag, samt i 13 sjöar (figur A) inom Eskilstunaåns vattensystem. Denna rapport redovisar en sammanfattning av resultaten från dessa undersökningar och klassning av den ekologiska statusen vid stationerna enligt Naturvårdsverkets bedömningsgrunder 2007 (NV 2007:4 Bilaga A) samt Havs- och vattenmyndighetens föreskrifter om klassificering och miljökvalitetsnormer avseende ytvatten (HVMFS 2013:19).  Väder och vattenföring Året 2015 hamnade på tredje plats bland de varmaste åren i Sverige. Det var framförallt i början och slutet av året som man hade de största temperaturöverskotten medan för årstiden ovanligt kyligt väder under maj, juni och delar av juli drog ner årsmedeltemperaturen.I princip gav varannan månad nederbörd över eller mycket över det normala medan övriga månader låg under eller mycket under. Vattenföringen låg nära eller under medel för mätperioden under de flesta av årets månader. Vattenkemi Halterna av näringsämnen är högst i Hjälmaren och Öljaren där andelen jordbruksmark i området är större än längre upp i avrinningsområdet. Högst halt av totalfosfor erhölls 2015 liksom tidigare år i Öljaren (4010) men Hemfjärden (9010) i Hjälmaren låg nästan lika högt. Den högsta kvävehalten återfanns i Hemfjärden med Öljaren och Mellanfjärden (9020) strax under. Belastningen av kväve och fosfor på Mälaren från Eskilstunaån visar inte på någon tydlig monoton trend sedan mätningarna startade 1997. Ett visst mönster kan man emellertid se. Efter en kraftig minskning av både fosfor och kväve i början av 2000-talet tycks halterna öka igen. Skillnaden mellan åren är dock stor och den beror till stor del på variationer i vattenföringen (figur A). Lägst klorofyllhalt och störst siktdjup finner man i sjöar i de västra delarna av avrinningsområdet. Störst siktdjup uppmättes även detta år i Östra Laxsjön där också klorofyllhalten var lägst. De högsta klorofyllhalterna återfanns i Öljaren och Hjälmaren där också de lägsta siktdjupen uppmättes. Vid årets provtagning var klorofyllhalten i Hjälmaren betydligt lägre än de två föregående åren vid alla provplatser. Detta till trots är det inga stora skillnader i siktdjup mellan åren.  Biologi Samtliga stationer i Hjälmaren är av växtplanktonutvecklingen att döma mer eller mindre tydligt på- verkade av fosforbelastning (jämför rapporten SLU 2014:10). En statusklassning baserad på de senaste tre årens sammanvägda värden ger vid handen att status 2015 är fortsatt otillfredsställande men svagt stigande i Hemfjärden och Mellanfjärden, otillfredsställande och oförändrade i Östra Hjälmaren samt måttlig och fortsatt stigande i Storhjälmaren. Liksom 2014 hade alla vattendragsstationer även 2015 en bottenfauna med litet antal arter och låg biologisk mångfald. Surhetsindexet MISA har indikerat nära neutrala förhållanden i alla stationer i Eskilstunaåns nedströms Hjälmaren. Den ekologiska statusen avseende bottenfauna vid undersökningspunkterna är 2015 god till hög. Liksom året innan visar Frommestabäcken-Ekeby sämre resultat än tidigare under 10-talet och erhåller bara god status. I Eskils-tunaån vid vattenverket samt nedströms Torshälla är den ekologiska statusen oförändrat hög. Indexen för Eskiltunaån nedströms avloppsverket har fluktuerat men visar i år liksom 2014 på god status. Sammanställning av statusklassningar Statusklassningen av vattendragen i den västra delen (delområde A), visade alla detta år på god eller hög status (figur B). I de södra delarna (delområde C och E), samt i Svartåns nedre del (delområde B), var statusen i vattendragen med några undantag måttlig. Lillån från Logsjön (2410) erhöll otillfredsställande status medan Vibysjöns utlopp (3010, Svartån, Karlslund (2070) och Frommestabäcken vid Ekeby (3210) erhöll god status. Vattendragen öster om Hjälmaren (delområde G) erhöll alla god status. Avseende sjöarna så visade Toften och Storhjälmaren och Näshultasjön måttlig status, medan övriga fjärdar i Hjälmaren visade otillfredsställande och Öljaren dålig status. Övriga sjöar visade på god eller hög status. Till viss del beror skillnader mellan åren på att olika antal kvalitetselement ingått olika år eftersom den biologiska provtagningen på många stationer bara sker vissa år. För en fullständig klassning av ekologisk status ska även hydromorfologiska kvalitetsfaktorer beaktas, men dessa ingår inte i uppdraget. 
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34.
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35.
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36.
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37.
  • Nygren, Ingrid, et al. (författare)
  • Fyrisåns avrinningsområde 2019 : Vattenkvalitet 2017-2019
  • 2020
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • NäringsämnenDe lägsta halterna av fosfor uppmättes under den senaste treårsperioden i Jumkilsån och Fyrisåns Vattholmastation medan de övriga stationerna legat betydligt högre, framförallt det två senaste åren. Även kvävehalterna är lägst i Jumkilsån och vid Vattholma men där är skillnaden inte lika stor mellan stationer utom vid Vindbron där kvävehalten är betydligt högre än vid någon annan station. Kvalitetsklassning avseende näringsämnen visade på måttlig status vid alla stationer utom vid Jumkilsån Kallön där den var hög och Fyrisån vid Vattholma där den var god.Syrgasförhållanden  De flesta stationerna visar goda syreförhållanden i vattnet under hela året. Undantaget är stationen vid Vattholma där syrgashalten tidigare under vissa år legat mycket lågt under delar av året, framförallt vintertid. På senare år har detta blivit mycket bättre utom under en period vintern 2017-2018.Surhet/försurning Fyrisåns avrinningsområde har generellt bra motståndskraft mot försurning. Stationen i Jumkilsån vid Kallön avviker med en låg buffertförmåga, mätt som alkalinitet. Detta kan förklaras av att stationen ligger långt upp i avrinningsområdet och avvattnar ett område som domineras av skog.Metaller Metallhalterna har i de flesta fall sjunkit vid de stationer där mätningar gjorts under perioden även om variationen mellan åren stundtals är stor. De högsta metallhalterna finner man i Sävjaån medan Fyrisån vid Vindbron och Flottsund oftast visar lägre halter.Kiselalger.Bedömning av vattenkvaliteten avseende kiselalger visade hög ekologisk status vid två stationer, nämligen Vattholma N. Bron och Jumkilsån Kallön. Stationen vid Flottsund uppvisade god status och de övriga måttlig status. Kiselalgsindexet ACID indikerade att alla stationer har alkaliska eller nära neutrala förhållanden.BottenfaunaBottenfaunaprov togs vid stationerna Fyrisån Vattholma, Vendelån Lena kyrka, Jumkilsån Kallön samt Fyrisån Klastorp. Bedömning av bottenfaunans ekologiska status grundas på tre olika index: ASPT, DJ och MISA. ASPT och DJ, som indikerar näringspåverkan, visade båda hög status vid alla stationer. Surhetsindexet MISA gav statusen Nära neutralt vid alla stationer utom Jumkilsån Kallön där statusen var Måttligt surt.
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38.
  • Nygren, Ingrid, et al. (författare)
  • Fyrisåns avrinningsområde 2020
  • 2021
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Under året har provtagning utförts en gång i månaden vid 4 stationer i Fyrisån samt i tillflödena Vendelån, Jumkilsån och Sävjaån. Provtagning och analys har utförts av det ackrediterade kemiska laboratoriet vid institutionen för vatten och miljö, SLU (SWEDAC nr 1208) på uppdrag av Fyrisåns vattenförbund. Utöver detta har under sommaren 2020 provtagning för analys av 12 PFAS-substanser och cirka 80 andra organiska mikroföroreningar utförts vid tre av de ordinarie provtagningsstationerna samt vid fyra tillfälliga stationer, se Tabell 1. Dessa prover har analyserats på POPs-laboratoriet, forskningslaboratoriet för organiska miljöföroreningar, vid institutionen för vatten och miljö, SLU. Resultaten bifogas detta nyhetsbrev. Detta nyhetsbrev innehåller en kortfattad sammanfattning av årets analysresultat.
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39.
  • Nygren, Ingrid (författare)
  • Fyrisåns avrinningsområde 2021
  • 2022
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Under året har provtagning utförts en gång i månaden vid 4 stationer i Fyrisån samt i tillflö-dena Vendelån, Jumkilsån och Sävjaån. Provtagning och analys har utförts av det ackredite-rade kemiska laboratoriet vid institutionen för vatten och miljö, SLU (SWEDAC nr 1208) på uppdrag av Fyrisåns vattenförbund.Detta nyhetsbrev innehåller en kortfattad sammanfattning av årets analysresultat. Analysresul-taten från den ordinarie provtagningen har levererats till nationell datavärd och finns tillgäng-liga via internet på webbportalen miljödata-MVM via direktlänken: https://mil-jodata.slu.se/MVM/Query?studies=446&startdate=2021-01-01&enddate=2021-12-31Metodförteckning med mätområden och mätosäkerheter återfinns på institutionens hemsida under vattenkemiska laboratoriet: https://www.slu.se/globalassets/ew/org/inst/vom/laborato-rier/Ackrediterade-vattenanlysmetoder.pdfFyrisåns avrinningsområde omfattar cirka 2000 km2, varav 2 % är sjöyta. Karta över avrin-ningsområdet visas i Figur 1 och provtagningsstationer och koordinater för dessa visas iTabell 1 nedan. Stationerna är i tabellen placerade i flödesordning med lokalen längst upp i av-rinningsområdet (Vattholma) först och lokalen längs ned (Flottsund) sist. Biflödena listas efter hur de mynnar i huvudfåran.
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40.
  • Nygren, Ingrid, et al. (författare)
  • Fyrisåns avrinningsområde 2022 : vattenkvalitet och biologisk status 2020-2022
  • 2023
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • De lägsta halterna av fosfor uppmättes i Jumkilsån och i Fyrisån vid Vattholma. Båda dessa stationer ligger tidigt i respektive avrinningsområde. Näringshalten ökar därefter nedåt i systemet då näringsämnen tillförs från omgivande mark liksom från biflöden och olika former av punktutsläpp. Även kvävehalterna är lägst i Jumkilsån och vid Vattholma men skillnaden mellan stationerna är där inte lika stor. Statusklassningen avseende totalfosfor visar på god status vid Vattholma, Klastorp och i Jumkilsån medan övriga stationer visar på måttlig status.Syrgasförhållanden är generellt goda vid alla provpunkter utom vid Vattholma där syrgashalten vid några tillfällen legat mycket lågt trots normalt flöde. I Jumkilsån har det förekommit låga syrgashalter vid två provtagningar efter varandra då flödet var mycket lågt.Fyrisåns avrinningsområde har generellt bra buffertförmåga men Jumkilsån Kallön är vid provpunkten en liten skogsbäck med hög halt TOC vilket gör den naturlig surare.Metallhalterna vid de fyra stationer där sådana prov tas har mestadels gått ner under de senaste tjugo åren men variationen mellan åren kan stundtals vara stor. Undantaget är nickel som legat på ungefär samma nivå under hela perioden.Statusklassningen avseende kiselalger visar på god status vid Vattholma, hög status i Jumkilsån och måttlig vid övriga stationer.Bottenfaunaprov togs vid stationerna Fyrisån Vattholma, Vendelån Lena kyrka, Jumkilsån Kallön samt Fyrisån Klastorp. Statusklassningen visar på hög status vid alla fyra provplatser.
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41.
  • Petersson, Lena, 1968-, et al. (författare)
  • Challenges to implementing artificial intelligence in healthcare : a qualitative interview study with healthcare leaders in Sweden
  • 2022
  • Ingår i: BMC Health Services Research. - London : BioMed Central (BMC). - 1472-6963. ; 22
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders’ perspectives on AI implementation has been undertaken, very few studies have investigated leaders’ perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare.Methods: The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach.Results: The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice.Conclusions: In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships. © The Author(s) 2022.
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42.
  • Petersson, Lena, 1968-, et al. (författare)
  • Developing an ethical model for guidance the implementation of AI in healthcare
  • 2023
  • Ingår i: 10th Nordic Health Promotion Research Conference 2023. Sustainability and the impact on health and well-being. - Halmstad : Halmstad University Press. - 9789189587410 ; , s. 84-84
  • Konferensbidrag (refereegranskat)abstract
    • Background: Artificial intelligence (AI) is predicted to improve healthcare, increase efficiency, save time and resources. However, research shows an urgent need to develop guidance to ensure that the use of AI in healthcare is ethically acceptable.Purpose: To develop an ethical model to support AI implementation in practice.Methods: The study used an explorative and empirically driven qualitative design. Individual interviews were conducted with 18 healthcare professionals from two emergency departments in Sweden where the county council has developed an AI application to predict the risk for unexpected mortality within 30 days after visiting an emergency department. A deductive analysis based on ethical theory i.e virtue, deontology and consequentialism, was used.Findings: The developed model shows how the healthcare professionals use ethical reasoning in relation to the implementation of AI. In relation to virtue ethics, moral considerations in relation to the use of AI were mentioned. In relation to deontology, considerations were mentioned on actions performed based on information acquired from the technology and adherence to specific duties, roles and responsibilities. In relation to consequentialism, considerations about how to provide better resources more rapidly in an equal way and how the technology can be adjusted to each patients’ individual needs and preferences in order to support decisions, self-determination, and actions that are in the patients best interest.Conclusions: Our findings provide an ethical model demonstrating the relevance of virtue, deontology and consequentialism when AI are to be implemented in practice.
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43.
  • Petersson, Lena, 1968-, et al. (författare)
  • Ethical considerations in implementing AI for mortality prediction in the emergency department : Linking theory and practice
  • 2023
  • Ingår i: Digital Health. - London : Sage Publications. - 2055-2076. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Artificial intelligence (AI) is predicted to be a solution for improving healthcare, increasing efficiency, and saving time and recourses. A lack of ethical principles for the use of AI in practice has been highlighted by several stakeholders due to the recent attention given to it. Research has shown an urgent need for more knowledge regarding the ethical implications of AI applications in healthcare. However, fundamental ethical principles may not be sufficient to describe ethical concerns associated with implementing AI applications.Objective: The aim of this study is twofold, (1) to use the implementation of AI applications to predict patient mortality in emergency departments as a setting to explore healthcare professionals’ perspectives on ethical issues in relation to ethical principles and (2) to develop a model to guide ethical considerations in AI implementation in healthcare based on ethical theory.Methods: Semi-structured interviews were conducted with 18 participants. The abductive approach used to analyze the empirical data consisted of four steps alternating between inductive and deductive analyses. Results: Our findings provide an ethical model demonstrating the need to address six ethical principles (autonomy, beneficence, non-maleficence, justice, explicability, and professional governance) in relation to ethical theories defined as virtue, deontology, and consequentialism when AI applications are to be implemented in clinical practice.Conclusions: Ethical aspects of AI applications are broader than the prima facie principles of medical ethics and the principle of explicability. Ethical aspects thus need to be viewed from a broader perspective to cover different situations that healthcare professionals, in general, and physicians, in particular, may face when using AI applications in clinical practice. © The Author(s) 2023.
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44.
  • Petersson, Lena, 1968-, et al. (författare)
  • Ethical Perspectives on Implementing AI to Predict Mortality Risk in Emergency Department Patients : A Qualitative Study
  • 2023
  • Ingår i: Caring is sharing - exploiting the value in data for health and innovation. - Amsterdam : IOS Press. - 9781643683881 - 9781643683898 ; , s. 676-677
  • Konferensbidrag (refereegranskat)abstract
    • Artificial intelligence (AI) is predicted to improve health care, increase efficiency and save time and recourses, especially in the context of emergency care where many critical decisions are made. Research shows the urgent need to develop principles and guidance to ensure ethical AI use in healthcare. This study aimed to explore healthcare professionals' perceptions of the ethical aspects of implementing an AI application to predict the mortality risk of patients in emergency departments. The analysis used an abductive qualitative content analysis based on the principles of medical ethics (autonomy, beneficence, non-maleficence, and justice), the principle of explicability, and the new principle of professional governance, that emerged from the analysis. In the analysis, two conflicts and/or considerations emerged tied to each ethical principle elucidating healthcare professionals' perceptions of the ethical aspects of implementing the AI application in emergency departments. The results were related to aspects of sharing information from the AI application, resources versus demands, providing equal care, using AI as a support system, trustworthiness to AI, AI-based knowledge, professional knowledge versus AI-based information, and conflict of interests in the healthcare system. © 2023 European Federation for Medical Informatics (EFMI) and IOS Press.
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45.
  • Petersson, Lena, 1968-, et al. (författare)
  • Expected values of implementing AI in healthcare – A Qualitative study
  • 2023
  • Ingår i: Nordic Health Promotion Research Conference 2023. - Halmstad.
  • Konferensbidrag (refereegranskat)abstract
    • Background: Artificial intelligence (AI) is often presented as a technology that will change healthcare and be useful inclinical work in disease prediction, diagnosis, and precision health. More knowledge is needed regarding the value of AI applications based on the perspectives of healthcare leaders to understand their roles as gatekeepers and facilitatorsfor successful implementation.The purpose of the study: To explore healthcare leaders’ perceptions of the value of AI applications in clinical work.Methods: The study had an explorative qualitative approach. Individual interviews were conducted from October2020 to May 2021 with 26 healthcare leaders with different experiences in implementing AI in clinical practice in acounty council in Sweden. Inductive qualitative content analysis was used, and eight sub-categories and threecategories emerged.Findings: The value of AI applications in clinical care was described in terms of expected benefits for patients as toolssupporting person-centered information and individualized self-management. The expected benefits for healthcareprofessionals included decision-support in diagnostics, risk assessments, and treatment recommendations but alsoproviding warning systems and second opinions in clinical work. On an organizational level, the benefits comprisedpatient safety and decision-support in prioritizing healthcare resources in and across healthcare organizations.Conclusions: The healthcare leaders perceived that AI applications would provide value on different levels inhealthcare for patients, healthcare professionals, and organizations. Across these levels, the implementation of AI cansupport person-centeredness, patient self-management, quality of care, patient safety, and resource optimization.
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46.
  • Petersson, Lena, 1968-, et al. (författare)
  • Healthcare Leaders' Perceptions of the Usefulness of AI Applications in Clinical Work : A Qualitative Study
  • 2023
  • Ingår i: Caring is sharing - exploiting the value in data for health and innovation. - Amsterdam : IOS Press. ; , s. 678-679
  • Konferensbidrag (refereegranskat)abstract
    • Artificial intelligence (AI) is often presented as a technology that changes healthcare and is useful in clinical work in disease prediction, diagnosis, treatment effectiveness, and precision health. This study aimed to explore healthcare leaders' perceptions of the usefulness of AI applications in clinical work. The study was based on qualitative content analysis. Individual interviews were conducted with 26 healthcare leaders. The usefulness of AI applications in clinical care was described in terms of expected benefits for 1) patients as supporting individualized self-management and person-centered information support tools 2) healthcare professionals in terms of providing decision-support in diagnostics, risk assessments, treatment recommendations, warning systems, and as a new colleague supporting the clinical work, and 3) organizations as providing patient safety and decision-support in prioritizing healthcare resources in organizing healthcare.
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47.
  • Petersson, Lena, 1968-, et al. (författare)
  • Implementering av AI i hälso- och sjukvården – ledares gränsarbete kan förändra professionella gränser
  • 2023
  • Konferensbidrag (refereegranskat)abstract
    • Just nu pågår en digital transformation av svensk hälso- och sjukvård och artificiell intelligens (AI) är tänkt att vara lösningen på många av de utmaningar sjukvården står inför. I en kunskapssammanställning från Myndigheten för arbetsmiljökunskap (MYNAK) (2020) om digitalisering och arbetsmiljö påtalas att den snabba tekniska utvecklingen kommer att förändra arbetsmiljö och yrkesrollers karaktär. Professionellas arbete är traditionellt omgärdat av gränser och att upprätthålla gränserna kring det egna kunskapsområdet är en grundläggande del av professionens utveckling. Digitalisering och implementering av olika former av teknik kan förändra professionella gränser och därmed generera så kallat gränsarbete (Petersson, 2020) som kan indelas i tre former; konkurrenskraftigt gränsarbete, kollaborativt gränsarbete och konfigurativt gränsarbete (Langley et al. 2019). De tre formerna av gränsarbete är ofta sammanflätade i praktiken, men konfigurativt gränsarbete kan dock beskrivas som en kraft som driver de andra två kategorierna av gränsarbete, eftersom det riktar sig emot andras aktiviteter i syfte att utforma gränser för förändring mellan grupper (Langley et al., 2019). Denna studie fokuserar på hur gränserna kring vårdprofessionernas arbete kan förändras vid implementering av AI och på vilket konfigurativt gränsarbete som aktörer på ledningsnivån i ett sjukvårdssystem förutser kommer att ske när sjukvården blir mer datadriven genom användning av AI-analyser.Vi genomförde semistrukturerade intervjuer med 26 ledare som var i en position att potentiellt påverka implementeringen och användningen av AI i en svensk region. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Analysen i studien fokuserar på den konfigurativa formen av gränsarbete.Sammantaget visar resultatet att ledarna beskriver olika typer av konfigurativt gränsarbete. Ledarna har makten att bedriva gränsarbete som förändrar gränserna kring vårdpersonalens arbete och de beskriver att de, medvetet eller omedvetet, vill förändra gränserna kring i första hand läkarnas arbete vid implementeringen av AI i hälso- och sjukvården.ReferenserLangley, A., Lindberg, K., Mork, B. E., Nicolini, D., Raviola, E., Walter, L. (2019). Boundary work among groups, occupations, and organization: From Cartography to process. Academy of Management Annals, 13(2): 704–736.Mynak (2020). Framtidens arbetsmiljö – trender, digitalisering och anställningsformer. 2020:3. www.mynak.se.Petersson, L. (2020). Paving the way for transparency: How eHealth technology can change boundaries in healthcare. Lund: Department of Design Sciences, Faculty of Engineering, Lund University.
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48.
  • Petersson, Lena, 1968-, et al. (författare)
  • Implementering av artificiell intelligens (AI) : Ett projekt om hur AI förändrar information och kunskapspraktiker i hälso- och sjukvården
  • 2023
  • Ingår i: Program och abstrakt. - Lund : Lunds universitet. ; , s. 53-53
  • Konferensbidrag (refereegranskat)abstract
    • Vi kommer att presentera ett nytt forskningsprojekt vid Högskolan i Halmstad med finansiering från Vetenskapsrådet, som förväntas bidra med kunskap om hur arbetets gränser i hälso- och sjukvården förändras vid implementering av artificiell intelligens (AI). Hälso- och sjukvården i Sverige brottas idag med utmaningar kring att klara av att fördela resurser där de gör mest nytta, säkerställa kvalitet i den vård som ges och att ställa om till en mer digitaliserad vård som sker i mer samproduktion mellan vårdpersonal och patienter. Ett teknikområde som förväntas kunna bidra till att lösa dessa utmaningar är AI, men forskning har visat att det finns många hinder för att lyckas med att införa och använda AI-applikationer inom hälso- och sjukvården. Hälso- och sjukvårdspersonal har en viktig roll att spela i förändringsarbete inom vården och AI-applikationer kan komma att konkurrera med det monopol på kunskap i förhållande till hälsa och behandling av sjukdomar som vårdpersonalen erhållit genom lång akademisk utbildning, träning och praktisk erfarenhet. Det övergripande syftet med forskningsprojektet ImpAI är att generera ny kunskap om implementering och användning av AI-applikationer i rutinsjukvård och hur professionella roller kan fungera som barriärer under implementeringsprocessen. Det teoretiska ramverket består av professionsteori med fokus på tillit och arbetets gränser samt implementeringsteori. Projektet bygger på olika case i form av AI-applikationer som implementeras under 2023–2024 i Region Halland, Sverige och mixad metod används vid processutvärderingen av dessa case. Resultatet kommer både att främja förståelsen för hur processer kan etableras vid införande av AI applikationer i hälso- och sjukvården och bidra med information om hur sådana processer kan bygga på hälso- och sjukvårdspersonalens kompetens och roller.
  •  
49.
  • Petersson, Lena, 1968-, et al. (författare)
  • The implementation of AI in healthcare – implications for professional boundaries and different forms of boundary work
  • 2022
  • Konferensbidrag (refereegranskat)abstract
    • A digital transformation of Swedish healthcare is currently taking place, and artificial intelligence (AI) is meant to solve many of the healthcare sector's challenges. We conducted 26 semi-structured interviews with healthcare leaders and 18 with healthcare managers and professionals. The result shows that the leaders, healthcare managers, and healthcare professionals describe different types of boundary work in regard to the implementation of AI.
  •  
50.
  • Sharma, Malvika, et al. (författare)
  • Artificial Intelligence Applications in Health Care Practice : Scoping Review
  • 2022
  • Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications. - 1438-8871. ; 24:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood.Objective: The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible?Methods: A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized.Results: Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare.Conclusions: Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection.Keywords: artificial intelligence; health care; implementation; scoping review; technology adoption.©Malvika Sharma, Carl Savage, Monika Nair, Ingrid Larsson, Petra Svedberg, Jens M Nygren. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.10.2022.
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