| 1. |
- Addelyan Rasi, Hamideh, 1975-
(författare)
-
Empowering Women in the Middle East by Psychosocial Interventions : Can provision of learning spaces in individual and group sessions and teaching of coping strategies improve women’s quality of life?
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This study set out to construct a conceptual framework that can be used in social work with women in the Middle East and other settings where women have limited access to resources, which, as a result, limits their decision-making capacity. The framework has both an empirical and a theoretical base. The empirical base comprises data from two intervention projects among Iranian women: single mothers and newly married women. The theoretical base is drawn from relevant psychological and social work theories and is harmonized with the empirical data. Psychosocial intervention projects, based on learning spaces for coping strategies, were organized to assess if Iranian women could use a problemsolving model (i.e. focused on cognition and emotion simultaneously) to effectively and independently meet challenges in their own lives and improve their quality of life.Methods: Descriptive qualitative and quasi-experimental quantitative methods were used for data collection and analysis. Forty-four single mothers and newly married women from social welfare services were allocated to nonrandomized intervention and comparison groups. The intervention groups were invited to participate in a 7-month psychosocial intervention; the comparison groups were provided with treatment as usual by the social welfare services. The WHOQOL-BREF instrument was used to measure quality of life, comparing each intervention groups’ scores before and after the intervention and with respective comparison groups. In addition, content analysis and constant comparative analysis were performed on the qualitative data collected from the participants before, during and after the intervention.Results: The results of the quasi-experimental study show significant and large effect sizes among the women exposed to the intervention. Small and not statistically significant effect sizes were observed in the women provided with traditional social welfare services. Accordingly, teaching coping strategies can be a means to improve the quality of life of women in societies where gender discrimination is prevalent. The qualitative findings from the Iranian projects illustrate a process of change —socio-cognitive empowerment— with regard to thinking, feeling and acting among women during and after the intervention. The women developed a number of mental capacities essential to coping and life management. All women used the model effectively, and consequently, made more deliberate decisions to improve their life situations.Conclusion: The practical lessons from the Iranian projects highlight the possibilities of empowering women through fostering mindfulness and deliberate decision making as well as achieving consciousness. This study provides provisional evidence that psychosocial intervention projects, based on learning spaces for coping strategies, can help many clients to achieve their goals and improve their quality of life, and that this psychosocial intervention project can be a useful model for social work practice with women in the Middle East. The conceptual framework can help social workers to bridge the gap between theory and practice: that is, to draw from existing social work theories and, through the psychosocial intervention model, better apply this knowledge in their practical work with women in challenging social environments.
|
|
| 2. |
- Ekberg, Joakim, 1976-
(författare)
-
Online health promoting communities : Design, implementation and formative evaluation of an intervention
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, obesity among children has not yet reached the epidemic proportions reported from other parts of the world. However, among adolescents, being overweight and self-consciousness regarding body shape, diet and exercise influence social, psychological and physical health. Obese children may be in need of secondary prevention because of adverse effects related to obesity, but it is less obvious exactly what to prevent in the rest of the population. General interventions to prevent overweight and obesity are problematic because of the lack of associations for general application; there is a need for personalized community-based health promotion. Online interventions are especially suitable considering the amount of time adolescents spend online.This thesis takes a design approach to interventions and describes the design of an online health promoting community as a path to health promotion among adolescents. The first two studies use data from the first 15 years of a 1991 cohort living in Östergötland to determine the predictability of obesity from childhood body mass index and to investigate interventions and available evidence to suggest appropriate interventions. The next two studies use these findings to design and formatively evaluate a health promotion intervention.In Study I we found reasons for offering population-based interventions systematically from 5 years of age. It would be worthwhile identifying at an early age those relatively few children with substantially increased risk of maintaining obesity in adulthood and offering them interventions; but interventions must be avoided when they are not necessary. The projections in Study II indicate that more specified interventions would benefit adolescents without increasing the costs. In Study III, we found than an online health promoting community can be designed simply at relatively low cost and can be negotiated to satisfy both the needs of the user community and public health goals and service capabilities. In Study IV, a checklist for pre-launch evaluation of online health promoting communities was developed and the most important result was the delicate balance between community autonomy and quality control. Future studies addressing health outcome constructs for use in online health promoting community evaluations are warranted.
|
|
| 3. |
- Jacobsson, Jenny
(författare)
-
Towards systematic prevention of athletics injuries : Use of clinical epidemiology for evidence-based injury prevention
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to outline the design protocol for a prospective clinical epidemiological study of injuries among athletics athletes; study the 1-year prevalence, the point prevalence and incidence of injuries in total cohorts of Swedish elite adult and talented youth athletics athletes; pinpoint the risk indicators and factors for different injury types/patterns in athletics.In paper I, an argument-based method to investigate complex design problems was used to structure the collection and analysis of data. A requirement analysis showed that a central requirement of an injury surveillance protocol for elite athletics should allow for detailed epidemiological analyses of overuse injuries, requiring self-reported data from athletes. The resulting study protocol was centred on a web-based weekly athlete e-diary enabling continuous collection of individual-level data on exposure and injuries.In paper II, the prevalence of injuries was examined and 278 athletes (87%) of the enrolled study population submitted their assessments via the web survey. The overall 1-year retrospective injury prevalence was 42.8% (95% CI 36.9–49.0%). The point prevalence of ongoing injury was 35.4% (95% CI 29.7–41.4%). The 1-year injury prevalence showed a tendency to vary with regard to gender and age (p = 0.11). The diagnostic group that displayed the highest 1-year prevalence (20.9%, 95% CI 16.2–22.2%) and point prevalence (23.2%, 95% CI 18.4–28.7%) of injury was inflammation and pain with gradual onset.In paper III, during the 52-week period, 292 athletes (91% of the study population) submitted weekly reports reporting a cumulative injury incidence of 3.57 injuries per 1000 hours of exposure to athletics. Most injuries (73%) were reported from training. There was a statistically significant difference with regard to gender and age in the proportion of athletes who avoided injury (P=0.043). Differences between event groups could not be statistically demonstrated (P=0.937). Ninety-six percent of the reported injuries were nontraumatic (associated with overuse). About every second injury (51%) was severe, causing a period of absence from normal training exceeding 3 weeks. Seventy-seven percent of the injuries occurred in lower extremities.In paper IV, 199 (68%) athletes reported an injury during the study year. The median time to first injury was 101 days (95% confidence interval (CI) 75–127). Univariate log-rank tests revealed risk differences with regard to athlete category (p = 0.046), serious injury (>3 weeks time loss) during the previous season (p = 0.039) and training load rank index (TLRI) (p = 0.019). Athletes in the third and fourth TLRI quartile had almost a twofold increased risk of injury compared to the first quartile. Youth male athletes with a previous serious injury had more than a fourfold increased risk of injury compared with youth females with no previous injury.
|
|
| 4. |
- Kullberg, Agneta, 1955-
(författare)
-
My Home is my Castle : Residential Well being and Perceived Safety in Different Types of Housing Areas in Sweden
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being.Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals.Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme.Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups.Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing.
|
|
| 5. |
- Rahimi, Bahol, 1975-
(författare)
-
Implementation of Health Information Systems
- 2008
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare organizations now consider increased efficiency, reduced costs, improved patient care and quality of services, and safety when they are planning to implement new information and communication technology (ICT) based applications. However, in spite of enormous investment in health information systems (HIS), no convincing evidence of the overall benefits of HISs yet exists. The publishing of studies that capture the effects of the implementation and use of ICT-based applications in healthcare may contribute to the emergence of an evidence-based health informatics which can be used as a platform for decisions made by policy makers, executives, and clinicians. Health informatics needs further studies identifying the factors affecting successful HIS implementation and capturing the effects of HIS implementation. The purpose of the work presented in this thesis is to increase the available knowledge about the impact of the implementation and use of HISs in healthcare organizations. All the studies included in this thesis used qualitative research methods. A case study design and literature review were performed to collect data.This thesis’s results highlight an increasing need to share knowledge, find methods to evaluate the impact of investments, and formulate indicators for success. It makes suggestions for developing or extending evaluation methods that can be applied to this area with a multi-actor perspective in order to understand the effects, consequences, and prerequisites that have to be achieved for the successful implementation and use of IT in healthcare. The results also propose that HIS, particularly integrated computer-based patient records (ICPR), be introduced to fulfill a high number of organizational, individualbased, and socio-technical goals at different levels. It is therefore necessary to link the goals that HIS systems are to fulfill in relation to short-term, middle-term, and long-term strategic goals. Another suggestion is that implementers and vendors should direct more attention to what has been published in the area to avoid future failures.This thesis’s findings outline an updated structure for implementation planning. When implementing HISs in hospital and primary-care environments, this thesis suggests that such strategic actions as management involvement and resource allocation, such tactical action as integrating HIS with healthcare workflow, and such operational actions as user involvement, establishing compatibility between software and hardware, and education and training should be taken into consideration.
|
|
| 6. |
- Wilhelmsson, Margaretha, 1948-
(författare)
-
Developing Interprofessional Competence : Theoretical and Empirical Contributions
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Different professions meet and work together in teams every day in health and social care. In order to idenUiy and deliver the best quality of care for the patient, the teamworkers need to be both professionally and interprofessionally competent. How can higher education prepare teamworkers to be both professionillly and interprofcssionally competent? This thesis seeks to contribute theoretically and empirically to this issuc. A starting point for interprofessional education (WE) worldwide was when WHO presented a document entitled "Leaming Together to Work Together for Bdter Health". The basic idea in this strateg)' was that it is favourable for undergraduilte students and the development of their own professionill identity to experience other professions in health and sodal sectors as earlyas during their undcrgraduate studies. Inherent in this scheme is that the various professions will work together in practice. Thc overall winner in this new thinking about education and professionai prLlctice would be the patient. One of the Hrst systematic attempts to organize IPE academically was initiated in 1986 at the Faculty of Health Sciences (FHS) at Linköping University in Sweden. The "Linköping Model" has now yielded 25 yeilrs of practical experience and development of IPE curricula.Aims: The overall aims of this thesis we.re to define, describe and measure effects and outcomes of interprofessional education/learning.Methods: In the research papers theoretical, aualitative and quantitative methods have been used.Results: The newly registered medical doctors educated at the FHS at Linköping University and exposed to WE and PBL reported more confidence (p < 0.0001) that their lIndergraduate studies had given them interprofessional skilIs and abilities to collaborate with other professions than medical students from all other medical faculties in Sweden. Nurses who hild been exposed to interprofessional curricula during their undergraduate education ilt FHS reported to greater extent (p = 0.003) that they were prepared to work as a nurse. Furthermore, they also reported to a greater extent (p < 0.0001) that their undergraduate education hild prepared them to work with other healt care professions. Other findings in this thesis wcre that female tudents in generill and nursing students had a more positive view of interprofessional learning and were more open-minded about collaboration with other professions. Only to a minor extent did exposure to a more extensive interprofessional curriculum promote a positive attitude towards teamwork.Conclusions: A major challenge to modern health care is the need for more interprofessional teamwork to improve the safety and quality of patient-centred care. This thesis indicates some directions for more successful interprofessional education.
|
|
| 7. |
- Backe, Stefan, 1963-
(författare)
-
Safety promotion and injury surveillance with special focus on young people´s club sports : Challenges and possibilities
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Physical activity in youth has many benefits, but parallel to these benefits, sport related injuries pose considerable risks. It is important to public health to address sport related injuries, particularly those affecting young people, who comprise the majority of participants in organised sport in Sweden. The first study in this research showed that inspections of local sport environments, where injuries often occur, did not occur uniformly. Two additional studies pointed out the need for better surveillance of injuries, and described the use of ambulance attendance reports as a possible improvement to current surveillance systems, with a possibility to improve safety for youth and other sport participants. Two other studies identify risk factors that were specific to football and climbing sports, which can be used to guide targeted safety interventions for the young participants of these sports. The studies, taken as a whole, provide new information about the factors associated with sport related injuries, particularly for young people, and point out the need for better sport injury surveillance, improved inspection strategies for fields maintained by organised sport clubs in local communities, and the need to address risk factors specific to different sport activities.
|
|
| 8. |
- Rahimi, Bahlol, 1975-
(författare)
-
Supporting Collaborative Work through ICT : How End-users Think of and Adopt Integrated HealthInformation Systems
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Health Information Systems (HISs) are implemented to support individuals,organizations, and society, making work processes integrated andcontributing to increase service quality and patient safety. However, theoutcomes of many HIS implementations in both primary care and hospitalsettings have either not met yet all the expectations decision-makersidentified or have failed in their implementation. There is, therefore, agrowing interest in increasing knowledge about prerequisites to be fulfilledin order to make the implementation and adoption of HIS more effective andto improve collaboration between healthcare providers.The general purpose of the work presented in this thesis is to explore issuesrelated to the implementation, use, and adoption of HISs and its contributionfor improving inter- and intra-organizational collaboration in a healthcarecontext. The studies included have, however, different research objectivesand consequently used different research methods such as case study,literature review, meta-analysis, and surveys. The selection of the researchmethodology has thus depended on the aim of the studies and their expectedresults.In the first study performed we showed that there is no standard frameworkto evaluate effects and outputs of implementation and use of ICT-basedapplications in the healthcare setting, which makes the comparison ofinternational results not possible yet.Critical issues, such as techniques employed to teach the staff when usingintegrated system, involvement of the users in the implementation process,and the efficiency of the human computer interface were particularlyreported in the second study included in this thesis. The results of this studyalso indicated that the development of evidence-based implementation processes should be considered in order to diminish unexpected outputs thataffect users, patients and stakeholders.We learned in the third study, that merely implementing of a HIS will notautomatically increase organizational efficiency. Strategic, tactical, andoperational actions have to be taken into consideration, includingmanagement involvement, integration in healthcare workflow, establishingcompatibility between software and hardware, user involvement, andeducation and training.When using an Integrated Electronic Prescribing System (IEPS), pharmaciesstaff declared expedited the processing of prescriptions, increased patientsafety, and reduced the risk for prescription errors, as well as the handingover of erroneous medications to patients. However, they stated also that thesystem does not avoid all mistakes or errors and medication errors stilloccur. We documented, however, in general, positive opinions about theIEPS system in the fifth article. The results in this article indicated thatsafety of the system compared to a paper-based one has increased. Theresults showed also an impact on customer relations with the pharmacy; andprevention of errors. However, besides finding an adoption of the IEPS, weidentified a series of undesired and non planned outputs that affect theefficiency and efficacy of use of the system.Finally, we captured in the sixth study indications for non-optimality in thecomputer provider entry system. This is because; the system was not adaptedto the three-quarters of physicians and one-half of nurses’ specificprofessional practice. Respondents pointed out also human-computerinteraction constrains when using the system. They indicated also the factthat the system could lead to adverse drug events in some circumstances.The work presented in this thesis contributes to increase knowledge in thearea of health informatics on how ICT supports inter- and intraorganizationalcollaborative work in a healthcare context and to identifyfactors and prerequisites needed to be taken into consideration whenimplementing new generations of HIS.
|
|
| 9. |
- Spreco, Armin
(författare)
-
Epidemiological and statistical basis for detection and prediction of influenza epidemics
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A large number of emerging infectious diseases (including influenza epidemics) has been identified during the last century. The emergence and re-emergence of infectious diseases have a negative impact on global health. Influenza epidemics alone cause between 3 and 5 million cases of severe illness annually, and between 250,000 and 500,000 deaths. In addition to the human suffering, influenza epidemics also impose heavy demands on the health care system. For example, hospitals and intensive care units have limited excess capacity during infectious diseases epidemics. Therefore, it is important that increased influenza activity is noticed early at local levels to allow time to adjust primary care and hospital resources that are already under pressure. Algorithms for the detection and prediction of influenza epidemics are essential components to achieve this.Although a large number of studies have reported algorithms for detection or prediction of influenza epidemics, outputs that fulfil standard criteria for operational readiness are seldom produced. Furthermore, in the light of the rapidly growing availability of “Big Data” from both diagnostic and prediagnostic (syndromic) data sources in health care and public health settings, a new generation of epidemiologic and statistical methods, using several data sources, is desired for reliable analyses and modeling.The rationale for this thesis was to inform the planning of local response measures and adjustments to health care capacity during influenza epidemics. The overall aim was to develop a method for detection and prediction of influenza epidemics. Before developing the method, three preparatory studies were performed. In the first of these studies, the associations (in terms of correlation) between diagnostic and pre-diagnostic data sources were examined, with the aim of investigating the potential of these sources for use in influenza surveillance systems. In the second study, a literature study of detection and prediction algorithms used in the field of influenza surveillance was performed. In the third study, the algorithms found in the previous study were compared in a prospective evaluation study. In the fourth study, a method for nowcasting of influenza activity was developed using electronically available data for real-time surveillance in local settings followed by retrospective application on the same data. This method includes three functions: detection of the start of the epidemic at the local level and predictions of the peak timing and the peak intensity. In the fifth and final study, the nowcasting method was evaluated by prospective application on authentic data from Östergötland County, Sweden.In the first study, correlations with large effect sizes between diagnostic and pre-diagnostic data were found, indicating that pre-diagnostic data sources have potential for use in influenza surveillance systems. However, it was concluded that further longitudinal research incorporating prospective evaluations is required before these sources can be used for this purpose. In the second study, a meta-narrative review approach was used in which two narratives for reporting prospective evaluation of influenza detection and prediction algorithms were identified: the biodefence informatics narrative and the health policy research narrative. As a result of the promising performances of one detection algorithm and one prediction algorithm in the third study, it was concluded that both further evaluation research and research on methods for nowcasting of influenza activity were warranted. In the fourth study, the performance of the nowcasting method was promising when applied on retrospective data but it was concluded that thorough prospective evaluations are necessary before recommending the method for broader use. In the fifth study, the performance of the nowcasting method was promising when prospectively applied on authentic data, implying that the method has potential for routine use. In future studies, the validity of the nowcasting method must be investigated by application and further evaluation in multiple local settings, including large urbanizations.
|
|
| 10. |
- Borälv, Erik, 1968-
(författare)
-
Design in Telemedicine : Development and Implementation of Usable Computer Systems
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Designing computer systems that effectively support the user is the major goal within human-computer interaction. To achieve this, we must understand and master several tasks. This process must initially deal with the question of knowing what to develop and later, with the question of knowing how to design and develop the system. This view might seem off-target at first, since it does not explicitly mention the goals or functions of the system. However, more often than not, there is no objective goal to aim for that can be formally specified and used as a target criterion that will signal when we have designed an appropriate system. Instead, there is a large set of vague goals – some of which may last through the entire project and some that will not. It is therefore somewhat confounding that most of the current methods of systems development require that these goals are explicitly laid out, in order to steer development. For researchers in Human-Computer Interaction, the existence of many varying – and possibly conflicting goals – presents is a great challenge. The constructive main focus on producing usable systems is a matter of understanding this complex situation and knowing how to proceed from there. There are many existing approaches that can be used to carry out this complex development process. This thesis presents one approach, based on the notion that the elements that constitute a successful system are also a part of the solution. This thesis presents this approach as it is applied to the development of systems for computer-supported work in health care. The projected solution suggests that we need to focus more intently on active user involvement in iterative development that is significantly long-term. The traditional, rather narrow circle of focus that encompasses design, development and evaluation is not sufficient.
|
|
| 11. |
- Dahlström, Örjan, 1973-
(författare)
-
Focus on Chronic Disease through Different Lenses of Expertise : Towards Implementation of Patient-Focused Decision Support Preventing Disability: The Example of Early Rheumatoid Arthritis
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Treatment strategies emphasize early multi-professional interventions to reduce disease activity and to prevent disability, but there is a lack of knowledge on how optimal treatment can be provided to each individual patient.Aim: To elucidate how clinical manifestations of early RA are associated to disease and disability outcomes, to strive for greater potential to establish prognosis in early RA, and to facilitate implementation of decision support through analyses of the decision-making environment in chronic care.Methods: Multivariate statistics and mathematical modelling, as well as field observations and focus group interviews.Results: Decision support: A prognostic tree that predicted patients with a poor prognosis (moderate or high levels of DAS-28) at one year after diagnosis had a performance of 25% sensitivity, 90% specificity and a positive predictive value of 76%. Implementation of a decision support application at a rheumatology unit should include taking into account incentive structures, workflow and awareness, as well as informal communication structures. Prognosis: A considerable part of the variance in disease activity at one year after diagnosis could be explained by disease progression during the first three months after diagnosis. Using different types of knowledge – different expertise – prior to standardized data mining methods was found to be a promising when mining (clinical) data for new patterns that elicit new knowledge. Disease and disability: Women report more fatigue than men in early RA, although the difference is not consistently significant. Fatigue in early RA is closely and rather consistently related to disease activity, pain and activity limitation, as well as to mental health and sleep disturbance.Conclusion: A decision tree was designed to identify patients at risk of poor prognosis at one year after the diagnosis of RA. When constructing prediction rules for good or poor prognosis, including more measures of disease and disability progressions showed promise. Using different types of knowledge – different lenses of expertise – prior to standardized data mining methods was also a promising method when mining (clinical) data for new patterns that elicit new knowledge.
|
|
| 12. |
- Lundqvist, Carolina, 1977-, et al.
(författare)
-
Aligning categories of mental health conditions with intervention types in high-performance sports: a narrative cornerstone review and classification framework
- 2024
-
Ingår i: Journal of Science and Medicine in Sport. - 1440-2440 .- 1878-1861.
-
Tidskriftsartikel (refereegranskat)abstract
- Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.
|
|
| 13. |
- Nilsen, Per, 1960-
(författare)
-
Opening the Black Box of Community-Based Injury Prevention Programmes : Towards Improved Understanding of Factors that Influence Programme Effectiveness
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes.Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes.The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs.Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based.The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level.
|
|
| 14. |
- Teder, Marie, 1947-
(författare)
-
Evaluation of a family-based behavioural intervention programme for children with obesity
- 2013
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Impaired eating habits and reduced physical activity have become associated with obesity in children in the last three decades. Parents have a responsibility to be good models for their children regarding lifestyle patterns and habits. The aim of this thesis was to evaluate a family-based behavioural intervention programme (FBIP) for children with obesity designed for use in paediatric outpatient care. The specific aims were to investigate the clinical outcomes and programme adherence and to examine the children’s lifestyle habits according to their own and their parents’ reports, the agreement between these reports, and the correlations to change in z-BMI (standardized body mass index) from baseline to 12 months after the FBIP.Subjects and methods: This thesis is based on a prospective single-group before/after design. Twenty-six children, 14 boys and 12 girls aged 8.3–12.0 years, and their parents attended 25 group sessions, in 3 child and 3 parental groups, during a 2-year FBIP. The treatment manual, Group treatment for children with Overweight and Obesity and their Parents and the semistructured interview called MORSE, a Swedish term for Food and Activity, Social and Emotional adaptation, emphasizes cognitive and behavioural guidelines and the focus is to change eating and physical activity habits and to maintain the new changes.Results: The results showed that the children decreased their z-BMI from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) 1 year after the completion of the programme. There was a significant decrease in z-BMI in boys from a mean of 3.5 (0.6 SD) at baseline to 3.0 (0.7 SD) (p = 0.001) at follow-up 12 months after completion of the programme; the z-BMI in the girls decreased from a mean of 3.0 (0.6 SD) at baseline to 2.7 (0.8 SD) (p = 0.155) at follow-up. The children’s waist/height ratio (the waist circumference in centimetres) divided by the height (in centimetres) showed no significant decrease over the same period. The biomedical markers of blood glucose metabolism and lipid status remained within the normal range at the 1-year follow-up after program completion compared with baseline. The rate of family adherence to the programme was high. The reports from the children and the parents regarding the children’s lifestyle habits showed a significant increase regarding the level of physical activity after the FBIP (24 months) compared with baseline. Agreement between the children and their parents improved after the FBIP (24 months) compared with baseline, regarding whether the children felt hungry most of the time and the children’s levels of physical and sedentary activity. Changes in the child or parental analyses of lifestyle were not significantly associated with reduced weight 1 year after the end of the FBIP.Conclusions: A 2-year FBIP against childhood obesity implemented in a paediatric outpatient setting can be seen as a potential model for children and their parents. It is important to offer interventions to children with obesity although this FBIP needs to be confirmed with larger populations in a randomized controlled trial.
|
|
