| 1. |
- Andersson, Gerhard, et al.
(författare)
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Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression : A randomized factorial design trial
- 2023
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 162
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Tidskriftsartikel (refereegranskat)abstract
- Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across con-ditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of su-pervision is not yet clear as advice can be transferred across clients.
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| 2. |
- Rajan, Gita, et al.
(författare)
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Health care consumption among adolescent girls prior to diagnoses of sexual abuse, a case-control study in the Stockholm Region
- 2020
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Ingår i: European Child and Adolescent Psychiatry. - : SPRINGER. - 1018-8827 .- 1435-165X. ; 29, s. 1363-1369
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Tidskriftsartikel (refereegranskat)abstract
- Victims of sexual abuse have more co-morbidities than other persons in the same age and the most affected group are adolescent girls. Little is known about how this is reflected in health care consumption patterns prior to the registered diagnosis. The aim of this investigation was to study health care consumption patterns among girls, 12-17 years old, 1 and 2 years prior to their diagnoses of sexual abuse. Through the Stockholm Region administrative database (VAL), data of co-morbidities, number of health care visits, and prescribed drugs were collected for cases (girls age 12-17 with diagnoses of sexual abuse, n = 519) and controls matched for age and socio-economic status (n = 4920) between 2011-2018. Health care consumption and co-morbidities were significantly higher for the cases compared to controls, with a rise 1 year before the diagnoses: the total number of health care visits (including no shows) 1 year prior to the first recording of the diagnosis was 20.4 (18.1-22.7) for the cases and 6.2 (5.8-6.6) for the controls. The most frequent visits 1 year prior to the diagnosis were to outdoor clinics, with a mean value of 19.1 (16.9-21.3) visits for the cases and 5.7 (5.3-6.1) for the controls, followed by psychiatric clinics with a mean value of 12.7 (10.6-14.8) visits for the cases and 2.0 (1.7-2.3) visits for the controls. The least visited health care clinic 1 year prior to the diagnosis was the emergency ward with a mean value of 1.3 (1.1-1.5) visits for the cases and 0.5 (0.4-0.5) visits for the controls. The most common psychiatric co-morbidities registered among the cases during the first year before the diagnosis of sexual abuse were stress, suicide attempt, and psychosis. Neuroleptics, sleeping pills, antidepressants, and tranquilizers were more frequently dispensed in cases than in controls. Similar patterns were found 2 years prior to the diagnosis. We encourage clinicians to actively ask for exposure of sexual abuse in girls with high health care consumption, making early detection and treatment of sexual abuse available as soon as possible.
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| 3. |
- Schobel, Markus, et al.
(författare)
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Human and organizational factors in European nuclear safety : A fifty-year perspective on insights, implementations, and ways forward
- 2022
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Ingår i: Energy Research & Social Science. - : Elsevier BV. - 2214-6296 .- 2214-6326. ; 85, s. 102378-
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Forskningsöversikt (refereegranskat)abstract
- In this essay we investigate the "lessons learned" within the domain of human and organizational factors (HOF) from operating European nuclear power plants (NPPs) in a fifty-year perspective. Specifically, we consider learning processes at an industry level that aim at promoting human contributions to nuclear safety. This is done by bringing together two main perspectives: (1) a historical perspective on HOF-related institutional and research initiatives is presented by outlining the history of nuclear safety according to three major nuclear accidents, (2) an applied perspective is provided on how HOF are managed in the field. This latter perspective rests on the results of the EU Project LearnSafe, conducted in the European nuclear industry between 2001 and 2004, and its re-evaluation 15 years later by means of an interview study carried out with 21 European managers from the nuclear industry. Our results reveal that the European nuclear industry has to some extent encoded the HOF lessons learned into routines, tools and systems. The three accidents have promoted a broadening of knowledge, ranging from simple ergonomics to crucial issues of interactions between major stakeholders in the nuclear domain. As a conclusion to our study, we suggest that academia and industry should search for improved collaboration, especially in terms of including HOF into safety activities and linking HOF issues to technical design factors and associated hazard potentials. Moreover, we conclude that avoiding major nuclear accidents requires a continuous re-invention of HOF, which should aim to involve and harmonize divergent interests of several stakeholders, demanding further research and efforts to translate insights into practice.
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| 4. |
- Wahlstrom, Bjorn, et al.
(författare)
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Safety management : A multi-level control problem
- 2014
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Ingår i: Safety Science. - : Elsevier BV. - 0925-7535 .- 1879-1042. ; 69, s. 3-17
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Tidskriftsartikel (refereegranskat)abstract
- Activities in safety management build on a control metaphor by which control loops are built into the man, technology, organisational and information (MTOI) systems to ensure a continued safety of the operated systems. In this paper we take a closer look on concepts of control theory to investigate their relationships with safety management. We argue that successful control relies on four necessary conditions, i.e. a system model, observability, controllability and a preference function. The control metaphor suggests a division of the state space of the modelled system into regions of safe and unsafe states. Models created for selected subsystems of the MTOI-system provide a focus for control design and safety assessments. Limitations in predicting system response place impediments to risk assessments, which suggest that new complementary approaches would be needed. We propose that polycentric control may provide a concept to consider in a search for a path forward. We investigate approaches for modelling management systems and safety management. In spite of promises in the use of a control metaphor for safety management there are still dilemmas that have to be solved case by case. As a conclusion we argue that the control metaphor provides useful insights in suggesting requirements on and designs of safety management systems. The paper draws on experience from the Vattenfall Safety Management Institute (SMI), which started its operation in 2006.
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