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1.	Nilsson, Kerstin, et al. (författare) 54 forskare: Inte alla klarar höjd pensions-ålder 2017 Ingår i: Svenska Dagbladet, Stockholm. - 1101-2412. Tidskriftsartikel (populärvet., debatt m.m.)abstract Ett hållbart och acceptabelt pensionssystem måste utformas utifrån personliga förutsättningar och förhållanden i arbetslivet, så att fler klarar att arbeta i högre ålder. Att enbart genom ekonomiska åtgärder höja pensionsåldern är inte långsiktigt hållbart, skriver 54 forskare.DEBATT \| PENSIONForskning visar att cirka var fjärde har en diagnos eller skada orsakad av sitt arbete. Detta gör arbetsorsakad sjukdom och skada till ett betydelsefullt folkhälsoproblem. Att då enbart genom ekonomiska åtgärder höja pensionsåldern för samtliga (yrkes)grupper utifrån deras kronologiska ålder är inte långsiktigt hållbart när individers biologiska ålder är så olika bland annat till följd av arbetslivet. Detta är en demokratifråga. Forskning om äldre i arbetslivet och hållbart arbete visar att man då främst flyttar individer från pensionssystemet till sjukförsäkringssystemet och ökar klyftorna i samhället.Debatt Det här är en argumenterande text med syfte att påverka. Åsikterna som uttrycks är skribentens egna.Vi är 54 forskare som nu gemensamt har skrivit denna debattartikel. Anledningen är att vi är oroade över att cirka var fjärde blir sjuk av sitt arbete samtidigt som man i det förslag som ligger om att senarelägga ålderspensionen i princip utgår ifrån att arbetskraftsdeltagande enbart styrs av ekonomin. Vi vill trycka på betydelsen av åtgärder i arbetslivet för att komma tillrätta med ohälsan, det vill säga inte enbart ekonomiska restriktioner som tvingar folk som inte kan, vill och orkar att stanna kvar i arbetslivet till en högre kronologisk ålder.Pensionssystemet bygger på att vi ska arbeta en viss del av våra liv för att förtjäna möjligheter till pension. Vi bör dock inte enbart utgå ifrån antalet år sedan en person föddes, då korttidsutbildade generellt träder in på arbetsmarknaden tidigare än långtidsutbildade. De har alltså varit en del av arbetskraften från en yngre ålder. Människor med kortare utbildning har oftare ett arbete som innebär påfrestningar som kan inverka negativt på hälsotillståndet och som till och med kan påskynda det biologiska åldrandet. Dessutom lever korttidsutbildade generellt sett inte lika länge som långtidsutbildade, vilket delvis även avspeglar skilda livs- och arbetsvillkor.Den svenska sjukförsäkringsreformen 2008 avsåg att få tillbaka människor i arbete. Men studien fann att den faktiskt bidrog till att fler gick i tidig ålderspension av dem som var i åldern 55–64 år. Ökningen var störst bland korttidsutbildade. Mer än 5 procent fler gick i tidig ålderspension då det blev svårare att få sjukpenning och sjukersättning. Vi kan notera att det är vanligare att manliga chefer tar ut tidig ålderspension, jämfört med kvinnliga maskinskötare inom tillverkningsindustrin. I vissa yrken är det dessutom vanligare att människor, trots pension, både orkar och faktiskt ges möjlighet att arbeta vidare om de har en specialkompetens som efterfrågas. Om vi endast kombinerar ekonomiska morötter med piskor finns en stor risk att vi ökar klyftan mellan grupper som både kan och vill fortsätta att yrkesarbeta och personer som av olika skäl inte längre kan eller orkar.Ta nytta av den forskning som vi har tagit fram. Ett hållbart och acceptabelt pensionssystem måste utformas utifrån personliga förutsättningar och förhållanden i arbetslivet. Ett hållbart arbetsliv för allt fler i vår åldrande befolkning fordrar att vi samtidigt beaktar faktorer som relaterar till biologisk/kroppslig ålder, mental/kognitiv ålder samt social ålder/livsloppsfas och våra attityder som är kopplade till ålder. Vi måste ta större hänsyn till olika förutsättningar och varierande funktionsförmåga och utifrån detta anpassa de åtgärder som gör att arbetslivet blir möjligt och hållbart för allt fler även i högre ålder.”Morötter” är viktigare för en god arbetshälsa och hög produktivitet än en piska i form av oron för en dålig ekonomi.Forskning visar att pedagogik som bygger på ”morötter” oftast är betydligt bättre än ”piskor” för att nå framgångsrika och långsiktiga mål. ”Morötter” i samhället, för organisationer, företag och individer är därför viktiga för god arbetshälsa och fortsatt produktivitet och kan bidra till ett längre arbetsliv även för grupper som tidigare inte ens klarat av att arbeta fram till pensionsåldern. Genom forskning inom området har bland annat swage-modellen utarbetats. Detta är ett verktyg som visar på komplexiteten i ett hållbart arbetsliv och tillsammans med systematiskt arbetsmiljöarbete, handlingsplaner och åtgärder syftar till ett mer hållbart arbetsliv. Morötter är enligt forskningen i detta sammanhang åtgärder för en god fysisk och mental arbetsmiljö, avpassad arbetsbelastning, stödjande teknik, att man kan anpassa arbetstakten, alternativa arbetstidsmodeller vid behov. Det är viktigt att man känner sig trygg och förväntas och tillåts vara delaktig, att man blir sedd av chefen och arbetskamraterna. Att de egna arbetsuppgifterna upplevs som meningsfulla och behövda av andra skapar självförverkligande och tillfredsställelse i arbetet. Att man känner att ens arbetsuppgifter och man själv är viktig för organisationen och företaget. Att man trots högre ålder inkluderas i olika nysatsningar och får tillgång till kompetensutveckling och inte blir åsidosatt eller åldersdiskriminerad. Utvärderingar visar att de äldre medarbetarna som fick några av dessa anpassningar och möjligheter var mer effektiva, utvilade, stimulerade när de var på arbetet samtidigt som sjukfrånvaron minskade. Vilket i sin tur bidrar till ett längre arbetsliv för grupper som tidigare inte klarat av att arbeta fram till pensionsåldern. I organisationer som bygger på en deltagar- och lärandekultur rustas de anställda för att klara omställningar, nya arbetsuppgifter och vid behov även yrkesbyten.Med en åldrande befolkning där allt fler lever allt längre behöver vi arbeta till en högre ålder i framtiden för att pensionssystemet ska hålla. Men ”morötter” är viktigare för en god arbetshälsa och hög produktivitet än en piska i form av oron för en dålig ekonomi. Det kräver också att vi ändrar våra attityder och förhållningssätt till äldre på arbetsmarknaden, vilket vi bäst gör genom att organisationer och företag får incitament till och erbjuder mer individanpassade arbetsvillkor, särskilt för personer i högre ålder. Låt oss därför använda den framtagna kunskapen i praktiken för att göra arbetslivet friskt och hållbart för alla åldrar.
2.	Nilsson, Kerstin, et al. (författare) Vi är oroade över senare ålderspension 2017 Ingår i: Dagens Samhälle. - 1652-6511. Tidskriftsartikel (populärvet., debatt m.m.)abstract Var fjärde person blir i dag sjuk till följd av sitt arbete. Att höja pensionsåldern för alla yrkesgrupper, utan konkreta åtgärder för att minska ohälsan, är därför problematiskt och mycket oroande. Det är, enligt forskarna, inte långsiktigt samhällsekonomiskt lönsamt att utan andra åtgärder höja pensionsåldern för alla. Vi – 54 forskare – är mycket oroade över konsekvenserna av att, som föreslagits, senarelägga ålderspensionen.Förslaget utgår i princip från arbetskraftsdeltagande i princip enbart styrs av ekonomin, medan forskningen visar att det bara är en av flera faktorer som styr hur länge och hur mycket människor väljer att arbeta.Det här sättet att lösa problemet med en åldrande befolkning och ett sviktande pensionssystem är inte samhällsekonomiskt lönsamt på lång sikt, utan riskerar bara att flytta runt folk mellan olika ersättningssystem. Pensionssystemet bygger på att vi ska arbeta en viss del av våra liv för att tjäna in vår pension. Vi bör dock inte enbart utgå ifrån ålder eller antalet år sedan en person föddes då korttidsutbildade generellt träder in på arbetsmarknaden tidigare än långtidsutbildade. De med kortare utbildningstid har alltså varit en del av arbetskraften från en yngre ålder. Människor med kortare utbildning har också oftare ett arbete som innebär påfrestningar som kan inverka negativt på hälsotillståndet och som till och med kan påskynda det biologiska åldrandet. Dessutom lever korttidsutbildade generellt sett inte lika länge som långtidsutbildade, vilket delvis även avspeglar skilda livs- och arbetsvillkor.Ta nytta av den forskning som vi har tagit fram. Ekonomin är självklart viktigt för att vi ska vilja arbeta, men den är som sagt enbart en av flera faktorer med betydelse vårt arbetsliv.Hälsotillståndet, både det fysiska och det mentala, har en avgörande betydelse för hur länge och hur mycket vi orkar arbeta. Ett fysiskt och mentalt belastande arbete är en stark riskfaktor för en nedsatt hälsa i slutet av arbetslivet. Arbetstid, arbetstakt och möjlighet till återhämtning spelar en allt större roll ju äldre vi blir. Andra aspekter är arbetsinnehåll, hur meningsfulla och stimulerande arbetsuppgifterna är, balansen mellan arbete och familjesituation och fritidsaktiviteter. Organisationskultur, ledarskapet, stöd i arbetet och kompetens har stor betydelse för om vi ska kunna och vilja arbeta till en högre ålder. Vi måste ta större hänsyn till olika förutsättningar och varierande funktionsförmåga och utifrån detta anpassa de åtgärder som gör att arbetslivet blir möjligt och hållbart för allt fler även i högre ålder.Ett hållbart och acceptabelt pensionssystem måste därför utformas utifrån personliga förutsättningar och förhållanden i arbetslivet. Ett hållbart arbetsliv för allt fler i vår åldrande befolkning fordrar att vi samtidigt beaktar faktorer som relaterar till biologisk/kroppslig ålder, mental/kognitiv ålder samt social ålder/livsloppsfas samt de attityder som är kopplade till ålder.
3.	van Essen, TA, et al. (författare) Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study 2019 Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 161:3, s. 435-449 Tidskriftsartikel (refereegranskat)
4.	Ander, Malin, et al. (författare) Guided Internet-Administered Self-Help to Reduce Symptoms Of Anxiety and Depression Among Adolescents and Young Adults Diagnosed With Cancer During Adolescence (U-CARE: YoungCan) : study protocol for a feasibility trial 2017 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:1 Tidskriftsartikel (refereegranskat)abstract Introduction A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial. Methods/analysis The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted. Ethics/dissemination This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences.
5.	Arvidsson, Anna, 1971-, et al. (författare) Being questioned as parents: : An interview studywith Swedish commissioning parents usingtransnational surrogacy 2019 Ingår i: Reproductive Biomedicine and Society Online. - : Elsevier BV. - 2405-6618. ; 8, s. 23-31 Tidskriftsartikel (refereegranskat)abstract This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.
6.	Arvidsson, Anna, 1971- (författare) Challenges of transnational parenthood : Exploring different perspectives of surrogacy in Sweden and India 2019 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Transnational surrogacy challenges traditional norms of parenthood, especially motherhood; additionally, it is viewed as the exploitation of poor women. The overall aim of this thesis was to shed light on the consequences of an unregulated situation on surrogacy in the Swedish and Indian contexts, and to give different perspectives on surrogacy and the surrogate. The experiences of using transnational surrogacy and the consequences of using this reproductive method in a context of a largely unregulated situation had rarely been explored at the start of the study. Between 2012 and 2015, qualitative interviews were conducted with commissioning parents in Sweden who used transnational surrogacy mainly in India, as well as with social workers in Sweden, who have handled cases regarding the legal recognition of parenthood. To capture a non-western perspective on surrogacy, the views of women and men in different social strata in Assam, India were explored through individual interviews and focus group discussions. At the start of the project, India was the most common country to turn to for surrogacy. The results reveal that both commissioning parents and social workers needed to navigate inadequate parental legislation, with the result that commissioning parents felt questioned as parents. Social workers tried to balance the protection of the surrogate’s rights with the child’s best interest. The ethical aspects made the users of surrogacy ambivalent, and, for social workers, it resulted in further reluctance to handle legal parenthood cases. However, from an Assamese point of view, no ethical considerations were expressed; instead, the surrogate would either be stigmatized for her act and seen as though she was “selling her child,” or seen as a woman doing a noble act, helping a childless couple. All the informants demonstrated a pragmatic view of legal parenthood, but the current legal situation in Sweden limits the scope to act as parents in relation to society, because of the length of time it takes to be recognized as legal parents. This comes with a risk for children. From the perspective of reproductive justice, a clearer regulation on surrogacy, and kinship rules that are more adjusted to the current family practice, are needed. Additionally, to limit the risks for all parties involved in the surrogacy process, a more transparent surrogacy process is needed.
7.	Arvidsson, Anna, et al. (författare) Gauging the interests of birth mother and child : a qualitative study of Swedish social workers’ experiences of transnational gestational surrogacy 2018 Ingår i: European Journal of Social Work. - : Taylor & Francis. - 1369-1457 .- 1468-2664. ; 21:1, s. 86-99 Tidskriftsartikel (refereegranskat)abstract Avvägningar mellan den biologiska moderns och barnets intressen: En kvalitativ studie av svenska familjerättsekreterares erfarenheter av transnationellt surrogatmoderskapDet finns få studier om hur socialarbetare handlägger ärenden som berör transnationellt surrogatmoderskap. Vår studie har för avsikt att bidra till att fylla detta tomrum. I Sverige är det inte tillåtet för sjukvården att utföra assisterad befruktning vid surrogatmoderskap. Detta har gjort att människor vänt sig utomlands för denna reproduktionsmetod, främst till Indien. Det finns inga lagar som reglerar surrogatmoderskap i Sverige, vilket har lett till svårigheter vid fastställande av rättsligt föräldraskap när föräldrarna återvänt med barnet. Denna kvalitativa intervjustudie med familjerättssekreterare har funnit att det finns rättslig osäkerhet och etiska frågeställningar som påverkar deras hantering av ärendet. Hur föräldraskap konstrueras i nuläget beror till stor del på enskilda familjerättssekreterares uppfattning om hur man bäst väger surrogatmammans intressen mot vad som är bäst för barnet. Avsaknad av riktlinjer och de etiska frågeställningarna har lett till osäker och olika hantering av ärendena, och en reglering behövs för att bättre skydda de inblandade och öka rättssäkerheten i handläggningen.
8.	Arvidsson, Anna, et al. (författare) Surrogate mother - praiseworthy or stigmatized : a qualitative study on perceptions of surrogacy in Assam, India 2017 Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 10:1 Tidskriftsartikel (refereegranskat)abstract Background: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers. Objective: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy. Methods: In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam. Results: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services. Conclusions: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.
9.	Arvidsson, Anna, et al. (författare) Views of Swedish Commissioning Parents Relating to the Exploitation Discourse in Using Transnational Surrogacy 2015 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 10:5 Tidskriftsartikel (refereegranskat)abstract Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.
10.	Barredo, José I., et al. (författare) Mapping and assessment of forest ecosystems and their services : Applications and guidance for decision making in the framework of MAES 2015 Rapport (övrigt vetenskapligt/konstnärligt)abstract The aim of this report is to illustrate by means of a series of case studies the implementation of mapping and assessment of forest ecosystem services in different contexts and geographical levels. Methodological aspects, data issues, approaches, limitations, gaps and further steps for improvement are analysed for providing good practices and decision making guidance. The EU initiative on Mappingand Assessment of Ecosystems and their Services (MAES), with the support of all Member States, contributes to improve the knowledge on ecosystem services. MAES is one of the building-block initiatives supporting the EU Biodiversity Strategy to 2020.
11.	Boschini, Anne, et al. (författare) Gender and altruism in a random sample 2018 Ingår i: Journal of Behavioral and Experimental Economics. - : Elsevier BV. - 2214-8043 .- 2214-8051. ; 77, s. 72-77 Tidskriftsartikel (refereegranskat)abstract We study gender differences in altruism in a large random sample of the Swedish population using a standard dictator game. Beside a baseline treatment we implement a priming treatment where participants are reminded of their gender, and two treatments with known male and female counterpart respectively. We find suggestive evidence that women are more altruistic than men only in the priming treatment. A post-hoc analysis using data on interviewer gender to explore gender context effects indicates that priming affects behavior only in mixedgender contexts.
12.	Boschini, Anne, et al. (författare) Gender, risk preferences and willingness to compete in a random sample of the Swedish population 2018 Rapport (övrigt vetenskapligt/konstnärligt)abstract Experimental results from student or other non-representative convenience samples often suggest that men, on average, are more risk-taking and competitive than women. Here we explore whether these gender preference gaps also exist in a simple random sample of the Swedish adult population. Our design comprises four different treatments to systematically explore how the experimental context may impact gender gaps; a baseline treatment, a treatment where participants are primed with their own gender, and a treatment where the participants know the gender of their counterpart (man or woman). We look at willingness to compete in two domains: a math task and a verbal task. We find no gender differences in risk preferences or in willingness to compete in the verbal task in this random sample. There is some support for men being more competitive than women in the math task, in particular in the pooled sample. The effect size is however considerably smaller than what is typically found. We further find no consistent impact of treatment on (the absence of) the gender gap in preferences.
13.	Boschini, Anne, et al. (författare) Gender, risk preferences and willingness to compete in a random sample of the Swedish population 2019 Ingår i: Journal of Behavioral and Experimental Economics. - : Elsevier BV. - 2214-8043 .- 2214-8051. ; 83 Tidskriftsartikel (refereegranskat)abstract Experimental results from student and other non-representative convenience samples often suggest that men, on average, are more risk taking and competitive than women. We explore whether these gender preference gaps also exist in incentivized tasks in a simple random sample of the Swedish adult population. Our design comprises four different conditions to systematically explore how the experimental context may impact gender gaps; a baseline condition, a condition where participants are primed with their own gender, and two conditions where the participants know the gender of their counterpart (man or woman). We further look at competitiveness in two domains: a math task and a verbal task. We find no gender gap in risk taking or competitiveness in the verbal task in this random sample. There is some support for men being more competitive than women in the math task in the pooled sample, but the effect size is small. We further find no consistent impact of the respective conditions on (the absence of) the gender gap in preferences.
14.	Byrskog, Ulrika, 1970-, et al. (författare) Rationale, development and feasibility of group antenatal care for immigrant women in Sweden : a study protocol for the Hooyo Project 2019 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:7 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.
15.	Cárdenas, J.-C, et al. (författare) Cooperativeness and competitiveness in children 2015 Ingår i: Journal of Behavioral and Experimental Economics. - : Elsevier: 24 months. - 2214-8043. ; 59, s. 32-41 Tidskriftsartikel (refereegranskat)abstract Cooperation and competition are both essential elements of economic life. Here we explore how cooperativeness in a prisoner's dilemma correlates with competitiveness in a sample of 9-12 years old children in Colombia and Sweden. Using two different measures and four different tasks for competitiveness, we find no consistent relationship between cooperativeness and competitiveness. However, we find evidence of a negative relationship between willingness to compete in a math task and cooperativeness in the overall sample. Competitiveness in math has previously been related to educational choices, and may therefore be the most economically relevant relationship.
16.	Cernvall, Martin, et al. (författare) Dimensions of Posttraumatic Stress Symptoms and their Relationships with Depression, Anxiety, and Quality of Life in Parents of Children Recently Diagnosed with Cancer 2016 Ingår i: Psycho-Oncology. - 1057-9249 .- 1099-1611. ; 25:SP. S3, s. 76-76 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
17.	Cernvall, Martin, 1980-, et al. (författare) Twelve-Month Follow-Up of a Randomized Controlled Trial of Internet-Based Guided Self-Help for Parents of Children on Cancer Treatment 2017 Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 19:7 Tidskriftsartikel (refereegranskat)abstract Background: A substantial proportion of parents of children on cancer treatment report psychological distress such as symptoms of post-traumatic stress (PTSS), depression, and anxiety. During their child’s treatment many parents also experience an economic burden.Objective: The aim of this study was to evaluate the long-term efficacy of Internet-based guided self-help for parents of children on cancer treatment.Methods: This study was a parallel randomized controlled trial comparing a 10-week Internet-based guided self-help program, including weekly support from a therapist via encrypted email, with a wait-list control condition. The intervention was based on cognitive behavior therapy (CBT) and focused on psychoeducation and skills to cope with difficult thoughts and feelings. Primary outcome was self-reported PTSS. Secondary outcomes were self-reported symptoms of depression, anxiety, health care consumption, and sick leave during the past month. Outcomes were assessed pre- and postintervention and at 12-month follow-up. Parents of children on cancer treatment were invited by health care personnel at pediatric oncology centers, and parents meeting the modified symptom criteria on the PCL-C were included in the study. Self-report assessments were provided on the Web.Results: A total of 58 parents of children on cancer treatment (median months since diagnosis=3) were included in the study (intervention n=31 and control n=27). A total of 18 participants completed the intervention, and 16 participants in each group participated in the 12-month follow-up. Intention-to-treat analyses revealed significant effects in favor of the intervention on the primary outcome PTSS, with large between-group effect sizes at postassessment (d=0.89; 95% CI 0.35-1.43) and at 12-month follow-up (d=0.78; 95% CI 0.25-1.32). Significant effects in favor of the intervention on the secondary outcomes depression and anxiety were also observed. However, there was no evidence for intervention efficacy on health care consumption or sick leave.Conclusions: Using the Internet to provide psychological interventions shows promise as an effective mode of delivery for parents reporting an increased level of PTSS and who consider Internet-based interventions as a viable option. Future research should corroborate these findings and also develop and evaluate interventions and policies that may help ameliorate the economic burden that parents may face during their child’s treatment for cancer.
18.	Dahlberg, M, et al. (författare) Who cares? Uncovering social Support Needs and Resources of malignant CNS Tumor Patients and their informal Caregivers 2019 Ingår i: INTERNATIONAL JOURNAL OF INTEGRATED CARE. - : Ubiquity Press, Ltd.. - 1568-4156. ; 19 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
19.	Dreber Almenberg, Anna, et al. (författare) Gender and preferences at a young age: Evidence from Armenia 2015 Ingår i: Journal of Economic Behavior and Organization. - : Elsevier. - 0167-2681. ; 118, s. 318-332 Tidskriftsartikel (refereegranskat)abstract We look at gender differences in competitiveness, risk preferences and altruism in a large sample of children and adolescents aged 7-16 in Armenia. Post-Soviet Armenia has few formal barriers to gender equality but is also characterized by a patrilineal kinship system and traditional gender roles. In contrast to research conducted in Western countries, we find that girls increase their performance more than boys in response to competition in a running task. We find no gender differences in the other three tasks we explore: skipping rope, a mathematical task, and a verbal task. We also find no difference in the willingness to compete in either the mathematical or the verbal task. In line with previous research, we find that boys are less altruistic and more risk taking than girls, and that the latter gap appears around the age of puberty.
20.	Ebbevi, David, et al. (författare) Persons with rheumatoid arthritis challenge the relevance of the health assessment questionnaire: a qualitative study of patient perception 2017 Ingår i: BMC Musculoskeletal Disorders. - : BMC (part of Springer Nature). - 1471-2474. ; 18:1 Tidskriftsartikel (refereegranskat)abstract Background: The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods: The study used secondary data analysis. Persons with RA participated in semi-structured interviews in previous research projects. Thirty-nine interviews were included based on data fit, and thematic analysis applied. Results: The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions: To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA. © 2017 The Author(s).Author keywords
21.	Ebbevi, David, et al. (författare) Value-based health care for chronic care : aligning outcomes measurement with the patient perspective 2016 Ingår i: Quality Management in Health Care. - : Lippincott, Williams & Wilkins. - 1063-8628 .- 1063-8628 .- 1550-5154. ; 25:4, s. 203-212 Tidskriftsartikel (refereegranskat)abstract Background: Value-based health care is increasingly used for developing health care services by relating patient outcomes to costs. A hierarchical value scorecard for creating outcome measurements has been suggested: The 3-Tier model. The objective of this study was to test the model against the patient's view of value in a chronic care setting. Methods: Semistructured interviews with 22 persons with rheumatoid arthritis were conducted, transcribed, and analyzed using qualitative content analysis. Themes were extracted, and the model was critically applied and revised. Results: The study validates existing dimensions in the model but suggests adding information, social health, predictability, and continuity to make it more useful and representative of patients' preferences. Conclusion: Although the model aims to focus on outcomes relevant to patients, it lacks dimensions important to individuals with rheumatoid arthritis. The data illustrate difficulties in finding patients' preferred outcomes and imply tactics for arriving at meaningful measurements.
22.	Essén, Anna, et al. (författare) Centralization vs. Decentralization on the blockchain in a health information exchange context 2019. - 1st Ingår i: Digital Transformation and Public Services : Societal Impacts in Sweden and Beyond. - Oxon : Routledge. - 9780429319297 - 9780367333430 ; , s. 58-82 Bokkapitel (refereegranskat)abstract The availability of health data for learning on a global scale seems to be what most actors engaged in the digitalization of society would like to see. Different views regarding how to achieve this state of affairs are, however, emerging. In an attempt to stimulate a discussion on alternative paths forward, this chapter juxtaposes the governance arrangement of today’s state-based health information exchanges (HIEs) with that of a potential decentralized (blockchain-based) HIE scenario. Based on interviews with individuals involved in the health care field, we outline some questions regarding the ability of current HIEs as well as completely decentralized (blockchain-based) infrastructures to enable the desired level of global data exchange. We conclude that a combination of decentralization and new forms of centralization will characterize the infrastructures of the future, be they blockchain based or not. Much effort will be required to reach agreement regarding how these infrastructures and governance models will best serve the interests of individuals, society, and humanity alike.
23.	Essén, Anna, et al. (författare) Co-production in chronic care : exploitation and empowerment 2016 Ingår i: European Journal of Marketing. - : Emerald. - 0309-0566 .- 1758-7123. ; 50:5-6, s. 724-751 Tidskriftsartikel (refereegranskat)abstract Purpose - Many scholars have urged firms to empower consumers to become co-producers, arguing that this empowerment leads to a win-win situation that benefits consumers and providers alike. However, critical voices have emphasised that co-production is a way to exploit rather than empower consumers and hence represents a win-lose idea that benefits providers only. Regrettably, these polarised positions remain disconnected and lack empirical investigation. The aim of the present study is to move the debate beyond this stalemate by integrating these perspectives using an empirical study to explore enabling and constraining implications of the attempts to empower consumers. Design/methodology/approach - This paper is based on a qualitative empirical study of an internationally unique example of a long-term co-production process in rheumatology care. Data were collected using both focused interviews and observations. Findings - The study indicates that both the optimistic and the critical perspectives of co-production are valid and the implications of empowering consumers are two-edged. Research Limitations/implications - The study highlights the need to zoom in and analyse how empowering and disempowering mechanisms relate to specific aspects of particular co-production processes rather than to co-production as a general phenomenon. Practical Implications - The empirical data illustrate the feasibility of employing patients in everyday healthcare production through simple means while raising numerous issues related to, for example, traditional healthcare roles and process design. Originality/value - The present study of a unique, long-term co-production illustrates how both perspectives of co-production are valid.
24.	Essén, Anna, et al. (författare) How Materiality Enables and Constrains Framing Practices: Affordances of a Rheumatology E-Service 2019 Ingår i: Journal of Management Inquiry. - : SAGE Publications (UK and US). - 1056-4926 .- 1552-6542. ; 28:4, s. 458-471 Tidskriftsartikel (refereegranskat)abstract Framing has been presented as a way for micro-level actors to change and diffuse innovations. However, most framing studies have given primacy to language, whereas the role of material artifacts has been largely ignored. The aim of this study is to conceptualize and illustrate how the materiality of technology enables and constrains framing practices. We use empirical data about the development and diffusion of an e-service in the Swedish rheumatology setting from 2000 to 2014. Our results show how three different material features of the technology (data content, user rights, and system integration) initially afforded two different framings of the technology: normalizing and radicalizing framings. The material features, however, lost their ability to afford radicalizing framings over time, along with changes in the collective-action frames governing the field studied.
25.	Essén, Anna, et al. (författare) How technology-afforded practices at the micro-level can generate change at the field level : Theorizing the recursive mechanism actualized in Swedish rheumatology 2000-2014 2019 Ingår i: MIS Quarterly. - : University of Minnesota, Management Information Systems Research Center. - 0276-7783. ; 43:4, s. 1155-1176 Tidskriftsartikel (refereegranskat)abstract The information systems literature has paid a great deal of attention to how macro-level structures shape local technology enactments. Less research has focused on the mutual shaping of situated technology enactments and such extra-organizational structures. This study explores how technology-afforded human action at the micro-level may transform field-level social structures and thus generate institutional change. We use a critical realist approach and institutional logics lens and draw on empirical data about the development and implementation of an e-health service in Swedish rheumatology between 2000 and 2014. We identify a recursive mechanism consisting of three recursive practices-material reconstruction, discursive reconstruction, and emergent use-that fostered a shift in the field's constellation of institutional logics, moving from a competitive to an additive relationship between logics.
26.	Essén, Anna, et al. (författare) Patient access to electronic health records : Differences across ten countries 2018 Ingår i: Health Policy and Technology. - : Elsevier. - 2211-8837 .- 2211-8845. ; 7:1, s. 44-56 Tidskriftsartikel (refereegranskat)abstract Abstract: Patient-accessible electronic health records (PAEHRs) are being implemented at international scale. Comparing policies and systems could allow countries to learn from each other to address global and nation-specific challenges. We compare national PAEHR policy (hard and soft regulation) and services in 10 countries.Methods: PAEHR policy and system documentation was gathered from Australia, Denmark, Estonia, Finland, France, the Netherlands, New Zealand, Norway, Sweden and the United States. A basic analytic model for policy analysis was used to delimit our focus to policy content, followed by an inductive thematic analysis across countries, in which we clustered initial themes into a set of categories of PAEHR service “approaches” related to three specific content areas.Results: Although all 10 countries ensured some patient rights to access medical records, policies and systems were highly variable, as were the technological processes arising from these. In particular, three policy areas showed great variability. Depending upon country of origin, a patient would encounter differences in: login procedures (security), access to own and other patients’ data during adolescence (user rights), and types of medical data made available to the patient (data sets).Conclusions: Individuals encounter very different access rights to their medical data depending on where they live. Countries may be able to develop improved policies by examining how other nations have solved common problems. Harmonizing policies is also an initial step likely to be needed before cross-national PAEHRs could be possible.
27.	Essén, Anna, et al. (författare) Patient Access to Electronic Health Records : Differences Across Ten Countries (vol 7, pg 44, 2018) 2018 Ingår i: Health Policy and Technology. - : Elsevier. - 2211-8837 .- 2211-8845. ; 7:2, s. 224-224 Tidskriftsartikel (refereegranskat)
28.	Essén, Anna, et al. (författare) Patient accessible electronic health records: Connecting policy and provider action in the Netherlands 2017 Ingår i: Health Policy and Technology. - : Elsevier. - 2211-8837. ; 6:2, s. 134-141 Tidskriftsartikel (refereegranskat)abstract Objectives: The study provides a conceptual model for analyzing the connections and gaps between national policy and care provider processes aimed at patient accessible electronic health records. We illustrate the model using empirical data from the Netherlands as an explorative case study.Methods: The conceptual model integrates governance and organizational theory of routines. Empirical material was gathered in 2015 in the Netherlands comprising documents and interviews with policymakers and healthcare providers (N=14). The integrated conceptual model guided the data analysis.Results: The findings reveal a common aim of patient participation and improving patents' self-management at both policy and care provider level, while both sides lack comprehensive strategies to translate this shared goal into regulatory frameworks, guidelines, technological solutions and daily performances. Furthermore, initiatives on the levels of policymaking and service providers are poorly connected, thereby constraining the vision of improved patient participation and innovation more generally.Conclusions: The research highlights the need for developing standards at various levels for the implementation of patient accessible electronic health records in order to improve equal access and interoperable technological solutions. The conceptual model illustrates the benefits of linking governance and organization theories to bring existing gaps between policy and healthcare provider perspectives into view, which may block more efficient implementation of e-Health policies. (C) 2017 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
29.	Essén, Anna, et al. (författare) The evolution of weak standards: the case of the Swedish rheumatology quality registry 2017 Ingår i: Sociology of Health and Illness. - : Wiley: 12 months. - 0141-9889 .- 1467-9566. ; 39, s. 513-531 Tidskriftsartikel (refereegranskat)abstract Research in sociology suggests that the effects of standards are not nearly as straightforward or as homogenising as they first appear. The present study extends these insights by demonstrating how even standards designed simply to collect data can produce extensive and unanticipated effects in medical fields as their uses evolve across actors and contexts. We draw on an embedded case study exploring the multifaceted consequences of the use of a practice-driven voluntary documentation standard: the Swedish rheumatology quality registry from 1995-2014. Data collection included document analysis; 100 interviews with specialists, patients and stakeholders in the field; fieldwork; and observations of physician-patient encounters. Our findings show that the scope and influence of the registry increased over time, and that this standard and its evolution contributed to changes in rheumatologist clinical practice, research practice, and governmental practice. These findings suggest that even initially 'weak', voluntary forms of standardisation can generate far-reaching and unpredictable consequences for the performance and delivery of care as well as for the development of a medical field. Future work about how standards can contribute both to uniformity and diversity is warranted.
30.	Essén, Anna, et al. (författare) The performativity of numbers in illness management: The case of Swedish Rheumatology 2017 Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 184, s. 134-143 Tidskriftsartikel (refereegranskat)abstract While there is a proliferation of numerical data in healthcare, little attention has been paid to the role of numbers in constituting the healthcare reality they are intended to depict. This study explores the performativity of numbers in the microlevel management of rheumatoid disease. We draw on a study of patients' and physicians' use of the numbers in the Swedish Rheumatology Quality Registry, conducted between 2009 and 2014. We show how the numbers performed by constructing the disease across time, and by framing action. The numerical performances influenced patients and physicians in different ways, challenging the former to quantify embodied disease and the latter to subsume the disease into one of many possible trajectory standards. Based on our findings, we provide a model of the dynamic performativity of numbers in the on-going management of illness. The model conceptualises how numbers generate new possibilities; by creating tension and alignment they may open up new avenues for communication between patients and physicians. © 2017 Elsevier Ltd
31.	Geijer, Erik, et al. (författare) Kommunal tillstyrkan av vindkraft : Hur fungerar det idag? 2017 Rapport (övrigt vetenskapligt/konstnärligt)abstract Den 1 augusti 2009 infördes de nya bestämmelserna för prövning av vindkraft som innebar att kravet på detaljplan och bygglov togs bort och kommunal tillstyrkan krävdes för större, tillståndspliktiga vindkraftverk. Bestämmelsen om kommunal tillstyrkan infördes genom miljöbalken 16 kap. 4 § (hädanefter MB 16:4). Förändringen av regelverket gjordes i syfte att effektivisera handläggningen och korta handläggningstiderna för att främja vindkraftsutbyggnaden i Sverige, samtidigt som prövningen skulle förbli omsorgsfull och rättsäker. Syftet med bestämmelsen om kommunal tillstyrkan var att kommunens inflytande i frågan om vilka ändamål som kommunens mark- och vattenområden är mest lämpade för inte skulle minska.Denna utvärdering har syftat till att belysa aktörernas bild av 1) hur kommunal tillstyrkan fungerar och om eller hur den kan eller bör förändras samt 2) om vägledningen kring kommunal tillstyrkan (utkommen 2015) har eller kommer att påverka planerings- och tillståndsprocessen.Utvärderingen konstaterar att aktörerna (kommuner, miljöprövningsdelegationer och projektörer) anser att vägledningen är bra men öppen för många tolkningar. Vägledningen verkar även vara välkänd men ingen av intervjupersonerna tror att den har någon större styreffekt.Avseende hur den kommunala tillstyrkan fungerar så kommer utvärderingen i stort fram till detsamma som tidigare studier. Regelförändringarna som infördes 2009 (som kommunal tillstyrkan var en del av) verkar inte ha lett till effektivisering, även om det anses fördelaktigt att kommunen inte längre behöver upprätta en detaljplan. Tidsåtgången för tillståndsprocessen verkar inte ha minskat, utan har om något ökat marginellt. Den så kallade ”dubbelprövningen”, det vill säga att etableringen prövas enligt både miljöbalken och plan- och bygglagen (2010:900), PBL, verkar i stort sett ha fortsatt även om kommunens ”prövning” inte längre är en formell prövning utan enbart utgör ett underlag för kommunens tillstyrkansbeslut.Projektörerna anser att bestämmelsen om kommunal tillstyrkan inte är rättssäker och att det ofta är svårt att förutsäga om kommunen kommer att tillstyrka en ansökan eller inte. Beslutet om kommunal tillstyrkan kan inte överklagas, behöver inte motiveras och det finns inte några kriterier för vad kommunen ska basera sitt beslut på. Tillstyrkansbeslutet kan även vara avhängigt ”politiska ställningstaganden” och politiska förhandlingar avseende frågor som inte har någon direkt anknytning till vindkraftsetableringen i sig. Ur projektörernas synvinkel innebär detta att vindkraftsetableringen inte nödvändigtvis prövas utifrån sina egna meriter. Utifrån åtminstone vissa av kommunernas synvinkel är det dock en självklarhet att en fråga av den här magnituden bör behandlas som en politisk fråga (snarare än något som kan/ bör prövas utifrån snäva kriterier). Det har även påpekats att det kan vara svårt för intressenterna (verksamhetsutövare men även kommunmedborgare) att veta vem som kommer att ta beslutet – dels på grund av till exempel kommunala val men även på grund av att det inte alltid går att vara säker på vem som kommer att närvara då beslutet tas eller på vilken nivå beslutet kommer att tas. Detta anses ha mindre betydelse vid exempelvis prövningar enligt PBL, då det finns kriterier och praxis på området, men kan ha relativt stor betydelse vid kommunal tillstyrkan då besluten bygger på ”politiska ställningstaganden”.Till skillnad från hur det var innan ändringen av bestämmelserna, där kommunen upprättade detaljplan och bygglov vilka projektören sedan hade att förhålla sig till, ger kommunal tillstyrkan ett visst utrymme för förhandlingar men innebär samtidigt ytterligare en osäkerhetsfaktor. En projektör kan idag i sin ansökan inkludera aspekter vilka de vet att kommunen egentligen inte vill ha, och hoppas att de ändå får en tillstyrkan, men samtidigt utsätta sig för en risk att det leder till avslag.Den punkt där utvärderingen främst skiljer sig från det som tidigare skrivits i frågan är att vi inte hittar någon stark koppling mellan förekomsten av olika typer av ekonomiska ersättningar (till exempel bygdepeng) och regeln om kommunal tillstyrkan.Som resultaten av denna utvärdering visar är ekonomiska ersättningar vid etablering av vindkraft allmänt förekommande. Utvärderingen visar att denna typ av ersättningar existerade redan innan bestämmelsen om kommunal tillstyrkan infördes. Det är dock otydligt i vilken utsträckning de förekommer kopplade till just tillstyrkanbeslutet. Överenskommelser om ekonomiska ersättningar i sig uppfattas inte nödvändigtvis som ett problem av projektörerna. För dem är det ett sätt att skapa goda relationer och acceptans, för kommunerna en möjlighet att få något tillbaka till bygden. Problemet för berörda aktörer är snarare när det uppstår en gråzon för vad som kan bedömas som muta och om den kommunala tillstyrkan används som ett påtryckningsmedel.
32.	Hagmarker, Linn, et al. (författare) Bone Marrow Absorbed Doses and Correlations with Hematologic Response During Lu-177-DOTATATE Treatments Are Influenced by Image-Based Dosimetry Method and Presence of Skeletal Metastases 2019 Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 60:10, s. 1406-1413 Tidskriftsartikel (refereegranskat)abstract This study aimed to compare different image-based methods for bone marrow dosimetry and study the dose-response relationship during treatment with Lu-177-DOTATATE in patients with and without skeletal metastases. Methods: This study included 46 patients with advanced neuroendocrine tumors treated with at least 2 fractions of Lu-177-DOTATATE at Sahlgrenska University Hospital. High- and low-uptake compartments were automatically outlined in planar images collected at 2, 24, 48, and 168 h after injection. The bone marrow absorbed doses were calculated from the cross doses of the high- and low-uptake compartments and the self-dose, using the time-activity concentration curve for the low-uptake compartment. This time-activity concentration curve was adjusted using a fixed constant of 1.8 for the planar dosimetry method and using the activity concentrations in vertebral bodies in SPECT images at 24 h after injection of Lu-177-DOTATATE in 4 hybrid methods: L4-SPECT used the activity concentration in the L4 vertebra, whereas V-SPECT, L-SPECT, and T-SPECT used the median activity concentration in all visible vertebrae, lumbar vertebrae, and thoracic vertebrae, respectively. Results: Using the planar method, L4-SPECT, V-SPECT, L-SPECT, and T-SPECT, the estimated median bone marrow absorbed doses were 0.19, 0.36, 0.40, 0.39, and 0.46 Gy/7.4 GBq, respectively, with respective ranges of 0.12-0.33, 0.15-1.44, 0.19-1.71, 0.21-1.60, and 0.18-2.12 Gy/7.4 GBq. For all methods, the bone marrow absorbed dose significantly correlated with decreased platelet counts. This correlation increased after treatment fraction 2: the Spearman correlation (r(s)) were -0.49 for the planar method, -0.61 for L4-SPECT, -0.63 for V-SPECT, -0.63 for L-SPECT, and -0.57 for T-SPECT. A separate analysis revealed an increased correlation for patients without skeletal metastases using the planar method (r(s) = -0.67). In contrast, hybrid methods had poor correlations for patients without metastases and stronger correlations for patients with skeletal metastases (r(s) = -0.61 to -0.74). The mean bone marrow absorbed doses were 3%-69% higher for patients with skeletal metastases than for patients without. Conclusion: The estimated bone marrow absorbed doses by image-based techniques and the correlation with platelets are influenced by the choice of measured vertebrae and the presence of skeletal metastases.
33.	Hagmarker, Linn, et al. (författare) Evaluation of planar versus hybrid SPECT image methodology for bone marrow dosimetry during 177Lu-DOTATATE treatments reveals the obstacles with bone marrow metastases and cross-irradiation for the SPECT activity concentration quantification 2018 Ingår i: 31st Annual Congress of the European Association of Nuclear Medicine (EANM’18). 13-17 October, Dusseldorf, Germany. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Introduction. The aim of this study is to compare the recently developed planar image-based method for bone marrow dosimetry with a hybrid method using SPECT/CT imaging at 24 h.p.i. of 177Lu-DOTATATE. Predictive ability of the methods is compared by investigating correlations of determined absorbed bone marrow dose, with haematological toxicity during the course of four treatment cycles. The aim is also to investigate the activity distribution in the vertebral column, and how the hybrid methodology can be optimized. Methods and Materials. 45 patients with advanced neuroendocrine tumours treated with 177Lu-DOTATATE at Sahlgrenska University Hospital in 2011-2016 (ILUMINET-study, EUDRACT nr 2011-etc) were included in this study. Absorbed bone marrow doses were calculated as the sum of the cross-doses from high-uptake organs and the remainder of the body, and the self-dose. Cross-doses were determined by time-activity curves created using planar images and a two-compartment method in the image platform PhONSAi. The self-dose was calculated using the time-activity concentration curve for the remainder of the body adjusted with the activity concentration determined in spheres placed in the vertebral bodies in SPECT-images. To improve recovery and reduce cross-irradiation of false counts in the SPECT-image, we utilized the Monte Carlo based reconstruction code SARec. Three activity concentrations were calculated to represent the activity concentration in the bone marrow; one mean (mean SPECT) and one median (median SPECT) activity concentration based on all visible vertebras and one where vertebras enclosing metastases were manually excluded (w/o Mets SPECT). Results. The planar method, the hybrid methods mean SPECT, median SPECT, and w/o Mets SPECT, yielded absorbed bone marrow doses after treatment cycle one at 0.19 (0.12-0.32), 0.35 (0.12-1.25), 0.29 (0.11-0.92) and 0.29 (0.15-0.81) Gy/7.4 GBq, respectively. A significant dose-response relationship was established after treatment cycle one between decreased platelet counts and absorbed bone marrow dose using the planar method (p=0.025, r=-0.16). With hybrid methods, a significant correlation was firstly found after treatment cycle two between absorbed dose and decreased platelet counts using median SPECT (p=0.018, r=-0.35). Conclusion. Early significant dose-response relationships were established. Despite using SARec-reconstructed SPECT-imaging for specific measurement of activity concentration in bone marrow cavities, the hybrid methods were not able to perform better than the planar method. The hybrid methods yielded higher absorbed bone marrow doses compared to the planar method as both bone metastases and cross-irradiation will influence the activity quantification. Further studies on minimizing influence of bone metastases and cross-irradiation are on-going.
34.	Korlén, Sara, et al. (författare) Ledaren - Viktig länk mellan styrmodell och medarbetare : Olika strategier för att förena ekonomiska krav med vårdpersonalens drivkraft att ge god vård 2018 Ingår i: Läkartidningen. - : Laekartidningen Foerlag. - 0023-7205. ; 115:22-23, s. 1-4 Tidskriftsartikel (populärvet., debatt m.m.)
35.	Korlén, S., et al. (författare) Managerial strategies to make incentives meaningful and motivating 2017 Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Ltd.. - 1477-7266 .- 1758-7247. ; 31:2, s. 126-141 Tidskriftsartikel (refereegranskat)abstract Purpose: Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach: The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings: The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value: Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.
36.	Lundmark Essen, Anna, et al. (författare) Cross-objective analysis of the environmental objectives : Background report for the 2015 in-depth evaluation of the environmental objectives 2015 Rapport (övrigt vetenskapligt/konstnärligt)abstract ON 20 FEBRUARY 2014, the Environmental Protection Agency was commissioned by theGovernment to present an in-depth evaluation by 1 September 2015 of the scope to achieve the environmental quality objectives and the generational goal. The evaluation must include analyses for each of the environmental objectives, in addition to a cross-objective analysis. The analyses must also cover national, international and EU-related factors, along with Sweden’s scope and proposals for adjustments to instruments and initiatives at national level or within the EU. The assignment is to be carried out in partnership with other government agencies which have responsibilities within the environmental objective system.The in-depth evaluation forms part of a systematic and regular follow-up of environmental policy and the environmental quality objectives, which is to provide the foundations for strategic measures. It provides the basis for the Government’s policies and priorities and for public debate, and support the long-term planning and priorities of government agencies, so that they can develop the environmental work. It will also provide a basis for dialogue between actors in the development and implementation of instruments and measures, as well as guidance for the environmental work of actors.This report presents a cross-objective analysis prepared by the Environmental Protection Agency as a basis for the report on the government assignment. The analysis is based on the evaluations of each of the 16 objectives1 and the key problems, instruments and measures that have been identified by the competent government agencies. The analyses are based on the priorities that were established in the background reports. The reports prepared within the focus areas of Sustainable consumption2, Sustainable cities3 and the Environmental work of industry4 have also augmented certain aspects of the analysis.In this context, “cross-objective” means causes, instruments and measures which are relevant to a number of objectives simultaneously. These can differ from those that are relevant to individual objectives. The cross-objective analysis was based on a system analysis perspective, i.e. to dissect a problem, understand links, assess how the structure is linked together and identify key factors and properties in the system5.The report describes relevant causes, perspectives and patterns which occur. It considers the environmental work through an analysis of key instruments and their effects, cost-effectiveness and different types of gaps to fulfilment of the objectives. The report also looks at a number of issues of relevance to the development of the follow-up.The Environmental Protection Agency is responsible for conducting the cross-objective analysis. The competent government agencies contributed to the task through providing background reports and reviewing factual aspects of the report. The Environmental Protection Agency is solely responsible for the content of this report. Within the Agency, the analysis was conducted by Anna Lundmark Essen, Marie Wiktorsson and Hördur Haraldsson of the Evaluation Unit.Stockholm, October 2015Björn RisingerDirector General
37.	Lundmark Essen, Anna, et al. (författare) Hantering och strömmar av farligt avfall 2015 : En utvärdering baserad på tillsynsmyndigheternas bild 2016 Rapport (övrigt vetenskapligt/konstnärligt)abstract Att begränsa avfallets mängd och hindra spridning av farliga ämnen är viktiga insatser för att miljömålen ska kunna nås. Avfall som innehåller ämnen som är särskilt farliga för människa och miljö benämns farligt avfall. En rad problem kopplade till farligt avfall har konstaterats under de senaste åren, bland annat brister i tillsyn över transporter, illegal export, osäkerhet i avfallsstatistiken samt brister i hanteringen av farligt avfall hos företag.Naturvårdsverket utvärderade hur tillsynen och hanteringen av farligt avfall fungerade 2007. 2015 fanns motivet att göra en ny utvärdering av frågan, vars resultat presenteras i denna rapport. Utvärderingen ger i första hand tillsynsmyndigheternas bild av verksamhetsutövares hantering. Resultaten visar att större verksamheter bedöms ha en bättre hantering än mindre verksamheter, även om en viss förbättring i bedömningen av de mindre kan noteras. Problem i avfallshanteringen bedöms främst uppkomma vid källan. Problematiska avfallsströmmar som lyfts fram är massor och jordar, bygg- och rivningsavfall, skrotbilar/bilskrotning, el- och elektronikavfall samt export av avfall.Tillsyn över farligt avfall bedrivs mer eller mindre frekvent utifrån olika delar av lagstiftningen. De vanligaste bristerna i hanteringen, utifrån tillsynsmyndigheternas bild, är upprättande av transportdokument och anteckningsskyldigheten. I stort är bilden av problemen och dess omfattning liknande den från 2007, även om vissa mindre förändringar har skett. Sammanfattningsvis tyder utvärderingen på att hanteringen av farligt avfall fungerar relativt väl vid stora verksamheter. Sett till hela avfallssystemet utifrån de krav som regelverket uttrycker, finns dock fortsatt brister.
38.	Wahlberg, Anna, 1988-, et al. (författare) Baseline data from a planned RCT on attitudes to female genital cutting after migration : when are interventions justified? 2017 Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 7 Tidskriftsartikel (refereegranskat)abstract Objectives: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. Setting: Sweden. Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years). Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. Trial registration number NCT02335697; Pre-results.
39.	Wahlberg, Anna, 1988- (författare) Continuity or Change? : Improved Understanding of Attitudes Towards Female Genital Cutting after Migration from Somalia to Sweden 2017 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semi-structured interviews and focus group discussions were conducted. Data were collected in 2015.The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.
40.	Wahlberg, Anna, 1988-, et al. (författare) Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants : a cross-sectional study in Sweden 2017 Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; :14:92 Tidskriftsartikel (refereegranskat)abstract Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis. Results: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44–20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46–5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25–13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. Conclusions: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values.
41.	Wahlberg, Anna, 1988-, et al. (författare) Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants - a cross-sectional study in Sweden 2017 Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 14 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
42.	Wahlberg, Anna, 1988-, et al. (författare) From sameness to difference : Swedish Somalis' post-migration perceptions of the circumcision of girls and boys. 2019 Ingår i: Culture, Health and Sexuality. - : Taylor & Francis. - 1369-1058 .- 1464-5351. ; 21:6, s. 619-635 Tidskriftsartikel (refereegranskat)abstract In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis' post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.
43.	Wahlberg, Anna, 1988-, et al. (författare) Shifting perceptions of female genital cutting in a Swedish migration context 2019 Ingår i: PLOS ONE. - : PLoS. - 1932-6203. ; 14:12 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. METHODS: In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants' approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala's B-statistic and Welch's t-test were used. RESULTS: We found a substantial agreement between an individual's own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis-and especially other Swedish Somali women-approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3-27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4-9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%). CONCLUSIONS: Swedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC.
44.	Wikman, Anna, et al. (författare) Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer : Participatory Action Research Approach 2018 Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 20:4 Tidskriftsartikel (refereegranskat)abstract Background: Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child’s cancer disease after end of treatment.Objective: One aim of this study was to develop an internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention.Methods: Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection.Results: A 10-week, internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in future studies testing and evaluating the intervention were discussed; consensus was not reached for all aspects.Conclusions: To the best of our knowledge, this study is the first use of a participatory action research approach to develop a psychological intervention for parents of children previously treated for cancer and to identify acceptable study procedures. Involvement of parents with lived experience was vital in the development of a potentially relevant and acceptable intervention for this population.
45.	Wikman, Anna, et al. (författare) Parents of children diagnosed with cancer : work situation and sick leave, a five-year post end-of-treatment or a child's death follow-up study 2016 Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 55:9-10, s. 1152-1157 Tidskriftsartikel (refereegranskat)abstract Background: Cancer in a child is associated with a significant impact on parental employment. We assessed the proportions of parents of survivors and bereaved parents working and reporting sick leave five years after end of successful treatment (ST)/child's death (T7) compared with one year after end of ST/child's death (T6) and the association between partial post-traumatic stress disorder (PTSD) and work situation and sick leave at T7.Participants and procedure: The sample included 152 parents of survivors (77 mothers, 75 fathers) and 42 bereaved parents (22 mothers, 20 fathers) of children diagnosed with cancer in Sweden.Results: The proportions of parents working or reporting sick leave did not differ among mothers and fathers of survivors (92% vs. 96% working, 20% vs. 18% on sick leave) or among bereaved mothers and fathers (91% vs. 90% working, 14% vs. 20% on sick leave) at T7. There was no change from T6 to T7 in the proportion of fathers working (fathers of survivors 91% vs. 96%, bereaved fathers 95% vs. 90%). Although more mothers of survivors (92% vs. 82%) and bereaved mothers (91% vs. 77%) worked at T7 than at T6, this increase was not significant. Fewer bereaved mothers reported sick leave at T7 than at T6 (14% vs. 59%, p<0.05). Although more fathers reported sick leave at T7 than at T6 (fathers of survivors 18% vs. 8%, bereaved fathers 20% vs. 15%), this was not significant. Partial PTSD was not associated with parents' work situation or sick leave at T7.Conclusion: Results suggest little adverse effect on work situation and sick leave among parents of survivors and bereaved parents five years after end of ST/child's death from cancer. However, the pattern of change observed differed between parents, which could potentially indicate possible delayed consequences for fathers not captured in the present paper.
46.	Wikman, Anna, et al. (författare) Prevalence and predictors of symptoms of anxiety and depression, and comorbid symptoms of distress in parents of childhood cancer survivors and bereaved parents five years after end of treatment or a child's death 2018 Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 57:7, s. 950-957 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Symptoms of anxiety and depression and their comorbidity in parents of children diagnosed with cancer, particularly later in the cancer trajectory, need further study. The aim was to investigate the prevalence and predictors of symptoms of anxiety and depression in parents of childhood cancer survivors and bereaved parents, five years after end of treatment or a child's death and to investigate comorbidity between symptoms of anxiety, depression and posttraumatic stress.MATERIAL AND METHODS:Participants were 132 parents (68 mothers, 64 fathers) of survivors and 37 bereaved parents (20 mothers, 17 fathers). Chi-square test and t-test were used to explore differences in symptoms of anxiety and depression. Comorbidity was explored using Pearson's correlations and Chi-square test. Multivariable hierarchical linear regressions were used to identify predictors of symptoms of anxiety and depression.RESULTS:In parents of survivors, 20% reported anxiety and 14% reported depression. Corresponding figures among bereaved parents were 30% and 35%. Among parents of survivors reporting clinically relevant anxiety and depression, a larger proportion were mothers than fathers. No such difference was found among bereaved parents. Symptoms of anxiety, depression and posttraumatic stress were highly correlated (all r ≥ 0.65, p < .001). Comorbid symptoms were reported by 7-11% of parents of survivors and 14-24% of bereaved parents. In multivariable analyses, more severe symptoms of depression were associated with anxiety, posttraumatic stress and distress related to previous stressful life events. Being a mother, symptoms of depression and posttraumatic stress were associated with more severe symptoms of anxiety.CONCLUSION:A subset of parents report clinically elevated symptoms of anxiety and depression, comorbid anxiety, depression and posttraumatic stress. Experiencing distress related to previous stressful life events as well as concurrent comorbidity were associated with more severe psychological distress at five years after end of treatment/a child's death. These results deserve further attention in research and clinical care.
47.	Wikman, Anna, et al. (författare) The interdependence of posttraumatic stress symptoms in parental dyads during and after their child’s treatment for cancer 2017 Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 56:12, s. 1698-1704 Tidskriftsartikel (refereegranskat)abstract Background: Cancer in a child is highly distressing and some parents are at increased risk for developing posttraumatic stress symptoms (PTSS). However, the interdependence of PTSS in parental dyads has rarely been accounted for. The aim was to explore the dyadic relationship of PTSS in parents of children diagnosed with cancer.Material and methods: The sample includes 150 parents (75 dyads) of 75 children diagnosed with cancer in Sweden during 2002–2004, with follow-up until one year after end of treatment. Data on PTSS from six assessments were included. The first three assessments were carried out during treatment and the remaining after end of treatment. Actor-partner interdependence models were estimated using a structural equation modeling approach to explore the dyadic relationship of PTSS. Actor effects refer to intra-individual dependency over time, and partner effects refer to inter-individual dependency over time, i.e., how much an individual’s symptom levels are affected by their partner’s symptom levels at the previous assessment.Results: Results show both actor and partner effects during the child’s treatment. Only an actor effect remained following end of treatment where level of PTSS at one assessment was associated with the level of PTSS at the subsequent assessment. The association between mothers’ and fathers’ PTSS did not remain after end of treatment.Conclusions: Parents appear to react as an interdependent emotional system during the child’s treatment but this effect disappears after end of treatment. Results suggest psychological interventions for parents during the child’s cancer treatment should also be sensitive to and address the influence that distress in one partner may have on the other.
48.	Woodford, Joanne, et al. (författare) Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer : Web-Based Survey 2018 Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 5:4 Tidskriftsartikel (refereegranskat)abstract Background:Clinical trials are often challenged with issues of recruitment and retention. Little is known concerning general attitudes and preferences toward trial design and willingness to participate among parents of children treated for cancer. Furthermore, willingness to participate in internet-administered psychological interventions remains unexplored. In this study, we examined attitudes and preferences of the population regarding study procedures for a hypothetical trial of an internet-administered psychological intervention. In addition, differences in the response rate between modes of study invitation and willingness to engage in internet-administered interventions were examined.Objective:The primary objective of this study was to examine attitudes and preferences toward participating in an internet-administrated psychological intervention. The secondary objective was to examine the response rates and help-seeking behavior among parents of children treated for cancer.Methods:A cross-sectional, Web-based survey was conducted with parents of children who had completed cancer treatment. This Web-based survey examined self-reported emotional distress, prior help-seeking and receipt of psychological support, past research participation, attitudes toward research, preferences concerning recruitment procedures, and attitudes toward different types of trial design.Results:Of all the parents invited, 32.0% (112/350) completed the survey, with no difference in response rate between modes of study invitation (χ21=0.6, P=.45). The majority (80/112, 71.4%) of parents responded that they had experienced past emotional distress. Responses indicated high (56/112, 50.0%) or somewhat high trust in research (51/112, 45.5%), and the majority of parents would accept, or maybe accept, internet-administered psychological support if offered (83/112, 74.1%). In addition, responses showed a preference for postal study invitation letters (86/112, 76.8%), sent by a researcher (84/112, 75.0%) with additional study information provided on the Web via text (81/112, 72.3%) and video (66/112, 58.9%). Overall, parents responded that trials utilizing a waiting list control, active alternative treatment control, or a patient-preference design were acceptable.Conclusions:Parents of children treated for cancer appear willing to participate in trials examining internet-administered psychological support. Findings of this study will inform the design of a feasibility trial examining internet-administered psychological support for the population.
49.	Woodford, Joanne, et al. (författare) Study protocol for a feasibility study of an internet-administered, guided, CBT-based, self-help intervention (ENGAGE) for parents of children previously treated for cancer 2018 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:6 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: A subgroup of parents of children previously treated for cancer report long-term psychological distress after end of treatment. However, needs for psychological support are commonly unmet and there is a lack of evidence-based treatments tailored to the specific needs of this population. An internet-administered, guided, cognitive-behavioural therapy-based, self-help intervention (ENGAGE) for parents of children previously treated for cancer may provide a solution. The aim is to examine the feasibility and acceptability of the intervention ENGAGE and the study procedures for a future controlled trial.METHODS AND ANALYSIS: The study has an uncontrolled within-group design with an embedded qualitative and quantitative process evaluation. Potential participants are parents of children previously treated for cancer, living in Sweden, recruited via their child's personal identification number (via the Swedish Childhood Cancer Registry and the Swedish Tax Agency). Parents are invited randomly with information packs sent to home addresses. Further interest in participating can be registered via information on relevant websites. The study aims to recruit 50 parents who will receive the intervention ENGAGE which is designed to be delivered over a 10-week period, and comprises one introductory chapter followed by up to 10 intervention modules addressing key concerns identified for the population. Consistent with feasibility study objectives, primary outcomes relate to recruitment, attrition, data collection, study resources, intervention delivery and acceptability. Clinical outcomes (post-traumatic stress, depression, anxiety, fear of cancer recurrence, psychological inflexibility and experiential avoidance, depressed inactivity, fatigue, quality of life and self-compassion) will be measured at baseline, post-treatment (12 weeks) and 6-month follow-up.ETHICS AND DISSEMINATION: The Regional Ethical Review Board in Uppsala, Sweden has granted approval for the study (Dnr: 2017/527). Results will be disseminated to relevant healthcare and patient communities, in peer-reviewed and popular science journals, and at scientific and clinical conferences.TRIAL REGISTRATION NUMBER: ISRCTN57233429; Pre-results.

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