| 1321. |
- Ryom, Knud, et al.
(författare)
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Self-reported measurements of physical literacy in adults : a scoping review
- 2022
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Ingår i: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9
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Forskningsöversikt (refereegranskat)abstract
- Physical literacy (PL) is a comprehensive concept covering motivation, confidence, physical competence, knowledge and understanding of individuals' physical activity throughout life. PL has three overlapping domains, such as: an affective, a physical and a cognitive domain. So far, PL has not been measured in the adults and no complete measurement has been developed to date. OBJECTIVES: The aim of this scoping review was to review existing self-reported instruments measuring different elements of domains of PL. METHOD: We reviewed Education Research Complete, Cochrane, Medline, ScienceDirect, Scopus and SPORTDiscus. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were coded using a thematic framework, which was based on the three domains of PL. The eligibility criteria were as follows: (1) age groups between 18 and 60 years; (2) meta-analyses, reviews or quantitative studies focusing on the measurement of at least one of the three domains of PL and (3) instrument that was self-reported. We finalised search on 1 August 2021 RESULTS: In total, 67 articles were identified as studies describing instruments reflecting the three domains of PL. Following full-text reading, 21 articles that met our inclusion criteria were included. Several instruments of relevance to PL are available for assessing motivation, confidence and the physical domain. However, few instruments exist that measure elements of the cognitive domain. CONCLUSION: This review showed that a range of existing and validated instruments exists, covering two out of the three domains of PL, namely affective and physical domains. However, for the knowledge domain no valid measurement tools could be found. This scoping review has identified gaps in the research (namely the cognitive domain) and also a gap in the research as no measures that consider the inter-relatedness of the three domains (holistic nature of the concept). © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 1322. |
- Ryösä, A., et al.
(författare)
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Acute Cuff Tear Repair Trial (ACCURATE) : Protocol for a multicentre, randomised, placebo-controlled trial on the efficacy of arthroscopic rotator cuff repair
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Rotator cuff tear is a very common and disabling condition that can be related to acute trauma. Rotator cuff tear surgery is a well-established form of treatment in acute rotator cuff tears. Despite its widespread use and almost a gold standard position, the efficacy of an arthroscopic rotator cuff repair is still unknown. The objective of this trial is to investigate the difference in outcome between arthroscopic rotator cuff repair and inspection of the shoulder joint defined as placebo surgery in patients 45–70 years of age with an acute rotator tear related to trauma.Methods and analysis Acute Cuff Tear Repair Trial (ACCURATE) is a randomised, placebo-controlled, multicentre efficacy trial with sample size of 180 patients. Concealed allocation is done in 1:1 ratio. The randomisation is stratified according to participating hospital, gender and baseline Western Ontario Rotator Cuff Index (WORC). Both groups receive the same standardised postoperative treatment and physiotherapy. The primary outcome measure is the change in WORC score from baseline to 2-year follow-up. Secondary outcome measures include Constant-Murley Score, the Numerical Rating Scale for pain, subjective patient satisfaction and the health-related quality of life instrument 15 dimensions (15D). Patients and outcome assessors are blinded from the allocated intervention. The primary analysis of results will be conducted according to intention-to-treat analysis.Ethics and dissemination The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and Regional Ethics Committee in Linköping Sweden and Regional Committees for Medical and Health Research Ethics South East in Norway. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals.
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| 1323. |
- Rådestad, Ingela, et al.
(författare)
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Country of birth, educational level and other predictors of seeking care due to decreased fetal movements: an observational study in Sweden using data from a cluster-randomised controlled trial
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness. Design Observational study with data from a cluster-randomised controlled trial. Setting 67 maternity clinics and 6 obstetrical clinics in Sweden. Participants All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks' gestation of 39 865 women. Methods Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby's fetal movement pattern. Outcome measures Predictors for contacting healthcare due to decreased fetal movements. Results Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall. Conclusion Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements.
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| 1324. |
- Saarela, Jan, et al.
(författare)
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Alcohol-related mortality by ethnic origin of natives : a prospective cohort study based on multigenerational population register data from Finland and Sweden
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim was to assess alcohol-related mortality of persons with mixed and uniform ethnic origins in two national contexts.Setting Data were from the multigenerational population registers of the total population of Finland and Sweden observed from 1971 to 2017. Study persons were men and women of ethnic Finnish and Swedish background, born in their country of residence.Participants Persons were born between 1953 and 1999. In Finland, ethnic origin was assessed through own, mother’s and father’s Finnish or Swedish ethnolinguistic affiliation. Data on Sweden included persons born in Sweden, with mother and father born in Sweden or Finland. A total of 2 997 867 and 4 148 794 persons were included in the Finnish and Swedish data, respectively. The total number of alcohol-related deaths by main cause was 13 204 and 3336. Cox regressions were used to examine associations.Outcome measures For the period 1971–2017, we studied alcohol as the main cause of death. For the period 1996–2017, we observed if alcohol was the main or contributing cause of death. Parallel analyses were performed for all-cause mortality.Results For men in Finland, the hazard rate of alcohol-related mortality of Swedish speakers with uniform Swedish background was 0.44 (95% CI: 0.38 to 0.52) that of Finnish speakers with uniform Finnish background. The corresponding hazard rate for women was 0.40 (95% CI: 0.28 to 0.55). In Sweden, the hazard rate of men with both parents born in Sweden was 0.40 (95% CI: 0.32 to 0.49) that of men with both parents born in Finland. The corresponding hazard rate for women was 0.50 (95% CI: 0.31 to 0.79). In both countries, persons with mixed background had an alcohol-related mortality rate between that of persons with uniform Finnish and Swedish background.Conclusion The consistent pattern across countries necessitates increased policy attention towards offspring disadvantaged via parental ethnicity to minimise harmful consequences of alcohol consumption across and within ethnic groups.
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| 1325. |
- Saarijärvi, Markus, 1988, et al.
(författare)
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Transition program for adolescents with congenital heart disease in transition to adulthood : protocol for a mixed-method process evaluation study (the STEPSTONES project)
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Today, the majority of young persons living with chronic conditions in high-income countries survive into adulthood and will need life-long medical follow-up. Therefore, transition programmes have been developed to facilitate transfer to adult care, and to support self-management and independence during adulthood. The Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS (STEPSTONES) project aims to evaluate the effectiveness of a person-centred transition programme for empowering adolescents with congenital heart disease in transition to adulthood. To understand how the transition programme causes change and how outcomes are created, process evaluation is imperative to assess implementation, context and mechanisms of impact. This protocol aims to describe the process evaluation of the STEPSTONES transition programme.METHODS AND DESIGN: Medical Research Council guidance for process evaluation of complex interventions will be the guiding framework for this mixed-method study. The combination of qualitative and quantitative data will capture different aspects of programme delivery. The sample will consist of participants in the STEPSTONES randomised controlled trial (RCT), persons implementing the programme and healthcare professionals. Quantitative data will consist of protocols and routine monitoring documents from the RCT, data collected from patient registries and sociodemographic data to assess the implementation of the intervention. This data will be analysed with quantitative content analysis, along with descriptive and inferential statistics. Qualitative data will consist of participatory observations, logbooks and interviews with persons implementing the programme, participants and healthcare professionals. Analyses will be performed using qualitative content analysis to investigate mechanism of impact, context and delivery. Quantitative and qualitative data will be integrated in the final stage by using a triangulation protocol according to mixed-method guidelines.ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board in Gothenburg, Sweden. Results will be presented in open access, peer-reviewed journals and at international scientific conferences.
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| 1326. |
- Saevarsdottir, KS, et al.
(författare)
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Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:7, s. e049967-
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Tidskriftsartikel (refereegranskat)abstract
- To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
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| 1327. |
- Safai, Narges, et al.
(författare)
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Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates : A retrospective cohort study from a specialised diabetes centre in Denmark
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate the impact of a multifactorial treatment programme in a real-life setting on clinical outcomes and estimated cardiovascular disease (CVD) risk. Design A retrospective observational cohort study, using data from the electronic medical records and national registers. Setting Tertiary diabetes centre in Denmark. Participants Patients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016. Outcomes Primary outcomes were changes in haemoglobin A1c (HbA 1c), blood pressure (BP) and low-density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CVD risk. Linear mixed model for repeated measurements were used for continuous variables and logistic regression for dichotomous variables. Results The patients achieved a mean±SD decrease in HbA 1c, systolic and diastolic BP and LDL cholesterol of 1.0%±0.04% (10.6±0.4 mmol/mol), 6.3±0.4 mm Hg, 2.7±0.2 mm Hg and 0.32±0.02 mmol/L, respectively (p<0.0001). The proportion of patients who met the treatment goal for HbA 1c (<7% (<53 mmol/mol)) increased from 31% to 58% (p<0.0001); for BP (<130/80 mm Hg) from 24% to 34% (p<0.0001), and for LDL cholesterol (<2.5 mmol/L (patients without previous CVD) or <1.8 mmol/L (patients with previous CVD)) from 52% to 65%. Those reaching all three guideline treatment targets increased from 4% to 15% (p<0.0001), and when relaxing the BP target to <140/85 from 8% to 24%. The estimated CVD risk was relatively reduced by 15.2% using the Swedish National Diabetes Register risk engine and 30.9% using the UK Prospective Diabetes Study risk engine. Conclusions Our data support that short-Term multifactorial treatment of patients with glycaemic dysregulation in a specialist outpatient setting is both achievable and effective, and associated with a clinically meaningful improvement in CVD risk.
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| 1328. |
- Sagar, Rachel L, et al.
(författare)
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An exploratory open-label multicentre phase I/II trial evaluating the safety and efficacy of postnatal or prenatal and postnatal administration of allogeneic expanded fetal mesenchymal stem cells for the treatment of severe osteogenesis imperfecta in infants and fetuses: the BOOSTB4 trial protocol
- 2024
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Ingår i: BMJ Open. - 2044-6055. ; 14:6
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Severe osteogenesis imperfecta (OI) is a debilitating disease with no cure or sufficiently effective treatment. Mesenchymal stem cells (MSCs) have good safety profile, show promising effects and can form bone. The Boost Brittle Bones Before Birth (BOOSTB4) trial evaluates administration of allogeneic expanded human first trimester fetal liver MSCs (BOOST cells) for OI type 3 or severe type 4.Methods and analysis BOOSTB4 is an exploratory, open-label, multiple dose, phase I/II clinical trial evaluating safety and efficacy of postnatal (n=15) or prenatal and postnatal (n=3, originally n=15) administration of BOOST cells for the treatment of severe OI compared with a combination of historical (1–5/subject) and untreated prospective controls (≤30). Infants<18 months of age (originally<12 months) and singleton pregnant women whose fetus has severe OI with confirmed glycine substitution in COL1A1 or COL1A2 can be included in the trial.Each subject receives four intravenous doses of 3×106/kg BOOST cells at 4 month intervals, with 48 (doses 1–2) or 24 (doses 3–4) hours in-patient follow-up, primary follow-up at 6 and 12 months after the last dose and long-term follow-up yearly until 10 years after the first dose. Prenatal subjects receive the first dose via ultrasound-guided injection into the umbilical vein within the fetal liver (16+0 to 35+6 weeks), and three doses postnatally.The primary outcome measures are safety and tolerability of repeated BOOST cell administration. The secondary outcome measures are number of fractures from baseline to primary and long-term follow-up, growth, change in bone mineral density, clinical OI status and biochemical bone turnover.Ethics and dissemination The trial is approved by Competent Authorities in Sweden, the UK and the Netherlands (postnatal only). Results from the trial will be disseminated via CTIS, ClinicalTrials.gov and in scientific open-access scientific journals.Trial registration numbers EudraCT 2015-003699-60, EUCT: 2023-504593-38-00, NCT03706482.
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| 1329. |
- Sahlin, Hanna, et al.
(författare)
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Emotion regulation group therapy for deliberate self-harm : A multi-site evaluation in routine care using an uncontrolled open trial design
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. Design Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. Setting 14 adult outpatient psychiatric clinics across Sweden. Participants Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment. Primary and secondary outcome measures Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties. Intervention ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation. Results At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up. Conclusions ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community. Trial registration number NCT01986257; results.
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| 1330. |
- Salazar, M, et al.
(författare)
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PositivMasc: masculinities and violence against women among young people. Identifying discourses and developing strategies for change, a mixed-method study protocol
- 2020
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 10:9, s. e038797-
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Tidskriftsartikel (refereegranskat)abstract
- Despite public policies and legislative changes aiming to curtail men’s violence against women (VAW) around the world, women continue to be exposed to VAW throughout their life. One in three women in Europe has reported physical or sexual abuse. Men who display unequitable masculinities are more likely to be perpetrators. VAW is increasingly appearing at younger ages. The aims of the project are fourfold: (1) to explore and position the discourses that young people (men and women, 18–24 years) in Sweden, Spain, Ireland and Israel use in their understanding of masculinities, (2) to explore how these discourses influence young people’s attitudes, behaviours and responses to VAW, (3) to explore individual and societal factors supporting and promoting anti-VAW masculinities discourses and (4) to develop actions and guidelines to support and promote anti-VAW masculinities in these settings.Methods and analysisA participatory explorative mixed-method study will be used. In Phase 1, qualitative methods will be used to identify the discourses that young people and stakeholders use to conceptualise masculinities, VAW and the actions that are needed to support and promote antiviolence masculinities. In Phase 2, concept mapping will be used to quantify the coherence, relative importance and perceived relationship between the different actions to support and promote anti-VAW masculinities. Phase 3 is a knowledge creation and translation phase, based on findings from Phases 1 and 2, where actions and guidelines to promote and support anti-VAW masculinities will be developed.Ethics and disseminationEthical clearance has been obtained from ethics review boards in each country. Results will be disseminated through peer-reviewed publications, presentations at international conferences, policy briefs, social media and through the project online hub. With its multicountry approach, our project results seek to inform policies and interventions aimed at promoting discourses which challenge hegemonic masculinities.
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