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  • Holmqvist, Marika, 1959- (författare)
  • Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol.This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey.Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient.OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories.Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy.MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
  • Holmqvist, Marika, 1959-, et al. (författare)
  • Alcohol prevention activity in Swedish primary health care and occupational health services : Asking patients about their drinking
  • 2008
  • Ingår i: Nordic Studies on Alcohol and Drugs. ; 25:6, s. 489-504
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims To investigate the alcohol preventive activity in Swedish Occupational health services (OHS) and Primary health care (PHC) in relation to education in handling risky drinking, perceived skills in achieving change in patients’ alcohol habits, and knowledge in alcohol issues among the physicians and nurses in these two settings. Design and Methods All Swedish physicians and nurses in OHS and PHC having the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 313 OHS physicians (response rate 54%), 759 OHS nurses (69%), 1821 PHC physicians (47%), and 3125 PHC nurses (55%). Regression analyses were used to assess the independent and interacting effects of skills, knowledge, education, sex, age, and years in practice, patient encounters per week, and location of unit. Results OHS professionals were more active in initiating discussions about alcohol with their patients than their colleagues in PHC. OHS professionals considered themselves more skilful and knowledgeable than PHC professionals. OHS nurses and PHC physicians were the professional categories that had received most education in handling risky drinking. Skills were positively associated with activity for all categories except OHS physicians. Knowledge and education were positively associated with activity for all categories except OHS nurses. Conclusions OHS professionals were more active than the PHC professionals in addressing alcohol issues with their patients. Education, knowledge, and skills were positively associated with activity for most professional categories in the two settings.  
  • Holmqvist, Marika, et al. (författare)
  • Asking patients about their drinking - A national survey among primary health care physicians and nurses in Sweden
  • 2008
  • Ingår i: Addictive Behaviors. - 0306-4603. ; 33:2, s. 301-314
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals. Methods All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate). Results Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity. Conclusions The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity. Keywords: Primary health care; Alcohol intervention; Risk consumption
  • Johansson Capusan, Andrea, et al. (författare)
  • Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults : a large twin study
  • 2016
  • Ingår i: Psychological Medicine. - Cambridge : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 46:12, s. 2637-2646
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundChildhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.MethodData from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.esultsCM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.ConclusionsCM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.
  • Johansson Capusan, Andrea, 1970- (författare)
  • Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Research in past decades has demonstrated the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood, but many questions regarding prevalence, causes, and comorbidities of ADHD in adults remain to be investigated. Previous research focusing on childhood ADHD identified high heritability. Genetic and environmental influences on ADHD symptoms in adults and their association with comorbid conditions are not fully understood.The overall aim of this thesis was to study adult ADHD symptoms in the population and investigate associations with substance use disorders (SUD) and binge eating. In all four papers, we used population-based self-report data from twins aged 20–46 years from the Swedish Twin Registry. We used twin methods to explore the role of genetic and environmental factors underlying ADHD symptoms and their comorbidities.Study I examined the phenotypic association between ADHD and various forms of SUD. ADHD in adults was strongly associated with alcohol abuse and alcohol dependence, illicit drug use and regular nicotine use, with no differences between ADHD subtypes and no apparent substance preference. In Studies II and IV, we used bivariate twin models to examine the role of genetic and environmental factors in the association of adult ADHD symptoms with alcohol dependence (II) and with binge eating (IV). For ADHD symptoms and alcohol dependence, 64% of the overlap was explained by common genetic factors. The remaining variance was accounted for by environmental factors specific for each twin, with no sex differences for the overlap. Similarly, 91% of the association between ADHD symptoms and binge-eating behaviour was explained by common genetic factors. In Study III, using a within-twin pair analysis, we demonstrated that although most of the association between adult ADHD symptoms and self-reported childhood maltreatment (an environmental risk factor for ADHD) was explained by familial (genetic and environmental) confounding, our results were also consistent with a causal interpretation.In conclusion, adult ADHD symptoms are associated with SUD and binge-eating behaviour. We replicated findings from adolescent studies regarding shared genetic risk factors for alcohol dependence and ADHD symptoms in adults. For binge eating, we showed for the first time that shared genetic factors mainly explained the association with ADHD symptoms. Alterations in mesolimbic reward processing as well as the frontal, executive and inhibitory systems have been described for ADHD, alcohol dependence and binge-eating behaviour, possibly suggesting common genetic and neurobiological factors for all three conditions. Results that support a causal hypothesis regarding the association between childhood maltreatment and ADHD symptoms in adults need follow-up in longitudinal clinical samples that can examine neurobiological underpinnings of environmental effects. Clinically, the results of this thesis support that ADHD in adults be considered and addressed in adults with SUD or binge-eating behaviour. Given the common genetic risk factors and the role of the early childhood environment, family interventions should be considered for these populations.
  • Johansson, Kjell, 1956-, et al. (författare)
  • Early intervention for problem drinkers : readiness to participate among general practitioners and nurses in Swedish primary health care
  • 2002
  • Ingår i: Alcohol and Alcoholism. - 0735-0414 .- 1464-3502. ; 37:1, s. 38-42
  • Tidskriftsartikel (refereegranskat)abstract
    • An exploration was made of attitudes and practices of general practitioners (GPs) and nurses concerning early identification of, and intervention for, alcohol-related problems. Sixty-five GPs and 141 nurses in 19 primary health centres in a county in southern Sweden answered a 28-item questionnaire before implementation of an intervention programme. The questionnaire covered experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. Self-reported frequency of asking about alcohol use was higher among GPs than nurses. Both groups reported more frequently asking about alcohol consumption in cases where they believed that the health status was influenced by alcohol. For both professions, knowledge and skills concerning identification were rated as better understood than that concerning intervention methods. Nurses rated their knowledge and skills less confidently than GPs. The overall attitude was fairly positive towards early identification and intervention, but nurses were more worried than GPs that patients would react negatively to questions about alcohol. Attitudes, self-rated capacity, and practice were related. The low level of early identification and intervention in primary care appears to be related more to insufficient practical skills than to attitudes. Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse-patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice.
  • Johansson, Kjell, 1956-, et al. (författare)
  • Factors influencing GPs' decisions regarding screening for high alcohol consumption : a focus group study in Swedish primary care
  • 2005
  • Ingår i: Public Health. - 0033-3506 .- 1476-5616. ; 119:9, s. 781-788
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective The aim of this study was to explore factors that influence general practitioners' (GPs') decisions regarding screening for high alcohol consumption.Methods GPs working at three primary healthcare centres in Sweden participated in focus group interviews. The interviews were recorded and transcribed verbatim, and a deductive framework approach was used for the analysis.Results The majority of the participating GPs did not believe in asking all patients about their alcohol consumption. Reported factors that influenced how many and which patients were questioned about alcohol consumption were time, age of the patient, consultation setting, patient–physician relationship, what symptoms the patient presented with, and knowledge of measures if patients appear to have a high alcohol consumption. Thus, alcohol screening and intervention were not performed in all patient groups as was originally intended, but were performed in limited groups of patients such as those with alcohol-related symptoms.Conclusions Although the number of participants in this study was small and the conclusions cannot be generalized, the results provide some valuable insights into why GPs are hesitant to engage in screening for high alcohol consumption. Since prevention of alcohol-related health problems is an important public health issue, many different screening and intervention strategies have to be formulated and evaluated in order to reach patients with both hazardous and harmful alcohol consumption within the healthcare system. Screening all consecutive patients for a limited period or screening patient groups known to include a fairly high frequency of high alcohol consumers are two ways of limiting the time requirements and increasing role legitimacy. Still, there is a need for a broader public health strategy involving many players in the community in alcohol preventive measures, especially in more primary preventive approaches.
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