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131.
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132.
  • Reinholdz, Hanna K, et al. (författare)
  • Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs
  • 2011
  • Ingår i: ALCOHOL AND ALCOHOLISM. - : Oxford University Press. - 0735-0414 .- 1464-3502. ; 46:3, s. 283-291
  • Forskningsöversikt (refereegranskat)abstract
    • Aims: To review the literature on detection of risky drinking to compare early identification based on everyday clinical encounters with systematic screening. We also reviewed specific clinical signs that have been suggested to be used as indicators of risky drinking. Methods: A literature review was performed in PubMed and CINAHL of articles up to November 2010. Results: Systematic screening and semi-systematic methods in various forms detected more risky drinkers than non-systematic identification during clinical encounter, but there was a lack of studies comparing the various means of identifying risky drinking. It may be too early to completely rule out the possibility of using non-systematic methods as an effective strategy to identify risky drinking. The earliest signs of risky drinking suggested in the literature are psychological distress and social problems. Conclusion: From a public health perspective, there is a lack of evidence that non-systematic or semi-systematic methods can substitute systematic screening in terms of numbers of risky drinkers detected. If early signs are going to be used to identify risky drinkers, or those to be screened for risky drinking, more focus should be on psychological and social signs because they appear earlier than somatic signs.
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133.
  • Reinholdz, Hanna, et al. (författare)
  • The Impact of an Implementation Project on Primary Care Staff Perceptions of Delivering Brief Alcohol Advice.
  • 2016
  • Ingår i: Journal Of Addiction. - : Hindawi Publishing Corporation. - 2090-7834 .- 2090-7850. ; 2016
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To explore how the perceptions and experiences of working with risky drinkers change over time among primary health care staff during a systematic implementation project. Methods. Qualitative focus group interviews took place before and after the implementation of the project. Results. The staff displayed a positive change during the implementation period with regard to awareness, knowledge, and confidence that led to a change in routine practice. Throughout the project, staff were committed to engaging with risky drinkers and appeared to have been learning-by-doing. Conclusions. The results indicated a positive attitude to alcohol prevention work but staff lack knowledge and confidence in the area. The more practical experience during the study is, the more confidence seems to have been gained. This adds new knowledge to the science of implementation studies concerning alcohol prevention measures, which have otherwise shown disappointing results, emphasizing the importance of learning in practice.
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134.
  • Rydén, Ingvar, et al. (författare)
  • Increased α1-acid glycoprotein fucosylation in patients with high alcohol consumption
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Changes in glycosylation of senun glycoproteins have been described in different pathologic conditions, and increased fucosylation has previously been reported in patients with liver disease. We analyzed serwn samples from patients admitted to hospital for detoxification of excessive alcohol consumption in order to study α1-acid glycoprotein (AGP) fucosylation and its correlation to other biochemical markers of alcoholism and liver damage.Methods: We used a novel lectin innmmoassay to analyze AGP fucosylation (AGP-F) in a prospective study of 21 consecutive patients admitted for treatment at Linköping University Hospital in the Southeast of Sweden. The results were compared with markers conunonly used for detecting alcoholism and liver cirrhosis, such as carbohydrate deficient transferrin, aminotransferase activity, including aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT), and with hyaluronic acid (HA). In addition, ultrasonography of the liver was performed in 16 of the 21 patients.Results: AGP-F was significantly higher in the male study patients than in normal controls. In addition, in these patients AGP-F correlated to the levels of AST/ALT-ratio and HA No correlation was found between AGP-F and steatosis of the liver, as indicated by ultrasonography, or between AGP-F and CDT.Conclusion: We conclude that AGP-F is increased in men with a high alcohol intake and correlates with AST/ALT ratio and HA, which previously have been found to be indictors of liver cirrhosis. AGP-F should be further evaluated as a potential early indicator ofliver cirrhosis in this patient category.
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135.
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136.
  • Stark Ekman, Diana, et al. (författare)
  • Electronic screening and brief intervention for risky drinking in Swedish university students - A randomized controlled trial
  • 2011
  • Ingår i: Addictive Behaviours. - Amsterdam : Elsevier. - 0306-4603 .- 1873-6327. ; 36:6, s. 654-659
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The limited number of electronic screening and brief intervention (e-SBI) projects taking place in young adult student populations has left knowledge gaps about the specific methods needed to motivate reduced drinking. The aim of the present study was to compare differences in alcohol consumption over time after a series of e-SBIs was conducted with two groups of young adult students who were considered risky drinkers. The intervention group (IC) (n = 80) received extensive normative feedback; the control group (CG) (n = 78) received very brief feedback consisting of only three statements. Method: An e-SBI project was conducted in naturalistic settings among young adult students at a Swedish university. This study used a randomized controlled trial design, with respondents having an equal chance of being assigned to either the IC or the CG. The study assessed changes comparing the IC with the CG on four alcohol-related measurements: proportion with risky alcohol consumption, average weekly alcohol consumption, frequency of heavy episodic drinking (HED) and peak blood alcohol concentration (BAC). Follow-up was performed at 3 and 6 months after baseline. Results: The study documented a significant decrease in the average weekly consumption for the IC over time but not for the CG, although the differences between the groups were non-significant. The study also found that there were significant decreases in HED over time within both groups: the differences were about equal in both groups at the 6-month follow-up. The proportion of risky drinkers decreased by about a third in both the CG and IC at the 3- and 6-month follow-ups. Conclusions: As the differences between the groups at 6 months for all alcohol-related outcome variables were not significant, the shorter, generic brief intervention appears to be as effective as the longer one including normative feedback. However, further studies in similar naturalistic settings are warranted with delayed assessment groups as controls in order to increase our understanding of reactivity assessment in email-based interventions among students.
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137.
  • Thomas, Kristin, 1978- (författare)
  • Implementation of coordinated healthy lifestyle promotion in primary care : Process and outcomes
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Implementation of healthy lifestyle promotion in routine primary has been suboptimal. There is emerging evidence that coordinating care can improve the efficiency and quality of care. However, more research is needed on the implementation of coordinated care in healthy lifestyle promotion, the role of patients in implementation and the long-term outcomes of implementation efforts.Overall aim: To investigate the implementation of coordinated healthy lifestyle promotion in primary care in terms of process and outcomes, from the perspectives of both staff and patients.Methods: In 2008, Östergötland county council commissioned primary care centres to implement a coordinated care initiative, lifestyle teams, to improve healthy lifestyle promotion routines. A lifestyle team protocol stipulated centres to: (1) create multi-professional teams, (2) appoint team managers, (3) hold team meetings, and (4) create in-house referral routines for at-risk patients. Paper I investigated the implementation process of three lifestyle teams during a two year period using a mixed method, convergent parallel design. A proposed theory of implementation process was used to analyse data from manager interviews, documents and questionnaires. Paper II explored patients’ role in implementation using grounded theory. Interview data from patients with varied experience of promotion was used. Paper III investigated implementation outcomes using a quasi-experimental, cross-sectional design that compared three intervention centres (lifestyle teams) with three control centres (no teams). Data were collected by staff and patient questionnaires and manager interviews at 3 and 5 years after commissioning. The RE-AIM framework was modified and used to define outcome variables: Reach of patients, Effectiveness (attitudes and competency among staff), Adoption among staff, Implementation fidelity to the lifestyle team protocol, and Maintenance of the results at 5-year follow-up.Results: Paper I: The implementation process was complex including multiple innovation components and groups of adopters. The conditions for implementation, e.g. resources varied between staff and team members which challenged the embedding of the teams and new routines. The lifestyle teams were continuously redefined by team members to accommodate contextual factors, features of the protocol and patients. The lifestyle team protocol presented an infrastructure for practice at the centres. Paper II: A grounded theory about being healthy with three interconnected subcategories emerged from data: (1) conditions, (2) managing, and (3) interactions regarding being healthy. Being healthy represented a process of approaching a health ideal which occurred simultaneously with, and could contradict, a process of maximizing well-being. A typology of four patient types (resigned, receivers, co-workers, and leaders) illustrated how processes before, during and after healthy lifestyle promotion were interconnected. Paper III: Reach: significantly more patients at control centres received promotion compared to intervention centres at 3-year (48% and 41% respectively) and 5-year followups (44% and 36% respectively). Effectiveness: At 3-year follow-up, after controlling for clustering by centres, intervention staff were significantly more positive concerning perceived need for lifestyle teams; that healthy lifestyle promotion was prioritized at their centre and that there was adequate competency at individual and centre level regarding lifestyle promotion. At 5-year follow-up, significant differences remained regarding prioritization of lifestyle promotion at centre level. The majority of both intervention and control staff were positive towards lifestyle promotion. Adoption: No significant differences were found between control and intervention centres at 3 years (59% and 47% respectively) or at 5 years (45% and 36% respectively). Implementation fidelity: all components of the lifestyle team protocol had been implemented at all the intervention centres and at none of the control centres.Conclusions: The implementation process was challenged by a complex interaction between groups of staff, innovation components and contextual factors. Although coordinated care are used for other conditions in primary care, the findings suggest that it is difficult to adopt similar routines for healthy lifestyle promotion. Findings suggest that the lifestyle team protocol did not fully consider social components of coordinated care or the varied conditions for change exhibited by adopters. Patients can be seen as coproducing implementation of healthy lifestyle promotion.
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138.
  • Thomas, Kristin, et al. (författare)
  • Implementation of healthy lifestyle promotion in primary care: Patients as coproducers
  • 2014
  • Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 97:2, s. 283-290
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To explore and theorize how patients perceive, interpret, and reactin healthy lifestyle promotion situations in primary care and to investigate patients role in implementation of lifestyle promotion illustrated by typologies. Methods: Grounded theory was used to assess qualitative interview data from 22 patients with varied experience of healthy lifestyle promotion. Data were analyzed by constant comparative analysis. Results: A substantive theory of being healthy emerged from the data. The theory highlights the processes that are important for implementation before, during, and after lifestyle promotion. Three interconnected categories emerged from the data: conditions for being healthy, managing being healthy, and interactions about being healthy; these formed the core category: being healthy. A typology proposed four patient trajectories on being healthy: resigned, receivers, coworkers, and leaders. Conclusion: Patients coproduced the implementation of lifestyle promotion through the degree of transparency, which was a result of patients expectations and situation appraisals. Practice implications: Different approaches are needed during lifestyle promotion depending on a variety of patient-related factors. The typology could guide practitioners in their lifestyle promotion practice.
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139.
  • Thomas, Kristin, et al. (författare)
  • Long-term impact of a real-world coordinated lifestyle promotion initiative in primary care: a quasi-experimental cross-sectional study
  • 2014
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15:201
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Integration of lifestyle promotion in routine primary care has been suboptimal. Coordinated care models (e.g. screening, brief advice and referral to in-house specialized staff) could facilitate lifestyle promotion practice; they have been shown to increase the quality of services and reduce costs in other areas of care. This study evaluates the long-term impact of a coordinated lifestyle promotion intervention with a multidisciplinary team approach in a primary care setting. Methods: A quasi-experimental, cross-sectional design was used to compare three intervention centres using a coordinated care model and three control centres using a traditional model of lifestyle promotion care. Outcomes were inspired by using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting daily practice of lifestyle promotion and referral; and implementation, of the coordinated care model. The impact was investigated after 3 and 5 years. Data collection involved a patient questionnaire (intervention, n = 433-497; control, n = 455-497), a staff questionnaire (intervention, n = 77-76; control, n = 43-56) and structured interviews with managers (n = 8). The X-2 test or Fisher exact test with adjustment for clustering by centre was used for the analysis. Problem-driven content analysis was used to analyse the interview data. Results: The findings were consistent over time. Intervention centres did not show higher rates for reach of patients or adoption among staff at the 3- or 5-year follow-up. Some conceptual differences between intervention and control staff remained over time in that the intervention staff were more positive on two of eight effectiveness outcomes (one attitude and one competency item) compared with control staff. The Lifestyle team protocol, which included structural opportunities for coordinated care, was implemented at all intervention centres. Lifestyle teams were perceived to have an important role at the centres in driving the lifestyle promotion work forward and being a forum for knowledge exchange. However, resources to refer patients to specialized staff were used inconsistently. Conclusions: The Lifestyle teams may have offered opportunities for lifestyle promotion practice and contributed to enabling conditions at centre level but had limited impact on lifestyle promotion practices.
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140.
  • Thomas, Kristin, et al. (författare)
  • Towards implementing coordinated healthy lifestyle promotion in primary care : a mixed method study
  • 2015
  • Ingår i: International Journal of Integrated Care. - Utrecht, Netherlands : Utrecht University Library Open Access Journals. - 1568-4156 .- 1568-4156. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting.Methods: A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources.Results: Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles.Conclusions: The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.
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