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Gröndal, Hedvig, 1983-
(författare)
Signs of bacteria: Enacting Sore Throat
2015
Konferensbidrag (refereegranskat) abstract
In this paper I analyse the diagnostic process in relation to bacterial sore throat and how this disease comes into being, or how it is enacted, at two Swedish health centres. The empirical data analysed consist of interviews with nurses and general practioners as well as observations at the health centres. The concept of enactment implies that disease is relationally constituted in and through relations between human and non-human actors. In the paper the relations between health care personnel, bodies, symptoms, instruments, bacteria and other actors are investigated, and I discuss how different enactments of bacterial sore throat come to being depending on how these relations are organized. When doing this the clinical gaze - the diagnosing gaze that interpret signs of an underlying pathology on the patients body – is explored and in relation to the empirical material this gaze is investigated, that is, how it is employed and how it is established in relation to a number of human and non-human actors.
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Kiadaliri, Ali
(författare)
Psychometric properties of the EQ-5D-5L in patients with knee or hip osteoarthritis : confirmatory factor analysis and item response theory
2024
Ingår i: Osteoarthritis and Cartilage. - 1063-4584. ; 32:Suppl 1, s. 196-197
Konferensbidrag (refereegranskat) abstract
Purpose (the aim of the study): There is limited evidence on psychometric properties of EQ-5D-5L among people with osteoarthritis (OA) undertaking non-surgical treatment. The aim of the current study was to evaluate the psychometric properties of the EQ-5D-5L among individuals with knee or hip OA participating in a digitally delivered education and exercise therapy.Methods: Secondary analysis of data obtained from individuals aged 40+ years participating in the digital treatment during the year 2021 with the responses to EQ-5D-5L at enrolment. Confirmatory factor analysis (CFA) with the weighted least square mean and variance adjusted estimator was used to assess dimensionality. Local independency assumption was assessed using residual correlations between item pairs with r>0.2 as violation of the assumption. Monotonicity was evaluated using Mokken analysis. Item response theory was implemented by generalized partial credit model. The item parameters (discrimination and difficulty) were estimated using the maximum marginal likelihood estimation. Targeting was assessed by inspecting the item-person map (the Wright map). Differential item functioning (DIF) by sex, age (≤65 years vs. >65 years) and OA site (knee vs. hip) were assessed and items with a McFadden pseudo-R2 change of ≥0.02 were flagged for potential DIF. All analyses were conducted in RStudio version 2022.02.0.Results: A total of 16,200 individuals with mean (standard deviation) age 64.3 (9.1), 74.0% females and 59.6% with knee OA were included. The included subjects reported 609 of the 3,125 possible health profiles of the EQ-5D-5L with slight or moderate problems with pain/discomfort dimension and no problems on the other dimensions (i.e. profiles “11121” and “11131”) being the first and second most common profiles (9.4% and 4.4% of respondents, respectively). CFA confirmed the unidimensionality of the EQ-5D-5L with factor loading ranged from 0.49 for anxiety/depression to 0.85 for usual activity dimensions, and an average variance extracted of 0.53 suggesting adequate convergent validity. Local independence and monotonicity assumptions were met. The fit statistics suggested an adequate fit of IRT model. Among five dimensions, pain/discomfort was the most affected (least difficult to endorse) while self-care was the least affected (most difficult to endorse). No disordered response thresholds were identified. EQ-5D-5L showed adequate reliability (>0.7) over a wide range of the underlying trait (76.4% of total information were within -1 to 4 standard deviation of average level of poor HRQoL) with an overall reliability of 0.80 (Figure 1). Usual activity and anxiety/depression were the most and least informative items. Inspecting the item-person map (Figure 2) suggested that while EQ-5D-5L covered the full range of HRQoL levels in the sample, it targeted, on average, a poorer HRQoL than experienced by the participants in the study. No DIF (uniform or nonuniform) was detected.Conclusions: The EQ-5D-5L demonstrated acceptable psychometric properties among subjects with hip or knee OA participating in a digital education and exercise therapy. These results support the use of EQ-5D-5L among people with less severe knee or hip OA.
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Marcheschi, Elizabeth, 1980, et al.
(författare)
To come home after a stroke: patients' early experiences of health and recovery in their home settings
2018
Konferensbidrag (övrigt vetenskapligt/konstnärligt) abstract
Healthcare systems and services for stroke patients are increasingly performed within home settings where both, people with moderate and severe disability can receive care. However, at present little knowledge is available in regard to early stroke phases and how the interaction with the physical environment of home settings might affect rehabilitation outcomes. The aim of this work was thus, to increase our understanding in regard to the interplay between home settings and people’s rehabilitation process, a month after stroke onset. A cross-sectional interdisciplinary investigation was conducted using validated measures in face-to-face interviews and by observing the participants’ interactions with their home settings. People with stroke (N = 16) that had a mild disability, and cognitive and communicative abilities to participate in an interview of approximately 2 hours, were recruited in the study and their data was collected within 4 to 7 weeks after stroke onset. Information was collected in regard to their experience of the physical and social home environment, their attachment to place, self-efficacy and the quality of continuity of care from the hospital to the home. Moreover, data about their recovery and overall health were collected with, Stroke Impact Scale and the EQ-5D. Preliminary results suggests the existence of a relation between recovery levels, self-efficacy and the perceived quality of the physical environment of home settings. More detailed results and their implication for early rehabilitation phases of stroke patients within home settings will be discussed.
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