| 1. |
- Karlsson, Staffan, 1959-, et al.
(författare)
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Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia : a review of the Swedish context
- 2017
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Ingår i: BMC Psychiatry. - London : BioMed Central. - 1471-244X. ; 17, s. 1-9
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Forskningsöversikt (refereegranskat)abstract
- Background: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities. Methods: The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field. Results: During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years. Conclusions: Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.
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| 2. |
- Ahlström, Gerd, et al.
(författare)
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Ageing people with intellectual disabilities and the association between frailty factors and social care : A Swedish national register study
- 2022
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Ingår i: Journal of Intellectual Disabilities. - Thousand Oaks, CA : Sage Publications. - 1744-6295 .- 1744-6309. ; 26:4, s. 900-918
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were Residential care, Daily activities and Contact person. Home help and Security alarm increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65–79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing. © The Author(s) 2021.
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| 3. |
- Soliman, Amira, 1980-, et al.
(författare)
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The Price of Explainability in Machine Learning Models for 100-Day Readmission Prediction in Heart Failure : Retrospective, Comparative, Machine Learning Study
- 2023
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Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications. - 1438-8871. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sensitive and interpretable machine learning (ML) models can provide valuable assistance to clinicians in managing patients with heart failure (HF) at discharge by identifying individual factors associated with a high risk of readmission. In this cohort study, we delve into the factors driving the potential utility of classification models as decision support tools for predicting readmissions in patients with HF. OBJECTIVE: The primary objective of this study is to assess the trade-off between using deep learning (DL) and traditional ML models to identify the risk of 100-day readmissions in patients with HF. Additionally, the study aims to provide explanations for the model predictions by highlighting important features both on a global scale across the patient cohort and on a local level for individual patients. METHODS: The retrospective data for this study were obtained from the Regional Health Care Information Platform in Region Halland, Sweden. The study cohort consisted of patients diagnosed with HF who were over 40 years old and had been hospitalized at least once between 2017 and 2019. Data analysis encompassed the period from January 1, 2017, to December 31, 2019. Two ML models were developed and validated to predict 100-day readmissions, with a focus on the explainability of the model's decisions. These models were built based on decision trees and recurrent neural architecture. Model explainability was obtained using an ML explainer. The predictive performance of these models was compared against 2 risk assessment tools using multiple performance metrics. RESULTS: The retrospective data set included a total of 15,612 admissions, and within these admissions, readmission occurred in 5597 cases, representing a readmission rate of 35.85%. It is noteworthy that a traditional and explainable model, informed by clinical knowledge, exhibited performance comparable to the DL model and surpassed conventional scoring methods in predicting readmission among patients with HF. The evaluation of predictive model performance was based on commonly used metrics, with an area under the precision-recall curve of 66% for the deep model and 68% for the traditional model on the holdout data set. Importantly, the explanations provided by the traditional model offer actionable insights that have the potential to enhance care planning. CONCLUSIONS: This study found that a widely used deep prediction model did not outperform an explainable ML model when predicting readmissions among patients with HF. The results suggest that model transparency does not necessarily compromise performance, which could facilitate the clinical adoption of such models. © Amira Soliman, Björn Agvall, Kobra Etminani, Omar Hamed, Markus Lingman. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.10.2023.
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| 4. |
- Källstrand Eriksson, Jeanette, 1965-, et al.
(författare)
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Seniors' self-preservation by maintaining established self and defying deterioration : A grounded theroy
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - Järfälla, Sweden : Co-action Publishing. - 1748-2623 .- 1748-2631. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of ‘‘remaining themselves as who they used to be’’ by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.
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| 5. |
- Archer, Trevor, 1949, et al.
(författare)
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Effects of physical exercise on depressive symptoms and biomarkers in depression
- 2014
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Ingår i: CNS & Neurological Disorders. - Bussum : Bentham Science Publishers. - 1871-5273 .- 1996-3181. ; 13:10, s. 1640-1653
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Tidskriftsartikel (refereegranskat)abstract
- Regular physical exercise/activity has been shown repeatedly to promote positive benefits in cognitive, emotional and motor domains concomitant with reductions in distress and negative affect. It exerts a preventative role in anxiety and depressive states and facilitates psychological well-being in both adolescents and adults. Not least, several meta-analyses attest to improvements brought about by exercise. In the present treatise, the beneficial effects of exercise upon cognitive, executive function and working memory, emotional, self-esteem and depressed mood, motivational, anhedonia and psychomotor retardation, and somatic/physical, sleep disturbances and chronic aches and pains, categories of depression are discussed. Concurrently, the amelioration of several biomarkers associated with depressive states: hypothalamic-pituitary-adrenal (HPA) axis homeostasis, anti-neurodegenerative effects, monoamine metabolism regulation and neuroimmune functioning. The notion that physical exercise may function as "scaffolding" that buttresses available network circuits, anti-inflammatory defences and neuroreparative processes, e.g. brain-derived neurotrophic factor (BDNF), holds a certain appeal. © 2014 Bentham Science Publishers.
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| 6. |
- Brennan, Marian C., et al.
(författare)
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Acceptability of Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults With Type 1 Diabetes : A Mixed Methods Approach
- 2021
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Ingår i: Canadian Journal of Diabetes. - Amsterdam : Elsevier B.V.. - 1499-2671. ; 46:1, s. 16-25.e2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Mixed methods were used to evaluate a group self-management education intervention to address type 1 diabetes (T1D)-specific barriers to physical activity (PA). We evaluated the acceptability of study resources and procedures. Methods: Consenting participants from a quantitative evaluation (n=70) were invited to participate in 1 of 5 focus groups. Interviews explored the acceptability of procedures across the randomized controlled trial schedule, acceptability of the intervention/control workshops and resources and the perceived effectiveness of the intervention/control on participant outcomes. The use and helpfulness of intervention take-home resources, Facebook data and fidelity coding were also examined to inform other aspects of intervention acceptability. Results: Twenty-one focus group participants from control or intervention arms participated in 1 of the 5 focus groups. Participants were 46±10 years of age; about half were female and had been living with T1D for 23±16 years. Study procedures were widely accepted; however, randomization and some aspects of the questionnaire were of concern to a small number of participants. Group education was acceptable and preferred, but participants expressed ambivalence toward the private Facebook group. Control participants indicated that basic information on PA guidelines and hypoglycemia risk are not currently being provided in standard care. Fidelity assessment confirmed the intervention was delivered consistently and was facilitated using behaviours and communication skills based on Social Cognitive Theory. Conclusions: Future definitive evaluation of this promising intervention should utilize a blinded randomized controlled trial study design. Alterations to the control workshop are required to better reflect standard care in Australia. Our qualitative findings suggest that group education can be an acceptable and preferred method of education in T1D management for PA. © 2021 Canadian Diabetes Association
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| 7. |
- Bökberg, Christina, et al.
(författare)
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Care and Service at Home for Persons With Dementia in Europe
- 2015
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Ingår i: Journal of Nursing Scholarship. - Hoboken : Wiley-Blackwell Publishing Inc.. - 1527-6546 .- 1547-5069. ; 47:5, s. 407-416
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries.Design: A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare.Methods: The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia.Findings: Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries.Conclusions: The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs.Clinical Relevance: This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.
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| 8. |
- Elsborg, Peter, et al.
(författare)
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The associations between motivational climate, basic psychological needs and dropout in volleyball – A comparison across competitive levels
- 2023
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Ingår i: European Journal of Sport Science. - Abingdon : Taylor & Francis. - 1746-1391 .- 1536-7290. ; 23:3, s. 393-403
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the importance of motivational climate for the satisfaction of psychological needs and dropout in recreational, intermediate and elite volleyball. Seven thousand nine hundred thirty six volleyball players from all 321 volleyball clubs across Denmark were invited to participate in the study. Three thousand three thirty answered the questionnaire and 2150 were included in the analysis. Dropout from Volleyball was measured as the proportion of players that had stopped playing volleyball over the last year. The coach-created motivational climate was measured using the Motivational Climate Scale for Youth Sports. The satisfaction of players’ psychological needs was measured using an adapted version of the basic psychological needs in exercise scale. The psychometric scales were validated and showed good model fit. For volleyball players of all levels, the degree of mastery climate predicted the satisfaction of the players’ basic psychological needs satisfaction during volleyball which was, in turn, associated with lower dropout rates. Performance climate had a weak negative association with the satisfaction of psychological needs on the intermediate level only. When adjusting the models for the negative association between performance climate and mastery climate this negative association became nonsignificant and a weak positive association to needs satisfaction emerged for players at the elite level. Findings confirm that the coach-created mastery climate in volleyball teams is important for the satisfaction of players’ basic psychological needs and continuation within the sport across the recreational, intermediate and elite levels. Highlights Coach-created mastery climate in volleyball teams was positively associated with the satisfaction of the players’ basic psychological and negatively associated with dropout. These associations between coach created climate, need satisfaction and dropout were similar across different sporting levels. Performance orientation had little influence and seemed mainly problematic if it was at the expense of mastery climate. © 2022 European College of Sport Science.
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| 9. |
- Göransson, Carina, 1967-, et al.
(författare)
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Testing an app for reporting health concerns-Experiences from older people and home care nurses
- 2018
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Ingår i: International Journal of Older People Nursing. - Hoboken : Wiley-Blackwell. - 1748-3735 .- 1748-3743. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To explore the experiences of using an app among older people with home-based health care and their nurses. Background: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Design: Explorative qualitative design. Methods: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. Results: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. Conclusions: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. Implications for practice: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd
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| 10. |
- H. Fosstveit, Sindre, et al.
(författare)
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The intensity paradox : A systematic review and meta-analysis of its impact on the cardiorespiratory fitness of older adults
- 2024
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - Chichester : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 34:2
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Forskningsöversikt (refereegranskat)abstract
- Aim: The present systematic review and meta-analysis aimed to compare the effect of moderate- versus high-intensity aerobic exercise on cardiorespiratory fitness (CRF) in older adults, taking into account the volume of exercise completed. Methods: The databases MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Cochrane Library) were searched to identify randomized controlled trials (RCTs). Two reviewers extracted data and assessed bias. Comprehensive Meta-Analysis software calculated overall effect size, intensity differences, and performed meta-regression analyses using pre-to-post intervention or change scores of peak oxygen uptake (V̇O2peak). The review included 23 RCTs with 1332 older adults (intervention group: n = 932; control group: n = 400), divided into moderate-intensity (435 older adults) and high-intensity (476 older adults) groups. Results: Meta-regression analysis showed a moderate, but not significant, relationship between exercise intensity and improvements in V̇O2peak after accounting for the completed exercise volume (β = 0.31, 95% CI = [−0.04; 0.67]). Additionally, studies comparing moderate- versus high-intensity revealed a small, but not significant, effect in favor of high-intensity (Hedges' g = 0.20, 95% CI = [−0.02; 0.41]). Finally, no significant differences in V̇O2peak improvements were found across exercise groups employing various methods, modalities, and intensity monitoring strategies. Conclusion: Findings challenge the notion that high-intensity exercise is inherently superior and indicate that regular aerobic exercise, irrespective of the specific approach and intensity, provides the primary benefits to CRF in older adults. Future RCTs should prioritize valid and reliable methodologies for monitoring and reporting exercise volume and adherence among older adults. © 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.
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