| 1. |
- Ekengren, Johan, 1979-
(author)
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Careers of Swedish Professional Handball Players : From an Empirical Model to Career-Long Psychological Support Services
- 2020
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Doctoral thesis (other academic/artistic)abstract
- This PhD Project with a specialization in sport psychology is inspired by the cultural praxis of athletes’ careers paradigm. This implies that the Project blends theory, research, and practice within the context of Swedish handball, by investigating career pathways of professional players providing empirically based, and context specific, implications. The overarching aim of the Project is twofold: (a) to examine the career experiences of Swedish professional handball players and consolidate them into the empirical career model of Swedish professional handball players (ECM-H), and (b) based on the ECM-H, to develop, validate, and test an applied framework promoting career-long psychological support services in Swedish handball (CPS-H). The first aim is covered by Study I and II, and the second aim is met in Study III and IV. The dissertation is designed as a collection of four articles with one article per study. Study I focused on a qualitative exploration of career experiences from 18 Swedish professional handball players including major career stages and transitions in their athletic and non-athletic development. The players’ accounts were consolidated into the ECM-H describing the context-specific features and pathways throughout the handball career. When developing the ECM-H, gender-specific issues appeared of interest for further investigation. Gender issues were addressed in Study II by re-analyzing the data from Study I. Two composite vignettes were created describing the career pathways of nine male and nine female players. Study III initiated a move from research to practice. Based on the ECM-H, applied sport psychology literature and experiences of the research team led by the first author, the applied framework CPS-H was heuristically developed and validated in three focus groups with end users; professional players, coaches, and sport psychology practitioners. The validated version of the CPS-H is presented with general and career stage-specific recommendations for its implementation among support providers (i.e., where, when, what, who, why, and how of psychological support service). Study IV was designed as an instrumental case study for testing a part of the CPS-H framework. More specifically, the mastery career stage. A career assistance program (CAP) named Life as a professional handball player was developed for, implemented with, and evaluated by Swedish League team. The program included eight workshops dealing with various aspects of the players’ athletic and non-athletic life (e.g., performance, training, lifestyle, recovery, future planning), together with crisis-related issues (e.g., coping with uncertainty). These workshops were delivered by the first author during 12 weeks of a competitive season. The mixed-methods evaluation revealed a perceived improvement in players’ personal coping resources (e.g., increased awareness) and a decrease in their fatigue and stress. This Project contributes to the athlete career sport psychology discourse and the emerging athlete mental health discourse by presenting the ECM-H and CPS-H frameworks, and the CAP Life as a professional handball player, grounded in the cultural context of Swedish handball. The frameworks and CAP can serve as inspiration for future research and practice, informed by a cultural praxis. The Project shows the usefulness of working as a scientist-practitioner and establishing theory-researchpractice-context links for the promotion of culturally informed implications, and supports the work of facilitating a holistic understanding of athletes’ striving for healthy, successful, and long-lasting careers in sport and life.
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| 2. |
- Lund Ohlsson, Marie
(author)
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New methods for movement technique development in cross-country skiing using mathematical models and simulation
- 2009
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Licentiate thesis (other academic/artistic)abstract
- This Licentiate Thesis is devoted to the presentation and discussion of some new contributions in applied mathematics directed towards scientific computing in sports engineering. It considers inverse problems of biomechanical simulations with rigid body musculoskeletal systems especially in cross-country skiing. This is a contrast to the main research on cross-country skiing biomechanics, which is based mainly on experimental testing alone. The thesis consists of an introduction and five papers. The introduction motivates the context of the papers and puts them into a more general framework. Two papers (D and E) consider studies of real questions in cross-country skiing, which are modelled and simulated. The results give some interesting indications, concerning these challenging questions, which can be used as a basis for further research. However, the measurements are not accurate enough to give the final answers. Paper C is a simulation study which is more extensive than paper D and E, and is compared to electromyography measurements in the literature. Validation in biomechanical simulations is difficult and reducing mathematical errors is one way of reaching closer to more realistic results. Paper A examines well-posedness for forward dynamics with full muscle dynamics. Moreover, paper B is a technical report which describes the problem formulation and mathematical models and simulation from paper A in more detail. Our new modelling together with the simulations enable new possibilities. This is similar to simulations of applications in other engineering fields, and need in the same way be handled with care in order to achieve reliable results. The results in this thesis indicate that it can be very useful to use mathematical modelling and numerical simulations when describing cross-country skiing biomechanics. Hence, this thesis contributes to the possibility of beginning to use and develop such modelling and simulation techniques also in this context.
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| 3. |
- Sjöberg, Carina, 1964-
(author)
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Barncentrerat förhållningssätt i perioperativ vård
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Bakgrund: Barns möjligheter att involveras i den perioperativa vårdkontexten kan förbättras med ett barncentrerat förhållningssätt. För att uppnå detta behöver hänsyn både tas till att barn är beroende av sin familj och att de som enskilda individer ska involveras och vara medaktörer i sin vård. Barns involvering i den perioperativa vården har många fördelar. Det bidrar till minskad oro och rädsla och att barnet kan stärka sin kompetens och bli behandlad med respekt. Barn upplever dock att det är svårt för dem att vara delaktiga och att ha kontroll i den främmande och skrämmande perioperativa sjukhusmiljön. Barns möjligheter att vara delaktiga i den perioperativa vården är därför beroende av föräldrar och hälso-och sjukvårdspersonal liksom rutiner och fördelning av resurser i vården. Det är därför viktigt att de vuxna som ska stödja barnen har förståelse för att barn är unika och uppfattar saker ur sitt eget perspektiv baserat på sina erfarenheter.Syfte: Det övergripande syftet med avhandlingen var att öka förståelsen för vad ett barncentrerat förhållningssätt innebär inom perioperativ vård - utifrån barn, föräldrars och ett organisatoriskt perspektiv. Metod: I delarbete I användes en deskriptiv kvalitativ design med intervjuer av 10 barn (8 till 11år). Delarbete II hade en explorativ kvalitativ design med intervjuer av 20 föräldrar. Delarbete I och II analyserades med kvalitativ innehållsanalys för att beskriva barn och föräldrars erfarenheter av delaktighet i pediatrisk perioperativ vård. I delarbete III användes en explorativ kvalitativ design med intervjuer av hälso-och sjukvårdpersonal. Analysen genomfördes med grundad teori för att utforska processen av ett organisatoriskt förbättringsarbete för barn som genomgick sedering för intratekal cytostatikabehandling. I delarbete IV användes en deduktiv kvantitativ design med registerdata och analys med deskriptiv statistik för att beskriva tidsintervall och använd Propofol-dos vid sedering för intratekal cytostatikabehandling i tre olika miljöer. Resultat: Delarbete I visar att barns upplevelse av delaktighet påverkats av hur de informerats inför och under det perioperativa vårdförloppet. Vidare har relationen till hälso-och sjukvårdspersonalen haft betydelse för barns möjligheter att involveras i beslutsfattande. Dessutom har sjukhusmiljön, väntetid och möjligheter att förströ sig haft inflytande på barns upplevelse av delaktighet. I delarbete II beskriver huvudkategorin att föräldrars delaktighet i pediatrisk perioperativa vård vid dagkirurgi betydde ”Having strength to participate despite an increased vulnerability ”. Tillsammans med underkategorierna; få information om vad som ska hända, att bli sedd som en resurs och att få tillgång till miljön. I delarbete III beskriver “The theory of a shielding place” hur hälso-och sjukvårdspersonalen med ett barncentrerat förhållningssätt utförde proceduren sedering för intratekal cytostatikabehandling på barnavdelningen. Resultatet i delarbete IV kontrollerar och kvantifierar objektivt delar av resultatet från delarbete III. Genom att visa att när proceduren utförs på barnavdelningen minskas väntetid och tidsåtgång för proceduren som helhet. Konklusion: För barn och föräldrar som genomgår dagkirurgi har information, samspelet med hälso-och sjukvårdspersonalen och miljön haft betydelse för upplevelsen av delaktighet. Ur ett organisatoriskt perspektiv påverkas ett barncentrerat förhållningssätt av de rutiner som har betydelse för hur barn och föräldrar förbereds. Resurser och rutiner påverkar också om sjukhusmiljöer är anpassade för barn, väntetid och tidsåtgång, liksom relationer mellan barn och hälso-och sjukvårdspersonal.
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| 4. |
- Sundqvist, Ann-Sofie, 1971-
(author)
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Perioperative patient advocacy : having the patient's best interests at heart
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Patient advocacy implies taking action on someone else’s behalf, and has been described as a key element of nurses’ professional care. In the perioperative setting, it involves not only critical decision making, but also all the small things that the nurses do for the sake of the patients during their working day. Since previous research on the advocacy role of a registered nurse anesthetist (RNA) is sparse, and has not been conducted in a Swedish context, this thesis was intended to contribute to a greater understanding of advocacy in the perioperative context. The overall aim was therefore to explore the characteristics and consequences of perioperative patient advocacy (Study I), and to describe RNAs’ views of advocacy in anesthetic nursing through interviews (Study II), a questionnaire (Study III), and observations (Study IV).The synthesis of the characteristics and consequences of perioperative patient advocacy was interpreted in this thesis as the RNAs having the patient’s best interests at heart, in that they (1) had control of the situation, (2) preserved human values, and finally (3) were emotionally affected, as the results from the four studies suggested this as the core of perioperative patient advocacy.Perioperative patient advocacy is not always perceived as easy. In praxis, it is linked to the code of ethics outlined by the International Council of Nurses, which states that all registered nurses, regardless of their working context, shall respect human rights, promote health, prevent illness, and ensure that the individual receives accurate and sufficient information. This thesis elaborates on how this is done by describing how RNAs exert perioperative patient advocacy and how they interact in order to facilitate the best possible care for the patient. The results deepen the understanding of perioperative patient advocacy from the RNA’s perspective and contribute to a new insight in the RNA’s professional role.
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| 5. |
- Amcoff, Karin, 1975-
(author)
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Serological and faecal biomarkers in inflammatory bowel disease
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, are relapsing and remitting disorders characterised by chronic inflammation at various sites in the gastrointestinal tract, resulting in diarrhoea and abdominal pain. Neither the aetiology nor the pathophysiology is yet fully understood, and there is currently no cure.The overall aim of this thesis was to add a piece of the puzzle to understanding the complex pathogenesis of IBD; to determine the role of genetic and environmental factors in the development of antibodies in IBD - which could provide insight to the aetiology of the diseases; and to find sensitive and specific faecal biomarkers to predict future flare in the diseases.By conducting twin-studies, we found that some serological antibodies associated with Crohn's disease seemed to be genetically predisposed (anti-OmpC and anti-I2). Genetic predisposition do not play a predominant role in the generation of other antibodies, such as ASCA, anti-CBir1 or the autoantibody most commonly found in ulcerative colitis; pANCA. Exposure to environmental factors during childhood are suggested to be of importance in the development of ASCA and anti-CBir1 in CD. Active smoking seemed to have a protective effect against development of pANCA.Faecal calprotectin is a known marker for intestinal inflammation. In our third study, three faecal calprotectin assays were compared, which revealed overall poor agreement. This implies that standardisation of the method is highly needed.In our final study, we measured faecal eosinophil derived neurotoxin (EDN) and eosinophil cationic protein (ECP) in patients with IBD every third month over a two-year period. The results revealed that the risk of relapse in UC can be predicted by measuring EDN consecutively.
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| 6. |
- Björk, Åsa, 1973-
(author)
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Drama, hat och vänskap : om ungdomars interaktioner i sociala medier
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Departing from narratives of young people, the aim of this thesis is to deepen the knowledge about the meaning of their social interactions in social media.In this qualitative study, young people’s interactions when they use social media are studied in a Swedish context. The study constitutes an important contribution since it makes young people’s voices heard. It is based on semi-structured interviews with 32 young people aged 13-15.The results show that young people do not use the term bullying when they define a situation that is of a negative nature. They use other terms such as hate and drama to define a situation they perceive to be negative, both in situations when they themselves are involved and in situations when they are among the audience. It depends on how they define the situation. Explanations for why drama, hate and negative actions occur can be understood based on on-going relation-building work and an effort to fit into a certain peer culture. The results also indicate that it is important to receive attention from significant others. In interaction with others, social skills are developed to navigate drama, hate, friendship, negative actions and relation-building efforts in social media.Social norms, gender norms and negotiating identities come to expression when the young people discuss self-presentations in pictures.Explanations as to why they choose to publish a certain kind of picture can be linked with complex relationship and identity construction processes where the young peoples position themselves and others in the struggle to doing gender and a desire to participate in a certain peer culture.
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| 7. |
- Rantala, Anna, 1974-
(author)
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- Snälla du! Kan du sätta dig? : om vägledning i förskolan
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Syftet med föreliggande avhandling är att fördjupa kunskapen om hur fostran gestaltas i förskolan. Det empiriska materialet som ligger till grund för resultaten består av videoobservationer där dagligen återkommande situationer har dokumenterats vid två svenska förskolor. Analyserna tar en utgångspunkt i Foucaults teorier om makt.Förskolan i Sverige har en egen läroplan (Skolverket, 2010) där uppdragen är formulerade. Som uppdragen framställs kan de upplevas svårtolkade och de erbjuder också stort tolkningsutrymme där uppdraget att fostra barn döljs under honnörsord som demokrati, värdegrund, solidaritet, empati, hänsyn och respekt. Utifrån detta otydliga fostransuppdrag blir det av vikt att studera hur fostran gestaltas.I avhandlingen presenteras resultaten av en tematisk analys där pedagogers vägledande yttranden har analyserats. Resultaten synliggör en verksamhet där barn i dagligen återkommande situationerna blir vägledda på olika sätt och där makt, disciplinering och normalisering är ett vanligt inslag. Ur analyserna framkommer en bild av hur det görs försök att förmedla normer om hur individer bör bete sig i ett demokratiskt samhälle samtidigt som vägledningen varierar både mellan kön och mellan olika barn. Avhandlingens bidrag är att visualisera vägledning i olika situationer vilket möjliggör att analysera både hur den gestaltas och i vilken riktning som barnen blir vägledda.
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| 8. |
- Rusner, Marie, 1958-
(author)
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Bipolär sjukdom - ur ett existentiellt perspektiv
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim was to create knowledge about what it means to live with bipolar disorder from an existential perspective, both for individuals with the diagnosis and for their close relatives.Method: An existential perspective in this context entails that it is explored and described from a lifeworld perspective of individuals who in various ways experience that which is termed as bipolar disorder. The lifeworld phenomenological approach Reflective Lifeworld Research (RLR) was used in the four empirical studies. Meaning-oriented interviews and analysis were conducted following the leading methodological principles of the chosen scientific approach. A synthesis, based on lifeworld hermeneutic existential philosophy, then presents how it is possible to understand the perspective of individuals with bipolar disorder and their close relatives as a coherent whole.Findings and conclusions: A magnitude and complexity of experiencing, which means that life with bipolar disorder is characterized by extra dimensions, specific tension and contradictions, has been elucidated. Knowledge of the meaning of these aspects enables for the persons with the illness and for their close relatives to understand, to put words to, and to communicate how their life is and what they need, which in turn enhances their ability to influence their lives. It also increases the opportunities for professional caregivers to develop care, both in content and organization, so that it can meet the actual needs of those concerned in an adequate way.Living with bipolar disorder means so much more than the usual description with changes between episodes of depression and mania. The diagnosis “bipolar disorder” thus appears to be an inadequate label that only reflects the more obvious and visible dimensions of the illness, while those that characterize life in its entirety remain hidden.The thesis also shows that the importance of the common everyday life of persons with bipolar disorder and their close relatives should be highlighted as the most important factor in a liveable existence. A change in the view of mental health care is thus needed; a change that is characterized by consensus, collaboration and transparent communication between the person with the illness, their close relatives and mental health care. The common goal should be about meeting actual needs, and to strengthen a profound connectedness in order to make everyday life more liveable.
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| 9. |
- Ahlander, Britt-Marie, 1954-
(author)
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Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown.Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients.Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies.Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV).Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality.
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| 10. |
- Blomqvist, Marjut, 1966-
(author)
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Health among people with psychotic disorders and effects of an individualized lifestyle intervention to promote health
- 2020
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of the thesis was to increase knowledge of health among people with psychotic disorders such as schizophrenia and other long-term psychotic conditions. The aim was also to investigate health effects, in terms of clinical health outcomes and self-reported questionnaires, of atwo-year individualized lifestyle intervention implemented in psychiatric outpatient services involving cooperation with the municipal social psychiatry services. The motivation for the study was to generate new knowledge in order to be able to promote health in people with psychotic disorders and to improve the care and support provided for this target group. The thesis consists of four studies. A quantitative study (Study I), was conducted using a cross-sectional design to investigate the prevalence of overweight, obesity, risk of cardiovascular disease (CVD) and the relationships between self-rated salutogenic health, sense of coherence, CVD risk, and body mass index among people with psychoticdisorders (n=57). The study was conducted in four psychiatric outpatient services; questionnaires were completed by the participants and clinical health measurements were collected by the participant’s contact nurse at the psychiatric outpatient services. The participants showed a moderate/high risk of CVD, the mean for BMI was 31.9 (59.6% were obese) and 31.6% were overweight. The results did not reveal any relationships between the subjective and objective measuresof health indicating the need for both subjective and objective assessments of health in psychiatric care. In a qualitative study (Study II), data were collected with semi-structured interviews (n=16) andanalyzed with qualitative content analysis. The interviews resulted in an overall theme “Being regarded as a whole human being by self and others”, which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a wholeperson if healthy living is to be enabled. In a quasi-experimental study (Study III), the potential effects of participation in the two-year lifestyle intervention (intervention group n=54 and control group (n=13) were investigated. The data were collected at baseline, after 12 months and after 24 months using the self-reported questionnaire the Salutogenic Health Indicator Scale (SHIS), the Hopkins Symptom Checklist (HSCL-25) and the National Public Health Survey. Measures of clinical healthoutcomes were conducted by the participant’s contact nurse at the psychiatric outpatient services. Multilevel modeling was used to test differences in changes over time. Significant changes were foundin physical activity, HbA1c and waist circumference after participation in individualized lifestyle intervention. The relationship between changes in physical activity, levels of salutogenic health and glycated hemoglobin (Hb1Ac) were investigated (n=54) in Study IV. The data were collected atbaseline, after 12 months and after 24 months using the self-reported questionnaires Salutogenic Health Indicator Scale (SHIS) and National Public Health Survey. Within-person changes in physical activity between baseline and at the end of the twenty-four-month intervention were calculated. Selfreported increased physical activity was positively associated with self-rated salutogenic health and negatively associated with level of HbA1c after participation in the intervention. The thesis shows that a well-founded assessment of general health needs must consider both the individual's subjective experiences and objective measurements in order to form a solid foundation for dialogue and shareddecision-making about essential care services. The results also show that it is possible to stimulate healthy behavioral changes with a two-year individualized lifestyle intervention and bring both subjectively and objectively measured health benefits for people with psychotic disorders. The importance of nurses in psychiatric care applying a holistic approach and integrating lifestyle interventions into daily person-centered psychiatric care in collaboration with other healthcare providers to facilitate changes towards a healthy lifestyle in persons with psychotic illness is emphasized in the thesis.
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