| 1. |
- Falkenström, Fredrik, Professor, 1972-, et al.
(author)
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Patient Attachment and Reflective Functioning as Predictors for Therapist In-Session Feelings
- 2024
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In: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 71:3, s. 190-201
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Journal article (peer-reviewed)abstract
- Therapists' in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients' pretreatment characteristics. This study aims to improve the understanding of therapists' emotional reactions in the psychotherapeutic setting by investigating if patients' pretreatment mentalization ability and attachment style predicted therapist in-session feelings. In a sample of 87 therapy dyads treated with interpersonal psychotherapy and cognitive behavioral therapy for depression, patient attachment was measured using self-reported Experiences in Close Relationships (ECR) and mentalization using Reflective Functioning (RF). ECR and RF were hypothesized to predict therapist feelings measured by the Feeling Word Checklist-24 at different treatment phases over the full course of treatment. Treatment method, patient age, gender, and pretreatment depression were evaluated as potential confounders. Multilevel modeling was used to analyze the data. Lower RF in patients predicted more negative therapist feelings in the mid- to late-treatment phases and less positive feelings in the late-treatment phase. Self-reported attachment anxiety or avoidance did not predict therapist feelings. Findings indicate that patients' ability to mentalize is important to consider when conducting psychotherapy, as it can influence therapists' feelings in the therapeutic process. Limitations of the present study's approach are discussed, and directions for future research are considered.
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| 2. |
- van der Pals, Jesper, et al.
(author)
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Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants
- 2021
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In: Thrombosis Update. - : Elsevier BV. - 2666-5727. ; 3
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Journal article (peer-reviewed)abstract
- Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. Results: In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p < 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). Conclusions: While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk.
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| 3. |
- Abdollahpur, Mostafa, et al.
(author)
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Respiratory Induced Modulation in f-Wave Characteristics During Atrial Fibrillation
- 2021
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In: Frontiers in Physiology. - : Frontiers Media SA. - 1664-042X. ; 12
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Journal article (peer-reviewed)abstract
- The autonomic nervous system (ANS) is an important factor in cardiac arrhythmia, and information about ANS activity during atrial fibrillation (AF) may contribute to personalized treatment. In this study we aim to quantify respiratory modulation in the f-wave frequency trend from resting ECG. First, an f-wave signal is extracted from the ECG by QRST cancelation. Second, an f-wave model is fitted to the f-wave signal to obtain a high resolution f-wave frequency trend and an index for signal quality control ((Formula presented.)). Third, respiratory modulation in the f-wave frequency trend is extracted by applying a narrow band-pass filter. The center frequency of the band-pass filter is determined by the respiration rate. Respiration rate is estimated from a surrogate respiration signal, obtained from the ECG using homomorphic filtering. Peak conditioned spectral averaging, where spectra of sufficient quality from different leads are averaged, is employed to obtain a robust estimate of the respiration rate. The envelope of the filtered f-wave frequency trend is used to quantify the magnitude of respiratory induced f-wave frequency modulation. The proposed methodology is evaluated using simulated f-wave signals obtained using a sinusoidal harmonic model. Results from simulated signals show that the magnitude of the respiratory modulation is accurately estimated, quantified by an error below 0.01 Hz, if the signal quality is sufficient ((Formula presented.)). The proposed method was applied to analyze ECG data from eight pacemaker patients with permanent AF recorded at baseline, during controlled respiration, and during controlled respiration after injection of atropine, respectively. The magnitude of the respiratory induce f-wave frequency modulation was 0.15 ± 0.01, 0.18 ± 0.02, and 0.17 ± 0.03 Hz during baseline, controlled respiration, and post-atropine, respectively. Our results suggest that parasympathetic regulation affects the magnitude of respiratory induced f-wave frequency modulation.
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| 4. |
- Abdollahpur, Mostafa, et al.
(author)
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Respiratory Modulation in Permanent Atrial Fibrillation
- 2020
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In: 2020 Computing in Cardiology, CinC 2020. - 2325-8861 .- 2325-887X. - 9781728173825 ; 2020-September
-
Conference paper (peer-reviewed)abstract
- Several studies have shown that the autonomic nervous system (ANS) can induce changes during atrial fibrillation (AF). There is currently a lack of methods for quantifying ANS induced variations during AF. The purpose of this study is to quantify respiratory induced modulation in the f-wave frequency trend. Following qrst-cancellation, the local f-wave frequency is estimated by fitting a harmonic f-wave model signal and a quality index (SQI) is computed based on the model fit. The resulting frequency trend is filtered using a narrow bandpass filter with a center frequency corresponding to the local respiration rate. The magnitude of the respiratory induced f-wave frequency modulation is estimated by the envelope of the filtered frequency trend. The performance of the method is validated using simulations and the method is applied to analyze ECG data from eight patients with permanent AF recorded during 0.125 Hz frequency controlled respiration before and after the full vagal blockade, respectively. Results from simulated data show the magnitude of the respiratory induced f-wave frequency modulation can be estimated with an error of less than = 0.005Hz if the SQI is above 0.45. The signal quality was sufficient for analysis in 7 out of 8 patients. In 4 patients the magnitude decreased and in 3 patients there was no change.
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| 5. |
- Alexandersson, Klas, et al.
(author)
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Session-to-session effects of therapist adherence and facilitative conditions on symptom change in CBT and IPT for depression
- 2023
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In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 33:1, s. 57-69
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Journal article (peer-reviewed)abstract
- Objective: The objective of this study was to analyze the effect of adherence to both specific technique factors and facilitative condition variables (e.g., therapists' involvement, understanding and support) in Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). In addition, we were interested in whether the effect of therapist adherence would depend on the level of the working alliance. Method: Three sessions each from 74 patients diagnosed with Major Depressive Disorder who were randomized to 14 sessions of IPT or CBT were rated for adherence using a modified version of The Collaborative Study Psychotherapy Rating Scale-6 (CSPRS-6). Data was analyzed using Multilevel Modeling. Results: No effects of adherence to specific factors on outcome were found in neither CBT nor IPT. Facilitative conditions were associated with better outcome in CBT but not in IPT, even after adjustment for the quality of the working alliance. No interaction effects were found. Conclusions: Our findings highlight the importance of relational factors in CBT, but do not support the need for specific adherence to any of the two treatments. Possible explanations of the findings and directions for future research are discussed.
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| 6. |
- Back, Malin, et al.
(author)
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Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy : results from a naturalistic study
- 2020
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In: Journal of Eating Disorders. - : BioMed Central. - 2050-2974. ; 8:1
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Journal article (peer-reviewed)abstract
- Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease.Methods: Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9).Results: Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session.Conclusions: IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.
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| 7. |
- Bazsefidpay, Nikoo, 1984-, et al.
(author)
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Antibiotic prescription in bone augmentation and dental implant procedures : a multi-center study
- 2023
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In: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections.METHODS: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010-2011 and 200 in 2014-2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012.RESULTS: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010-2011 to 18.5% (n = 37/200) in 2014-2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010-2011 to 35% in 2014-2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines.CONCLUSIONS: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.
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| 8. |
- Berggren, Sofia, et al.
(author)
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ProQ-dependent activation of Salmonella virulence genes mediated by post-transcriptional control of PhoP synthesis
- 2024
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In: mSphere. - : American Society for Microbiology. - 2379-5042. ; 9:3
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Journal article (peer-reviewed)abstract
- Gastrointestinal disease caused by Salmonella enterica is associated with the pathogen's ability to replicate within epithelial cells and macrophages. Upon host cell entry, the bacteria express a type-three secretion system encoded within Salmonella pathogenicity island 2, through which host-manipulating effector proteins are secreted to establish a stable intracellular niche. Transcription of this intracellular virulence program is activated by the PhoPQ two-component system that senses the low pH and the reduced magnesium concentration of host cell vacuoles. In addition to transcriptional control, Salmonella commonly employ RNA-binding proteins (RBPs) and small regulatory RNAs (sRNAs) to regulate gene expression at the post-transcriptional level. ProQ is a globally acting RBP in Salmonella that promotes expression of the intracellular virulence program, but its RNA repertoire has previously been characterized only under standard laboratory growth conditions. Here, we provide a high-resolution ProQ interactome during conditions mimicking the environment of the Salmonella-containing vacuole (SCV), revealing hundreds of previously unknown ProQ binding sites in sRNAs and mRNA 3 ' UTRs. ProQ positively affected both the levels and the stability of many sRNA ligands, some of which were previously shown to associate with the well-studied and infection-relevant RBP Hfq. We further show that ProQ activates the expression of PhoP at the post-transcriptional level, which, in turn, leads to upregulation of the intracellular virulence program.
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| 9. |
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| 10. |
- Ekeblad, Annika, et al.
(author)
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Change in reflective functioning in interpersonal psychotherapy and cognitive behavioral therapy for major depressive disorder
- 2023
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In: Psychotherapy Research. - : Routledge; Taylor & Francis. - 1050-3307 .- 1468-4381. ; 33:3, s. 342-349
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Journal article (peer-reviewed)abstract
- Background Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). Methods In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. Results The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. Conclusions IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction.
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| 11. |
- Eranti, Antti, et al.
(author)
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Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register
- 2020
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In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 22:8, s. 1173-1181
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Journal article (peer-reviewed)abstract
- AIMS: Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology. METHODS AND RESULTS: P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978-80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66-6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66-5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26-0.83; P = 0.006), compared to the rest of the subjects. CONCLUSION: P-wave parameters associate with the risk of hospitalization with AF.
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| 12. |
- Falkenström, Fredrik, 1972-, et al.
(author)
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Therapist in-session feelings predict change in depressive symptoms in interpersonal and brief relational psychotherapy
- 2022
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In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 32:5, s. 571-584
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Journal article (peer-reviewed)abstract
- Objective: Brief Relational Therapy (BRT) includes the idea that the therapists use their in-session feelings in meta-communications about the therapy relationship to facilitate resolution of alliance ruptures. The current study aimed to explore the effect of therapist feelings on patient depressive symptoms in BRT compared to Interpersonal Psychotherapy (IPT). Methods: The effects of therapist feelings were studied in 40 patients randomized to 16 sessions of IPT or BRT, using the Feeling Word Checklist-24, the Patient Health Questionnaire-9 and the Working Alliance Inventory. Data was analyzed using dynamic structural equation modeling. Results: Negative therapist feelings predicted increase and positive feelings decrease in next-session PHQ-9 via the alliance and the patients' engaged feelings, in both treatments. The direct effect of negative therapist feelings on PHQ-9 differed significantly between BRT and IPT, with more negative feelings predicting a decrease in PHQ-9 in BRT but not in IPT. Conclusion: Negative therapist feelings may cause increase/less decrease and positive feelings more decrease in depressive symptoms via disruptions in the alliance. In BRT, if the alliance is unaffected by negative therapist feelings, the patient's depressive symptoms may improve. Findings need replication in a larger sample.
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| 13. |
- Hamrefors, Viktor, et al.
(author)
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Gut microbiota composition is altered in postural orthostatic tachycardia syndrome and post-acute COVID-19 syndrome
- 2024
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In: Scientific Reports. - 2045-2322. ; 14:1
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Journal article (peer-reviewed)abstract
- Postural Orthostatic Tachycardia Syndrome (POTS) reflects an autonomic dysfunction, which can occur as a complication to COVID-19. Our aim was to examine gastrointestinal symptoms and gut microbiota composition in patients with POTS and post-acute COVID-19 syndrome (PACS), compared with controls. POTS patients (n = 27), PACS patients (n = 32) and controls (n = 39) delivered fecal samples and completed a 4-day food diary, irritable bowel syndrome-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). A total of 98 DNA aliquots were sequenced to an average depth of 28.3 million (M) read pairs (Illumina 2 × 150 PE) per sample. Diversity and taxonomic levels of the microbiome, as well as functional abundances were calculated for POTS and PACS groups, then compared with controls. There were several differences in taxonomic composition between POTS and controls, whereas only the abundance of Ascomycota and Firmicutes differed between PACS and controls. The clinical variables total IBS-SSS, fatigue, and bloating and flatulence significantly correlated with multiple individual taxa abundances, alpha diversity, and functional abundances. We conclude that POTS, and to a less extent PACS, are associated with differences in gut microbiota composition in diversity and at several taxonomic levels. Clinical symptoms are correlated with both alpha diversity and taxonomic and functional abundances.
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| 14. |
- Holmqvist, Fredrik, et al.
(author)
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Study of ECG-derived atrial fibrillatory rate for prediction of the outcome of cardioversion of short duration atrial fibrillation (CASAF)
- 2023
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In: Journal of Electrocardiology. - 0022-0736. ; 81, s. 20-22
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Journal article (peer-reviewed)abstract
- Aims: The present study aimed at testing the hypothesis that atrial fibrillatory rate (AFR) is predictive of sinus rhythm maintenance after electrical cardioversion. Methods and results: The study comprised 32 patients admitted for cardioversion of atrial fibrillation of short duration (mean duration 3.8 ± 7.7 days). AFR was estimated using frequency power spectrum analysis of QRST-cancelled ECG. At six-weeks follow-up 22% of the patients had relapsed to AF. The pre-cardioversion mean AFR of those was 332 ± 64 fpm compared to 378 ± 59 fpm among patients maintaining sinus rhythm (p = 0.12). Conclusion: AFR was not predictive of sinus rhythm maintenance in patients of short duration AF undergoing cardioversion. This is in stark contrast with the earlier reported findings. Clinical trial registration: NCT02112318 (http://www.clinicaltrials.gov).
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| 15. |
- Holmqvist Larsson, Kristina, et al.
(author)
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"It's ok that I feel like this" : a qualitative study of adolescents' and parents' experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training
- 2023
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In: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Journal article (peer-reviewed)abstract
- BackgroundEmotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants' in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants' experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.MethodsTwenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.ResultsThe analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.ConclusionThe results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.
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| 16. |
- Kronzer, V. L., et al.
(author)
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Respiratory Diseases as Risk Factors for Seropositive and Seronegative Rheumatoid Arthritis and in Relation to Smoking
- 2021
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In: Arthritis & Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 73:1, s. 61-68
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Journal article (peer-reviewed)abstract
- Objective The link and interplay between different airway exposures and rheumatoid arthritis (RA) risk are unclear. This study was undertaken to determine whether respiratory disease is associated with development of RA, and specifically to examine this relationship by RA serostatus and smoking exposure. Methods Using data from the Epidemiological Investigation of Rheumatoid Arthritis study, this analysis included 1,631 incident RA cases and 3,283 matched controls recruited from 2006 to 2016. Linking these individuals to the National Patient Register provided information on past diagnoses of acute or chronic upper or lower respiratory disease. For each disease group, we estimated adjusted odds ratios (ORadj) with 95% confidence intervals (95% CIs) for RA, using logistic regression models adjusted for age, sex, residential area, body mass index, and education level both overall and stratified by anti-citrullinated protein antibody (ACPA)/rheumatoid factor (RF) status and by smoking status. Results Respiratory disease diagnoses were associated with risk of RA, with an ORadj of 1.2 (95% CI 0.8-1.7) for acute upper respiratory disease, 1.4 (95% CI 1.1-1.9) for chronic upper respiratory disease, 2.4 (95% CI 1.5-3.6) for acute lower respiratory disease, and 1.6 (95% CI 1.5-3.6) for chronic lower respiratory disease. These associations were present irrespective of RF or ACPA status, though the association was somewhat stronger for ACPA-positive or RF-positive RA than for ACPA-negative or RF-negative RA. The association between any respiratory disease and RA was stronger for nonsmokers (ORadj 2.1 [95% CI 1.5-2.9]) than for smokers (ORadj 1.2 [95% CI 0.9-1.5]). Conclusion Respiratory diseases increase the risk for both seropositive and seronegative RA, but only among nonsmokers. These findings raise the hypothesis that smoking and airway disease are associated with RA development through partly different mechanisms.
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| 17. |
- Loring, Zak, et al.
(author)
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Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block
- 2022
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In: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X .- 1542-474X. ; 27:4
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Journal article (peer-reviewed)abstract
- Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p =.005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
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| 18. |
- Mannewald, Christine, et al.
(author)
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Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation
- 2024
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In: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 29:3
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Journal article (peer-reviewed)abstract
- Background: To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2-VASc score. Method: Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018–2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann–Whitney U-test and Pearson Chi-squared analysis to test for correlation. Results: Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2-VASc score, more often presented in AF at TEE and less often had a normal sized left atrium. Conclusion: There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.
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| 19. |
- Nissen-Lie, Helene A., et al.
(author)
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Does it make a difference to be more "on the same page"? Investigating the role of alliance convergence for outcomes in two different samples
- 2021
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In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 31:5, s. 573-588
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Journal article (peer-reviewed)abstract
- Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of alliance research using dyadic multilevel modeling, the present study investigated the hypothesis that convergence in the patient-therapist working alliance (i.e., increased similarity in ratings of the alliance across treatment) would be associated with better outcomes. Method: Data were retrieved from two samples: 1. A randomized controlled trial for treatment resistant depression (N = 96 dyads), and 2. An archival dataset of naturalistic psychotherapies from public health care (N = 139 dyads). Multilevel growth curve analysis was employed to investigate the degree of change in session-to-session agreement of global WAI ratings between therapists and patients (i.e., alliance convergence) as a predictor of symptom reduction in the BDI-II and the SCL-90R. Results: Contrary to our expectations, alliance convergence did not predict outcome in either sample, but was negatively associated with symptom severity in Study 2. Implications for understanding the complexity of dyadic processes and alliance work in psychotherapy are discussed.
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| 20. |
- Redlinger-Pohn, Jakob D., et al.
(author)
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Mechanisms of Cellulose Fiber Comminution to Nanocellulose by Hyper Inertia Flows
- 2022
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In: ACS Sustainable Chemistry and Engineering. - : American Chemical Society. - 2168-0485. ; 10:2, s. 703-719
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Journal article (peer-reviewed)abstract
- Nanocelluloses are seen as the basis of high-performance materials from renewable sources, enabling a bio-based sustainable future. Unsurprisingly, research has initially been focused on the design of new material concepts and less on new and adapted fabrication processes that would allow large-scale industrial production and widespread societal impact. In fact, even the processing routes for making nanocelluloses and the understanding on how the mechanical action fibrillates plant raw materials, albeit chemically or enzymatically pre-treated, are only rudimentary and have not evolved significantly during the past three decades. To address the challenge of designing cellulose comminution processes for a reliable and predictable production of nanocelluloses, we engineered a study setup, referred to as Hyper Inertia Microfluidizer, to observe and quantify phenomena at high speeds and acceleration into microchannels, which is the underlying flow in homogenization. We study two different channel geometries, one with acceleration into a straight channel and one with acceleration into a 90° bend, which resembles the commercial equipment for microfluidization. With the purpose of intensification of the nanocellulose production process, we focused on an efficient first pass fragmentation. Fibers are strained by the extensional flow upon acceleration into the microchannels, leading to buckling deformation and, at a higher velocity, fragmentation. The treatment induces sites of structural damage along and at the end of the fiber, which become a source for nanocellulose. Irrespectively on the treatment channel, these nanocelluloses are fibril-agglomerates, which are further reduced to smaller sizes. In a theoretical analysis, we identify fibril delamination as failure mode from bending by turbulent fluctuations in the flow as a comminution mechanism at the nanocellulose scale. Thus, we argue that intensification of the fibrillation can be achieved by an initial efficient fragmentation of the cellulose in smaller fragments, leading to a larger number of damaged sites for the nanocellulose production. Refinement of these nanocelluloses to fibrils is then achieved by an increase in critical bending events, i.e., decreasing the turbulent length scale and increasing the residence time of fibrils in the turbulent flow. © 2022 The Authors.
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| 21. |
- Rizvanovic, Alisa, et al.
(author)
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Saturation mutagenesis charts the functional landscape of Salmonella ProQ and reveals a gene regulatory function of its C-terminal domain
- 2021
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In: Nucleic Acids Research. - : Oxford University Press. - 0305-1048 .- 1362-4962. ; 49:17, s. 9992-10006
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Journal article (peer-reviewed)abstract
- The global RNA-binding protein ProQ has emerged as a central player in post-transcriptional regulatory networks in bacteria. While the N-terminal domain (NTD) of ProQ harbors the major RNA-binding activity, the role of the ProQ C-terminal domain (CTD) has remained unclear. Here, we have applied saturation mutagenesis coupled to phenotypic sorting and long-read sequencing to chart the regulatory capacity of Salmonella ProQ. Parallel monitoring of thousands of ProQ mutants allowed mapping of critical residues in both the NTD and the CTD, while the linker separating these domains was tolerant to mutations. Single amino acid substitutions in the NTD associated with abolished regulatory capacity strongly align with RNA-binding deficiency. An observed cellular instability of ProQ associated with mutations in the NTD suggests that interaction with RNA protects ProQ from degradation. Mutation of conserved CTD residues led to overstabilization of RNA targets and rendered ProQ inert in regulation, without affecting protein stability in vivo. Furthermore, ProQ lacking the CTD, although binding competent, failed to protect an mRNA target from degradation. Together, our data provide a comprehensive overview of residues important for ProQ-dependent regulation and reveal an essential role for the enigmatic ProQ CTD in gene regulation.
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| 22. |
- Sun, Qiwu, et al.
(author)
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Separating the effects of alliance ruptures and improvements on outcome session-by-session using the asymmetric fixed-effect model
- 2021
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In: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 68:6, s. 696-704
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Journal article (peer-reviewed)abstract
- Objective: The aim of this paper was to introduce the Asymmetric Fixed Effects model to psychotherapy mechanisms of change researchers as a novel way of studying the effects of improvements and deteriorations in the candidate mechanism(s) separately. Alliance-outcome research was used to illustrate the possibility of estimating separate effects of improvements and deteriorations in the allianceMethod: Two archival datasets were used. One was from community-based primary care services in Sweden using theClinical Outcomes in Routine Evaluation — Outcome Measure (CORE-OM) and the Working Alliance Inventory—Short form (WAI-S, therapist form) each session with 1096 patients. The other dataset was from a university counseling center in China using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS) each session with 292 patients. Data was analyzed using the asymmetric fixed-effects model.Results: The findings indicated that with raw scores, improvements in alliance from one session to the next were followed by lower symptoms/distress scores by the next session, but alliance deteriorations had no effect on next-session symptoms/distress. With alliance deteriorations and improvements defined relative to the sample’s average linear change over time, improvements and deteriorations had equal but opposite effects on next session symptom level.Conclusion: Findings confirm the utility of the Asymmetric Fixed Effect model across two cross-national samples in showing that alliance deteriorations and improvements can predict next session symptoms separately at the within-person level. Findings raise new questions regarding the use of detrending in within-patient mechanism of change studies.
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| 23. |
- Sun, Qiwu, et al.
(author)
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Separating the Effects of Improvements and Deteriorations in Mechanisms on Outcome Using the Asymmetric Effects Model
- 2021
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In: Journal of counseling psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-0167 .- 1939-2168. ; 68:6, s. 696-704
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Journal article (peer-reviewed)abstract
- Objective: The aim of this article was to introduce the Asymmetric Fixed Effects (AFE) model to psychotherapy mechanisms of change researchers as a novel way of studying the effects of improvements and deteriorations in the candidate mechanism(s) separately. Alliance-outcome research was used to illustrate the possibility of estimating separate effects of improvements and deteriorations in the alliance. Method: Two archival data sets were used. One was from community-based primary care services in Sweden using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Working Alliance Inventory-Short form (WAI-S, therapist form) each session with 1,096 patients. The other data set was from a university counseling center in China using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS) each session with 292 patients. Data were analyzed using the AFE model. Results: The findings indicated that with raw scores, improvements in alliance from one session to the next were followed by lower symptoms/distress scores by the next session, but alliance deteriorations had no effect on next-session symptoms/distress. With alliance deteriorations and improvements defined relative to the samples average linear change over time, improvements, and deteriorations had equal but opposite effects on next session symptom level. Conclusions: Findings confirm the utility of the Asymmetric Fixed Effect model across two cross-national samples in showing that alliance deteriorations and improvements can predict next session symptoms separately at the within-person level. Findings raise new questions regarding the use of detrending in within-patient mechanism of change studies.
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| 24. |
- Söderberg Gidhagen, Ylva, et al.
(author)
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The role of the working alliance in psychological treatment of substance use disorder outpatients
- 2021
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In: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 31:5, s. 557-572
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Journal article (peer-reviewed)abstract
- Objective: The main objective of this study was to explore the relationship between alliance and treatment outcome of substance use disorder (SUD) outpatients in routine care. Attachment, type of substance use, and treatment orientation were analyzed as potential moderators of this relationship.Method: Ninety-nine SUD outpatients rated their psychological distress before every session. Patients and therapists rated the alliance after every session. At treatment start and end, the patient completed the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test (DUDIT), and the Experiences in Close Relationships (ECR-S). Data were analyzed using multilevel growth curve modeling and Dynamic Structural Equation Modeling (DSEM).Results: The associations between alliance and outcome on psychological distress and substance use were, on average, weak. Within-patient associations between patient-rated alliance and outcome were moderated by self-rated attachment. Type of abuse moderated associations between therapist-rated alliance and psychological distress. No moderating effect was found for treatment orientation.Conclusions: Patients' attachment style and type of abuse may have influenced the association between alliance and problem reduction. A larger sample size is needed to confirm these findings.
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| 25. |
- Uckelstam, Carl-Johan, 1983-, et al.
(author)
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A relational perspective on the association between working alliance and treatment outcome
- 2020
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In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 30:1, s. 13-22
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Journal article (peer-reviewed)abstract
- Objective: Evidence is inconclusive on whether variability in alliance ratings within or between therapists is a better predictor of treatment outcome. The objective of the present study was to explore between and within patient and therapist variability in alliance ratings, reciprocity among them, and their significance for treatment outcome. Method: A large primary care psychotherapy sample was used. Patient and therapist ratings of the working alliance at session three and patient ratings of psychological distress pre-post were used for analyses. A one-with-many analytical design was used in order to address problems associated with nonindependence. Results: Within-therapist variation in alliance ratings accounted for larger shares of the total variance than between-therapist variation in both therapist and patient ratings. Associations between averaged patient and therapist ratings of the alliance for the individual therapists and their average treatment outcome were weak but the associations between specific alliance ratings and treatment outcome within therapies were strong. Conclusions: The results indicated a substantial dyadic reciprocity in alliance ratings. Within-therapist variation in alliance was a better predictor of treatment outcome than between-therapist variation in alliance ratings.
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| 26. |
- Uckelstam, Carl-Johan, 1983-
(author)
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Looking into the Future : How to Use Advanced Statistical Methods for Predicting Psychotherapy Outcomes in Routine Care
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed.The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today.Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment.The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research.
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| 27. |
- von Olshausen, Gesa, et al.
(author)
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Cardiac tamponades related to interventional electrophysiology procedures are associated with higher risk of short-term hospitalization for pericarditis but favourable long-term outcome
- 2023
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In: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 25:6
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Journal article (peer-reviewed)abstract
- AIMS: To investigate the association of iatrogenic cardiac tamponades as a complication of invasive electrophysiology procedures (EPs) and mortality as well as serious cardiovascular events in a nationwide patient cohort during long-term follow-up.METHODS: From the Swedish Catheter Ablation Registry between 2005 and 2019, a total of 58 770 invasive EPs in 44 497 patients were analysed. From this, all patients with periprocedural cardiac tamponades related to invasive EPs were identified (n = 200; tamponade group) and matched (1:2 ratio) to a control group (n = 400). Over a follow-up of 5 years, the composite primary endpoint-death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure-revealed no statistically significant association with cardiac tamponade [hazard ratio (HR) 1.22 (95% CI, 0.79-1.88)]. All single components of the primary endpoint as well as cardiovascular death revealed no statistically significant association with cardiac tamponade. Cardiac tamponade was associated with a significantly higher risk with hospitalization for pericarditis [HR 20.67 (95% CI, 6.32-67.60)].CONCLUSION: In this nationwide cohort of patients undergoing invasive EPs, iatrogenic cardiac tamponade was associated with an increased risk of hospitalization for pericarditis during the first months after the index procedure. In the long-term, however, cardiac tamponade revealed no significant association with mortality or other serious cardiovascular events.
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| 28. |
- von Olshausen, Gesa, et al.
(author)
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Cardiac tamponades related to interventional electrophysiology procedures are associated with higher risk of short-term hospitalization for pericarditis but favourable long-term outcome.
- 2023
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In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press. - 1532-2092 .- 1099-5129. ; 25:6
-
Journal article (peer-reviewed)abstract
- To investigate the association of iatrogenic cardiac tamponades as a complication of invasive electrophysiology procedures (EPs) and mortality as well as serious cardiovascular events in a nationwide patient cohort during long-term follow-up.From the Swedish Catheter Ablation Registry between 2005 and 2019, a total of 58 770 invasive EPs in 44 497 patients were analysed. From this, all patients with periprocedural cardiac tamponades related to invasive EPs were identified (n = 200; tamponade group) and matched (1:2 ratio) to a control group (n = 400). Over a follow-up of 5 years, the composite primary endpoint-death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure-revealed no statistically significant association with cardiac tamponade [hazard ratio (HR) 1.22 (95% CI, 0.79-1.88)]. All single components of the primary endpoint as well as cardiovascular death revealed no statistically significant association with cardiac tamponade. Cardiac tamponade was associated with a significantly higher risk with hospitalization for pericarditis [HR 20.67 (95% CI, 6.32-67.60)].In this nationwide cohort of patients undergoing invasive EPs, iatrogenic cardiac tamponade was associated with an increased risk of hospitalization for pericarditis during the first months after the index procedure. In the long-term, however, cardiac tamponade revealed no significant association with mortality or other serious cardiovascular events.
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| 29. |
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| 30. |
- Åkerman, Anna, et al.
(author)
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Effects of Mentalization-based Interventions on Mental Health of Youths in Foster Care
- 2022
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In: Child Care in Practice. - : Taylor & Francis Group. - 1357-5279 .- 1476-489X. ; 28:4, s. 536-549
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Journal article (peer-reviewed)abstract
- Knowledge about the development of mental health in young people in foster care is limited. This naturalistic study examined the effects of a relational and mentalization-focused treatment in foster families in Sweden on the placed young people’s mental health. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure change in psychiatric symptoms. Self-ratings showed significant improvements and medium to strong effects after 24 months in both boys and girls. No significant changes were found in the foster parents’ ratings or in the school staff’s ratings. Foster parents’ ratings suggested that girls’ behavioral problems decreased, but not the boys’. Based on these findings, we want to emphasize the importance of evaluating treatment effects using self-ratings by the young people in addition to parents’ and parent substitutes’ ratings.
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| 31. |
- Åkerman, Anna-Karin E., 1969-
(author)
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Relationally focused specialized foster care : Relational experiences and changes in mental health and adaptive functioning
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: Foster care is a relatively common arrangement when parents are unable to meet the needs of their children. Specialized foster care is sometimes applied in cases when problems are more serious and complex. More knowledge is needed about the effects of such specialized foster care.Aims: To explore trajectories of change associated with specialized foster care in a treatment model with a relational and mentalization-based orientation, and to develop the understanding of foster children’s and their foster parents’ experiences of their relationship living in a treatment foster family.Methods: Children and young people between the ages of 5 and 20 years who received treatment within a specialized foster care model, Treatment By Foster care (TBF), participated in this study. Longitudinal data collected in a naturalistic setting were analyzed quantitatively. In Studies 1 and 2, the number of participants at baseline varied for different instruments between 76 – 105. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure how psychiatric symptoms change from the perspectives of the foster children, the foster parents, and teachers. The Adaptive Behavior Assessment System – second edition (ABAS-II) was used to measure adaptive functioning from the foster parents’ perspective. Self-ratings by the children and young people of their emotional and social problems were measured with the Beck Youth Inventories of Emotional and Social Impairment (BYI). Data about experiences of the relationship between child and foster parent were collected through repeated individual short interviews/speeches with both children and their foster parents according to Five Minute Speech Sample (FMSS) (n = 14). Interviews/speeches were analyzed using Thematic Analysis (TA).Results: The ratings of foster parents and foster children differed. The analyses showed a significant reduction in psychiatric symptoms, emotional and social problems according to the self-ratings by the children and young people. According to foster parents and teachers, psychiatric symptoms did not decrease. The baseline ratings of adaptive functioning by foster parents showed that adaptive functioning was considerably below peers from the Swedish non-clinical norm group. Adaptive functioning did improve but not enough to approach or catch up with peers.Analysis of the interviews/speeches generated three main themes containing seven subthemes. Main themes were: No 'real' family, A co-created relationship, and Time. Participants related to a norm for what a 'real' family is and seemed to presuppose that the biological family is the 'real' family. A co-created relationship related to No 'real' family as an answer or a solution. The challenges in the foster family constellation could be overcome by a mutual ambition to build a relationship and by liking each other. Time appeared as a common theme and both as an opportunity and a threat to the relationship. Despite the fact that no interview question concerned the duration of the relationship, the participants described their relationship based on how long they had known each other.Conclusions: According to the foster children’s and young people’s self-ratings, their mental health improved, and their social problems decreased. It is likely that the TBF-model contributed to this improved psychological well-being, although causal relationships could not be established without any comparison group. However, the model did not seem to contribute to the foster parents experiencing improvement in the foster children’s psychological well-being or adaptive functioning.Based on the results of this thesis, it may be effective to place children and young people in specialized foster care with a relational and mentalization-oriented focus, but the results are not clear-cut. Practice and policies should take greater account of the time aspect in foster care, and work with the aim of increasing clarity and security, and thereby enabling a more stable upbringing for some of society’s most vulnerable children. Also, this may make foster parents want to continue their mission.More studies are needed to gain knowledge about how specialized foster care should be applied. Future studies also need to focus on creating knowledge about which aspects of the treatment are decisive.
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| 32. |
- Åkerman, Anna, 1969-, et al.
(author)
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What changes during specialized foster care? : A study on adaptive functioning and emotional and social problems
- 2023
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In: Child & Family Social Work. - : John Wiley & Sons. - 1356-7500 .- 1365-2206. ; 28:2, s. 405-416
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Journal article (peer-reviewed)abstract
- Various models of specialized foster care have been developed, but research on them is limited. This longitudinal, exploratory study analysed data on adaptive functioning, emotional and social problems and self-concept in a specialized foster care service in Sweden. The focus of the study was on the development of the children and young people in placement. The Adaptive Behaviour Assessment System (ABAS-II) was used to measure adaptive functioning, and the Beck Youth Inventories of Emotional and Social Impairment (BYI) was used to measure self-rated emotional and social problems and self-concept. Self-ratings showed significant improvements in disruptive behaviour, anger, anxiety and depression. Adaptive functioning as rated by foster parents improved but not enough to catch up with the non-clinical norm group. The average adaptive functioning among the participants at baseline was considerably below the Swedish norm group. Similar to the results of a previous study of the same treatment model, children and young people rated improvement while their foster parents did not do so to the same extent. Possible explanations for this are discussed in the paper. The study is limited by the lack of a control group and by data attrition.
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