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  • 1.
    Amsberg, Susanne
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Wijk, Ingrid
    Sophiahemmet högskola.
    Livheim, Fredrik
    Karolinska Institutet.
    Toft, Eva
    Karolinska Institutet; Ersta sjukhus.
    Johansson, Unn-Britt
    Sophiahemmet högskola; Södersjukhuset.
    Anderbro, Therese
    Karolinska institutet; Stockholms universitet.
    Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 11, p. 1-8, article id e022234Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

    METHODS AND ANALYSIS: This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

    ETHICS AND DISSEMINATION: The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

    TRIAL REGISTRATION NUMBER: NCT02914496; Pre-results.

  • 2.
    Flink, Maria
    et al.
    Karolinska Institutet; Karolinska Universitetsjukhuset.
    Lindblad, Marléne
    Karolinska institutet; Kungliga Tekniska högskolan (KTH).
    Frykholm, Oscar
    Karolinska Institutet.
    Kneck, Åsa
    Karolinska Institutet.
    Nilsen, Per
    Linköpings universitet.
    Årestedt, Kristofer
    Linnéuniversitetet; Länssjukhuset i Kalmar.
    Ekstedt, Mirjam
    Karolinska institutet; Kungliga Tekniska högskolan (KTH); Länssjukhuset i Kalmar.
    The supporting patient activation in transition to home (sPATH) intervention: a study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 7, p. 1-8, article id e014178Article in journal (Refereed)
    Abstract [en]

    Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention.

    Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management.

    Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. 

    Trial registration number NCT02823795; Pre-results.

  • 3.
    Godskesen, Tove
    et al.
    Marie Cederschiöld University, Department of Health Care Sciences. Uppsala universitet.
    Eriksson, Stefan
    Uppsala universitet.
    Oermann, Marilyn H
    Duke University, US.
    Gabrielsson, Sebastian
    Luleå tekniska universitet.
    Predatory conferences: A systematic scoping review2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 11, article id e062425Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To systematically map the scholarly literature on predatory conferences and describe the present state of research and the prevalent attitudes about these conferences.

    METHODS: This scoping review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched (PubMed/Medline, Web of Science, Scopus and ProQuest Social Sciences Premium Collection). In addition, the included studies' reference lists were scanned for additional papers not found in the searches. Peer-reviewed publications were included irrespective of study design. Letters and commentary were included if they were peer reviewed. Editorials and literature reviews were excluded.

    RESULTS: From 809 initial publications, 20 papers were included in the review, from 12 countries and covered a wide range of science disciplines, from nursing/medicine to energy/technology and computer science. More than half were empirical and published after 2017. In most papers, a definition of the term predatory conferences was put forward. Spam email invitations with flattering language were the most common characteristics, and the conferences were often hosted by unknown organisations that used copied pictures without permission. High fees, lack of peer review, and a multidisciplinary scope were signal features. All papers explicitly or implicitly suggested possible reasons for participating in predatory conferences. Some reasons were related to the overall context of academic work, the nature of predatory conferences (eg, researchers falling prey to misleading information about a conference or choosing a conference based on an attractive location) and the personal characteristics of researchers. Only one paper reported empirically identified reasons for participating in predatory conferences. The three countermeasures proposed most frequently to deal with predatory conferences were increasing education, emphasising responsibilities of universities and funders, and publishing lists of predatory publishers associated with conferences.

    CONCLUSIONS: This review identified a scarcity of research concerning predatory conferences. Future empirical as well as fully analytical research should be encouraged by funders, journals and research institutions.

  • 4.
    Lindblad, Marléne
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences. Kungliga Tekniska högskolan.
    Flink, Maria
    Karolinska institutet.
    Ekstedt, Mirjam
    Karolinska institutet; Linnéuniversitetet.
    Exploring patient safety in Swedish specialised home healthcare: An interview study with multidisciplinary teams and clinical managers2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 12, p. 1-7, article id e024068Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Home healthcare is the fastest growing arena in the healthcare system but patient safety research in this context is limited. The aim was to explore how patient safety in Swedish specialised home healthcare is described and adressed from multidisciplinary teams' and clinical managers' perspectives.

    DESIGN: An explorative qualitative study.

    SETTING: Multidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden.

    METHODS: Nine focus group interviews with multidisciplinary teams and six individual interviews with clinical managers were conducted, in total 51 participants. The data were transcribed verbatim and analysed using qualitative content analysis.

    RESULTS: Patient safety was inherent in the well-established care ideology which shaped a common mindset between members in the multidisciplinary teams and clinical managers. This patient safety culture was challenged by the emerging complexity in which priority had to be given to standardised guidelines, quality assessments and management of information in maladapted communication systems and demands for required competence and skills. The multiple guidelines and quality assessments that aimed to promote patient safety from a macro-perspective, constrained the freedom, on a meso-level and micro-level, to adapt to challenges based on the care ideology.

    CONCLUSION: Patient safety in home healthcare is dependent on adaptability at the management level; the team members' ability to adapt to the varying conditions and on patients being capable of adjusting their homes and behaviours to reduce safety risks. A strong culture related to a patient's value as a person where patients' and families' active participation and preferences guide the decisions, could be both a facilitator and a barrier to patient safety, depending on which value is given highest priority.

  • 5.
    Mattelin, Erica
    et al.
    Linköpings universitet.
    Khanolkar, Amal R.
    University College London, United Kingdom; Karolinska institutet.
    Fröberg, Frida
    Linköpings universitet.
    Jonsson, Linda
    Ersta Sköndal Bräcke University College, Department of Social Sciences.
    Korhonen, Laura
    Linköpings universitet.
    'Long journey to shelter': a study protocol : a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 9, article id e043822Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail.

    METHODS AND ANALYSIS: Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden.

    ETHICS AND DISSEMINATION: The Regional Ethics Board of Linköping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.

  • 6.
    Omerov, Pernilla
    et al.
    Karolinska Institutet.
    Steineck, Gunnar
    Karolinska Institutet; Sahlgrenska akademin Göteborgs universitet.
    Nyberg, Tommy
    Sahlgrenska akademin Göteborgs universitet.
    Runeson, Bo
    Karolinska Institutet.
    Nyberg, Ullakarin
    Karolinska Institutet.
    Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey2013In: BMJ Open, E-ISSN 2044-6055, Vol. 3, no 8, article id e003108Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide.

    DESIGN: Population-based survey.

    SETTING: Sweden, between 2009 and 2010.

    PARTICIPANTS: All parents who lost a child, age 15-30, through suicide between 2004 and 2007 according to National population registries. Non-bereaved parents matched for age, sex, living area, marital status, number of children.

    EXCLUSION CRITERIA: born outside a Nordic country, not Swedish speaking, contact details missing. Participants: 666 of 915 (73%) suicide-bereaved and 377 of 508 (74%) non-bereaved parents.

    MAIN OUTCOME MEASURES: Depression measured by the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) and study-specific questions to assess psychological premorbidity and experience of the child's presuicidal morbidity.

    RESULTS: In all, 94 (14%) suicide-bereaved and 51 (14%) non-bereaved parents (relative risk 1.0; 95% CI 0.8 to 1.4) had received their first treatment for psychological problems or had been given a psychiatric diagnosis more than 10 years earlier. The prevalence of moderate-to-severe depression was 115 (18%) in suicide-bereaved versus 28 (7%) in non-bereaved parents (RR 2.3; 95% CI 1.6 to 3.5). For those without psychological premorbidity, the relative risk was 2.3 (95% CI 1.4 to 3.6). 339 (51%) suicide-bereaved parents expressed worry over the child's psychological health during the month preceding the suicide and 259 (39%) had anticipated the suicide.

    CONCLUSIONS: In parents who lost a child through suicide in Sweden we did not find a higher prevalence of long-term psychological premorbidity than among parents who had not lost a child; the more than twofold risk of depression among the bereaved can probably be explained by the suicide and the stressful time preceding the suicide.

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  • 7.
    Schildmeijer, Kristina Görel Ingegerd
    et al.
    Linnéuniversitetet.
    Unbeck, Maria
    Danderyds sjukhus; Karolinska institutet.
    Ekstedt, Mirjam
    Linnéuniversitetet; Karolinska institutet.
    Lindblad, Marléne
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences. Kungliga tekniska högskolan.
    Nilsson, Lena
    Linköpings universitet.
    Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology.2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 1, article id e019267Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.

    DESIGN: A study using retrospective record review and trigger tool methodology.

    SETTING AND METHODS: Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 predefined triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.

    RESULTS: The patients were aged 20-79 years, 280 men and 320 women. The review teams identified 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.

    CONCLUSIONS: AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies.

  • 8. Schildmeijer, Kristina
    et al.
    Nilsson, Lena
    Perk, Joep
    Årestedt, Kristofer
    Ersta Sköndal University College, Palliative Reserch Centre, PRC. Linnéuniversitetet.
    Nilsson, Gunilla
    Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members2013In: BMJ Open, E-ISSN 2044-6055, Vol. 3, no 9, p. e003131-Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm.

    Design: A qualitative, descriptive approach with focus group interviews using content analysis.

    Setting: 5 Swedish hospitals in 2011.

    Participants: 5 GTT teams, with 5 physicians and 11 registered nurses.

    Intervention: 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim.

    Results: 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members' knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics.

    Conclusions: The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

  • 9.
    Wijk, Ingrid
    et al.
    Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
    Amsberg, Susanne
    Marie Cederschiöld University, Department of Health Care Sciences.
    Johansson, Unn-Britt
    Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Livheim, Fredrik
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Toft, Eva
    Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Anderbro, Therese
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden.
    Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: A randomised controlled trial2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e072061Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU).

    Setting: An endocrinologic clinic in Sweden.

    Participants: In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18-70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals.

    Intervention: The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action.

    Outcomes: The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group.

    Results: Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years.

    Conclusions: No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study.

    Trial registration number: NCT02914496.

  • 10.
    Åkeflo, Linda
    et al.
    Göteborgs universitet.
    Dunberger, Gail
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Elmerstig, Eva
    Malmö universitet.
    Skokic, Viktor
    Göteborgs universitet.
    Steineck, Gunnar
    Göteborgs universitet.
    Bergmark, Karin
    Göteborgs universitet.
    Cohort profile: an observational longitudinal data collection of health aspects in a cohort of female cancer survivors with a history of pelvic radiotherapy : a population-based cohort in the western region of Sweden2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e049479Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study 'Health among women after pelvic radiotherapy' was conducted in response to the need for more advanced and longitudinal data concerning long-term radiotherapy-induced late effects and chronic states among female cancer survivors. The objective of this paper is to detail the cohort profile and the study procedure in order to provide a sound basis for future analyses of the study cohort.

    PARTICIPANTS: Since 2011, and still currently ongoing, participants have been recruited from a population-based study cohort including all female patients with cancer, over 18 years of age, treated with pelvic radiotherapy with curative intent at Sahlgrenska University Hospital in Gothenburg, in the western region of Sweden, which covers 1.7 million of the Swedish population. The dataset presented here consists of baseline data provided by 605 female cancer survivors and 3-month follow-up data from 260 individuals with gynaecological, rectal or anal cancer, collected over a 6-year period.

    FINDINGS TO DATE: Data have been collected from 2011 onwards. To date, three studies have been published using the dataset reporting long-term radiation-induced intestinal syndromes and late adverse effects affecting sexuality, the urinary tract, the lymphatic system and physical activity. These projects include the evaluation of interventions developed by and provided in a nurse-led clinic.

    FUTURE PLANS: This large prospective cohort offers the possibility to study health outcomes in female pelvic cancer survivors undergoing a rehabilitation intervention in a nurse-led clinic, and to study associations between demographics, clinical aspects and long-term late effects. Analysis focusing on the effect of the interventions on sexual health aspects, preinterventions and postinterventions, is currently ongoing. The cohort will be expanded to comprise the entire data collection from 2011 to 2020, including baseline data and data from 3-month and 1-year follow-ups after interventions. The data will be used to study conditions and treatment-induced late effects preintervention and postintervention.

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