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  • 1.
    Arnold, Samuel R. C.
    et al.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Foley, Kitty-Rose
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Hwang, Ye In (Jane)
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Richdale, Amanda L.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Uljarevic, Mirko
    Stanford Autism Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University.
    Lawson, Lauren P.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Cai, Ru Ying
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Torbjörn
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Marita
    Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Lennox, Nick
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Urbanowicz, Anna
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Trollor, Julian N.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Cohort profile: The Australian Longitudinal Study of Adults with Autism2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 12, artikel-id e030798Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​

    PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​

    FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area.

    ​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

  • 2.
    Clarke, David
    et al.
    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, United Kingdom.
    Jones, Fiona
    Faculty of Health Social Care and Education, St George's University of London, London, United Kingdom.
    Harris, Ruth
    Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings?: A rapid evidence synthesis2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 7, artikel-id e014650Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.

    Aims

    To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.

    Design

    Rapid evidence synthesis.

    Data sources

    Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.

    Study selection

    Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.

    Findings

    712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.

    Conclusions

    Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered. 

  • 3.
    Eide, Leslie S. P.
    et al.
    Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan Erik
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
    Norekval, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway .
    Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 10, artikel-id e012683Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission.

    Design: Prospective cohort study of patients undergoing elective SAVR or TAVI.

    Setting: Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway.

    Participants: Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. Primary and secondary outcome measures: The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries.

    Results: Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (nondelirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. Conclusions: Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.

  • 4.
    Hvitfeldt-Forsberg, Helena
    et al.
    Medical Management Centre, Karolinska Institutet.
    Mazzocato, Pamela
    Medical Management Centre, Karolinska Institutet.
    Glaser, Daniel
    Medical Management Centre, Karolinska Institutet.
    Keller, Christina
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Unbeck, Maria
    Danderyds sjukhus.
    Staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in quality improvement: A focus group discussion study at two hospital settings in Sweden2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 5, artikel-id e013869Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore healthcare staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in improvement efforts.

    Design: Two focus group discussions were performed.

    Settings: Two settings were included: a rheumatology department and an orthopaedic section both situated in Sweden.

    Participants: Healthcare staff and managers (n=13) from the two settings.

    Interventions: Two workshops were performed, one at each setting. Workshops were initiated by a short introduction to simulation modelling. Results from the respective simulation model were then presented and discussed in the following focus group discussion.

    Results: Categories from the content analysis are presented according to the following research questions: how and when simulation modelling can assist healthcare improvement? Regarding how, the participants mentioned that simulation modelling could act as a tool for support and a way to visualise problems, potential solutions and their effects. Regarding when, simulation modelling could be used both locally and by management, as well as a pedagogical tool to develop and test innovative ideas and to involve everyone in improvement work.

    Conclusions: Its potential as an information and communication tool and as an instrument for pedagogic work with healthcare improvement render a broader application and value of simulation modelling than previously reported.

  • 5.
    Johnsen, Anna M.
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Fransson, Eleonor I.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 10, artikel-id e012692Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction.

    Design Prospective cohort study.

    Participants Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity.

    Outcome Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day.

    Conclusions No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

  • 6.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Käll, Jacob
    Djursdala samhällsförening, Djursdala, Sweden, Sweden.
    McGrath, Jane
    London, United Kingdom.
    Donetto, Sara
    Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikel-id e029723Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION:

    Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

    METHODS AND ANALYSIS:

    Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

    ETHICS AND DISSEMINATION:

    All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

  • 7.
    Olsen, Birgitta
    et al.
    Högskolan i Jönköping, Hälsohögskolan. Univ Orebro, Sch Hlth & Med Sci, Orebro, Sweden.
    Månsson, Fredrik
    Lund Univ, Dept Clin Sci, Infect Dis Res Unit, Malmo, Sweden.
    Camara, Cidia
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Monteiro, Mario
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Biai, Ansu
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Alves, Alfredo
    Simao Mendes Natl Hosp, Dept Obstet & Gynaecol, Bissau, Guinea Bissau.
    Andersson, Sören
    Örebro Univ Hosp, WHO Collaborating Ctr Gonorrhoea & Other STIs, Natl Reference Lab Pathogen Neisseria, Dept Lab Med, Örebro, Sweden.
    Norrgren, Hans
    Lund Univ, Dept Clin Sci, Div Infect Med, Lund, Sweden.
    Unemo, Magnus
    Örebro Univ Hosp, WHO Collaborating Ctr Gonorrhoea & Other STIs, Natl Reference Lab Pathogen Neisseria, Dept Lab Med, Örebro, Sweden.
    Phenotypic and genetic characterisation of bacterial sexually transmitted infections in Bissau, Guinea-Bissau, West Africa: a prospective cohort study2012Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, nr 2, s. e000636-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowledge regarding characteristics and transmission of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium and antibiotic resistance in N gonorrhoeae in Guinea-Bissau, West Africa, is entirely lacking. Objectives: To characterise N gonorrhoeae, C trachomatis and M genitalium samples from Guinea-Bissau and to define bacterial populations, possible transmission chains and for N gonorrhoeae spread of antibiotic-resistant isolates. Design: Prospective cohort study. Setting: Two sexual health and family planning clinics, Bissau, Guinea-Bissau. Participants: Positive samples from 711 women and 27 men. Material and methods: Positive samples for N gonorrhoeae (n=31), C trachomatis (n=60) and M genitalium (n=30) were examined. The gonococcal isolates were characterised with antibiograms, serovar determination and N gonorrhoeae multiantigen sequence typing (NG-MAST). The C trachomatis ompA gene and the M genitalium mgpB gene were sequenced, and phylogenetic analyses were performed. Results: For N gonorrhoeae, the levels of resistance (intermediate susceptibility) to ciprofloxacin, erythromycin, rifampicin, ampicillin, tetracycline, penicillin G and cefuroxime were 10% (0%), 6% (10%), 13% (10%), 68% (0%), 74% (0%), 68% (16%) and 0% (84%), respectively. All isolates were susceptible to cefixime, ceftriaxone, spectinomycin and azithromycin, and the minimum inhibitory concentrations of kanamycin (range: 8-32 mg/l) and gentamicin (range: 0.75-6 mg/I) were low (no resistance breakpoints exist for these antimicrobials). 19 NC-MAST sequence types (STs) (84% novel STs) were identified. Phylogenetic analysis of the C trachomatis ompA gene revealed genovar G as most prevalent (37%), followed by genovar D (19%). 23 mgpB STs were found among the M genitalium isolates, and 67% of isolates had unique STs. Conclusions: The diversity among the sexually transmitted infection (STI) pathogens may be associated with suboptimal diagnostics, contact tracing, case reporting and epidemiological surveillance. In Guinea-Bissau, additional STI studies are vital to estimate the STI burden and form the basis for a national sexual health strategy for prevention, diagnosis and surveillance of STIs.

  • 8.
    Robert, Glenn
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale, Faculty of Nursing and Midwifery, King's College, London, London, United Kingdom.
    Philippou, J.
    Leamy, M.
    Reynolds, E.
    Ross, S.
    Bennett, L.
    Taylor, C.
    Shuldham, C.
    Maben, J.
    Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-20152017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 1, artikel-id e014326Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so.

    Setting: Public healthcare organisations in England.

    Participants: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations.

    Results: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'.

    Conclusions: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England.

  • 9.
    Roos Af Hjelmsäter, Elin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Höglandssjukhuset, Region Jönköping, Eksjö, Sweden.
    Ros, Axel
    Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov, Region Jönköping, Jönköping, Sweden.
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Futurum, Landstinget i Jönköpings län, Jönköping, Sweden.
    Westrin, Åsa
    Faculty of Medicine, Department of Clinical Sciences, Division of Psychiatry, Lund University, Lund, Sweden.
    Deficiencies in healthcare prior to suicide and actions to deal with them: A retrospective study of investigations after suicide in Swedish healthcare2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 12, artikel-id e032290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    The overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro-meso-macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority's decisions.

    Design and setting

    This is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.

    Results

    In 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in 'suicide risk assessment' and 'treatment'. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were 'education and competence', present in 52% of cases (n=227) and did not much correspond with identified deficiencies. Sixty-five per cent of the deficiencies and actions were at microlevel, while the remainders were at mesolevel. In 65% (n=284) of cases, the supervisory authority approved the investigation without further requirements.

    Conclusions

    The most common identified deficiencies were related to care in the immediate interface between patient and staff. Actions proposed to prevent new suicides were centred on single educational interventions without distinctive sustainable effects in the organisations and usually did not correspond with the identified deficiencies. Future research should examine if application of a framework based on knowledge of the suicide process, suicide prevention strategies and patient safety would enable more sophisticated investigations that could facilitate progress on suicide prevention. 

  • 10.
    Vislapuu, Maarja
    et al.
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Igland, Jannicke
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Vorderstrasse, Allison
    Rory Meyers College of Nursing, New York University, New York City, New York, USA.
    Iversen, Marjolein M.
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Psychometric properties of the Norwegian version of the short form of The Problem Areas in Diabetes scale (PAID-5): a validation study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 2, artikel-id e022903Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To assess the psychometric properties of the short form of The Problem Areas in Diabetes scale (PAID-5) in Norwegian adult patients with type 1 or type 2 diabetes.

    DESIGN: Cross-sectional survey design.

    METHODS: Participants (n=143) were included from three Western-Norway endocrinology outpatient clinics. Demographic and clinical data were collected in addition to questionnaires concerning diabetes-related distress, fear of hypoglycaemia, symptoms of depression, emotional well-being and perception of general health. Psychometric evaluation of the PAID-5 included confirming its postulated one-factor structure using confirmatory factor analysis (CFA) and assessing convergent validity, discriminant validity, internal consistency and test-retest reliability. The retest questionnaire was sent out 35±15 days after the initial assessment to those who agreed (n=117).

    RESULTS: The CFA for the PAID-5 scale showed excellent one-factor structure, and there was high internal consistency (α=0.89) and good test-retest reliability (Intraclass Correlation Coefficient, ICC=0.81). The PAID-5 correlated positively with fear of hypoglycaemia (r=0.598) and depression (r=0.380) and negatively with emotional well-being (r=-0.363) and perception of general health (r=-0.420), thus satisfying convergent validity. Patients who had experienced episodes of serious hypoglycaemia in the past 6 months had a significantly higher PAID-5 mean score (7.5, SD=4.95) than those who had not had these episodes (5.0, SD=4.2 (p=0.043)).

    CONCLUSION: The Norwegian PAID-5 was shown to be a reliable and valid short questionnaire for assessing diabetes-related distress among people with type 1 or type 2 diabetes. However, its ability to discriminate between groups needs to be tested further in larger samples. The PAID-5 scale can be a particularly valuable screening instrument in outpatient clinics, as its brevity makes it easy to use as a tool in patient-provider encounters. This short questionnaire is useful in the national diabetes registry or population cohort studies as it enables increased knowledge regarding the prevalence of diabetes-related distress.

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