Showing papers by "Stockholm County Council published in 2011"
TL;DR: This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010 that provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI.
768 citations
TL;DR: This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010 that provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI.
429 citations
TL;DR: The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.
Abstract: The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.
222 citations
TL;DR: This study shows that certain assemblage A subtypes are potentially zoonotic and that flatulence is connected to assemblages B infections in young children and can be a valuable tool in outbreak situations and to help identify possibleZoonotic transmission.
Abstract: Background: Giardia intestinalis is one of the most common diarrhea-related parasites in humans, where infection ranges from asymptomatic to acute or chronic disease G intestinalis consists of eight genetically distinct genotypes or assemblages, designated A-H, and assemblages A and B can infect humans Giardiasis has been classified as a possible zoonotic disease but the role of animals in human disease transmission still needs to be proven We tried to link different assemblages and sub-assemblages of G intestinalis isolates from Swedish human patients to clinical symptoms and zoonotic transmission Methodology/Principal Findings: Multilocus sequence-based genotyping of 207 human Giardia isolates using three gene loci: beta-giardin, glutamate dehydrogenase (gdh), and triose phosphate isomerase (tpi) was combined with assemblage-specific tpi PCRs This analysis identified 73 patients infected with assemblage A, 128 with assemblage B, and six with mixed assemblages A+B Multilocus genotypes (MLGs) were easily determined for the assemblage A isolates, and most patients with this genotype had apparently been infected through anthroponotic transmission However, we also found evidence of limited zoonotic transmission of Giardia in Sweden, since a few domestic human infections involved the same assemblage A MLGs previously reported in Swedish cats and ruminants Assemblage B was detected more frequently than assemblage A and it was also more common in patients with suspected treatment failure However, a large genetic variability made determination of assemblage B MLGs problematic Correlation between symptoms and assemblages was found only for flatulence, which was significantly more common in children less than six years of age infected with assemblage B Conclusions/Significance: This study shows that certain assemblage A subtypes are potentially zoonotic and that flatulence is connected to assemblage B infections in young children Determination of MLGs from assemblages A and B can be a valuable tool in outbreak situations and to help identify possible zoonotic transmission
142 citations
TL;DR: Eco-CimT influenced development more than ordinary treatment at this age when Eco-CIMT was performed by parents and preschool teachers supervised by the child's ordinary therapist.
81 citations
TL;DR: Despite universal access to treatment, substantial but decreasing small-area variations were observed in sales per capita of tumour necrosis factor (TNF) inhibitors, and their persistence calls for investigation of patient equity and treatment appropriateness.
Abstract: Objective: To measure small-area variations in sales per capita of tumour necrosis factor (TNF) inhibitors.Methods: For 2000–2009, sales data on etanercept, infliximab, and adalimumab were retrieved from the Swedish National Corporation of Pharmacies, which keeps data on drugs dispensed in ambulatory care and hospitals. As points of reference, data were retrieved on all drugs, non-biologic treatments for chronic inflammatory disorders (sulfasalazine, methotrexate, azathioprine), and for a biologic used in a different therapeutic area (trastuzumab). As a corollary measure to sales per capita, penetration of biologics in the rheumatoid arthritis (RA) population was calculated using nationwide registers. Small areas were defined as the 21 counties of Sweden.Results: From 2000 to 2009, annual TNF inhibitor sales increased 9-fold from 195 to 1779 million SEK (0.7–5.0% of total drug expenditure). The county variation in sales per capita, initially 6.2-fold (coefficient of variation 42%), decreased to 2.3-fold i...
58 citations
TL;DR: Analysis of individual predictors showed that AAS users were almost always young men, regular weight trainers and more often users of drugs and nutritional supplements, and the higher prevalence of AAS use among gym users than in the general population makes the former an appropriate target group for AAS prevention.
Abstract: The purpose of this study was to estimate the prevalence of anabolic androgenic steroid (AAS) use and offers to use among gym users in Stockholm County (Sweden), and to conduct a comparison of concordance in estimates of AAS and supplements at gyms between two data collection methods. A questionnaire was distributed to members at 36 training facilities and 1,752 gym users participated in the study. An observation study was conducted as covert participant observations at 64 gyms. According to the questionnaire, 3.9% of men reported life time use of AAS, 1.4% use during the past 12 months and 0.4% AAS use during past 30 days. Not only were there similar patterns found in the two methods, i.e., similar age and gender distributions for AAS use, but analyses of concordance showed that gyms with a higher prevalence of self-reported AAS-use and supplement use (questionnaire) showed a significantly higher proportion of observer-assessed AAS users. Analyses of individual predictors showed that AAS users were almost always young men, regular weight trainers and more often users of drugs and nutritional supplements. The higher prevalence of AAS use among gym users than in the general population makes the former an appropriate target group for AAS prevention. The connection between supplements, drugs and AAS use suggests that effective AAS prevention need to focus on several risk factors for AAS use. The clear resemblance in estimates between the observation and questionnaire data strengthen the credibility of the two methods.
57 citations
TL;DR: The monovalent AS03-adjuvanted influenza vaccine was highly effective in prevention of the pandemic influenza in Stockholm County, except in immunocompromised hosts.
Abstract: Background. Vaccination against the pandemic influenza A(H1N1)v was performed in many countries during 2009, but population-based data on vaccine effectiveness are lacking. Methods. We conducted a prospective cohort study involving all inhabitants in Stockholm County (n 5 2,019,183) who were offered a monovalent AS03-adjuvanted influenza A(H1N1)v vaccine (Pandemrix, GSK), between 12 October and 31 December 2009. Overall vaccine coverage was 52%. A Web-based register with data on all vaccinated was linked by unique personal identification number to mandatory reports of influenza A(H1N1)v diagnoses. Vaccine failure was defined as a diagnosis or admission to hospital because of influenza .14 days after vaccination. Risk factors associated with vaccine failure were investigated by conditional stepwise logistic regression in a nested case‐control study. The weekly incidence rate ratio for being diagnosed with influenza among vaccinated versus nonvaccinated persons was calculated. Results. Vaccine failure was seen in 25 patients, 11 children and 14 adults, of 2594 patients diagnosed with influenza A(H1N1)v. Compared with age-matched controls, patients with vaccine failure were more often immunocompromised (Hazard Ratio, 4.89; 95% confidence interval [CI], 2.19‐10.89). During the 4 weeks with maximum influenza activity, the relative risk per week for an influenza A(H1N1)v diagnosis in the vaccinated population was .06 (95% CI .008‐.41), .13 (95% CI .06‐.27), .05 (95% CI .02‐.12), and .07 (95% CI .03‐.15), respectively, corresponding to a weekly vaccine effectiveness of 87‐95%. Conclusions. The monovalent AS03-adjuvanted influenza vaccine was highly effective in prevention of the pandemic influenza in Stockholm County. A single dose seemed to be sufficient in most, both children and adults, except in immunocompromised hosts.
53 citations
TL;DR: In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents and global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression.
Abstract: The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance In 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU) Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Broset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R) A multiple logistic regression analysis with SOAS-R as outcome variable was performed The global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression The use of segregation reduced the number of SOAS-R incidents In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients NCT00184119
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NCT00184132
52 citations
TL;DR: The Örebro prevention programme as currently delivered in Sweden does not appear to reduce or delay youth drunkenness.
Abstract: Aims: This study aimed to assess the effectiveness of the Orebro prevention program (OPP), an alcohol misuse prevention programme that aims to reduce youth drinking by changing parental behaviour. Design: Cluster-randomized trial, with schools randomly assigned to the OPP or no intervention. Setting: Forty municipal schools in 13 counties in Sweden. Participants: 1752 students in the 7th grade and 1314 parents were assessed at baseline. Students' follow-up rates in the 8th and 9th grades were 92.1% and 88.4% respectively. Measurements: Classroom questionnaires to students and postal questionnaires to parents were administered before randomization and 12 and 30 months post-baseline. Findings: Two-level logistic regression models, under four different methods of addressing the problem of loss to follow up, revealed a statistically significant programme effect for only one out of three drinking outcomes under one loss-to-follow-up method, and that effect was only observed at the 12-month follow up. Conclusions: The Orebro prevention programme as currently delivered in Sweden does not appear to reduce or delay youth drunkenness. Language: en
48 citations
TL;DR: The results showed that the Stockholm outbreak was caused by a CRF01_AE variant imported from Helsinki, Finland, around 2003, which was quiescent until the outbreak started in 2006, and was best explained by an introduction of HIV into a standing network of previously uninfected IDUs.
Abstract: Detailed phylogenetic analyses were performed to characterize an HIV-1 outbreak among injection drug users (IDUs) in Stockholm, Sweden, in 2006. This study investigated the source and dynamics of HIV-1 spread during the outbreak as well as associated demographic and clinical factors. Seventy Swedish IDUs diagnosed during 2004 to 2007 were studied. Demographic, clinical, and laboratory data were collected, and the V3 region of the HIV-1 envelope gene was sequenced to allow detailed phylogenetic analyses. The results showed that the Stockholm outbreak was caused by a CRF01_AE variant imported from Helsinki, Finland, around 2003, which was quiescent until the outbreak started in 2006. Local Swedish subtype B variants continued to spread at a lower rate. The number of new CRF01_AE cases over a rooted phylogenetic tree accurately reflected the transmission dynamics and showed a temporary increase, by a factor of 12, in HIV incidence during the outbreak. Virus levels were similar in CRF01_AE and subtype B infections, arguing against differences in contagiousness. Similarly, there were no major differences in other baseline characteristics. Instead, the outbreak in Stockholm (and Helsinki) was best explained by an introduction of HIV into a standing network of previously uninfected IDUs. The combination of phylogenetics and epidemiological data creates a powerful tool for investigating outbreaks of HIV and other infectious diseases that could improve surveillance and prevention.
TL;DR: In this article, the authors evaluate if depressive symptoms, anxiety and pain intensity are potential risk factors for dropout or relapse during the withdrawal process and assess internal consistency of scales for assessment of these potential risks.
TL;DR: One out of four primary care patients with hypertension reach target blood pressure, and β-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity.
Abstract: The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure <140/90 mm Hg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary health-care centres, with a combined registered population of 330 000 subjects. We included all patients ⩾30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n=21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure <140/90 mm Hg. The number of prescribed drugs increased with age, except among the oldest (⩾90 years). Only 29% of patients given monotherapy had a blood pressure <140/90 mm Hg. Women more often received diuretics (52 vs 42%), and less often angiotensin-converting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. β-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control.
TL;DR: A majority of the GPs found sickness certification problematic, and most problems were related to professional competence in insurance medicine, and better possibilities to develop, maintain, and practise such professionalism are warranted.
Abstract: Objective. Tasks involved in sickness certification constitute potential problems for physicians. The objective in this study was to obtain more detailed knowledge about the problems that general practitioners (GPs) experience in sickness certification cases, specifically regarding reasons for issuing unnecessarily long sick-leave periods. Design. A cross-sectional national questionnaire study. Setting. Primary health care in Sweden. Subjects. The 2516 general practitioners (GPs), below 65 years of age, who had consultations involving sickness certification every week. This makes it the by far largest such study worldwide. The response rate among GPs was 59.9%. Results. Once a week, half of the GPs (54.5%) found it problematic to handle sickness certification, and one-fourth (25.9%) had a patient who wanted to be sickness absent for some reason other than medical work incapacity. Issues rated as problematic by many GPs concerned assessing work capacity, prognosticating the duration of incapacity, handling...
TL;DR: Strong associations were found between four of the items reported at age 18 and lifetime criminal offending: low marks for conduct in school, contact with the police or child care authorities, crowded living conditions, and arrest for public drinking.
Abstract: Background
Recent evidence suggests that factors predicting offending among individuals with no mental disorder may also predict offending among individuals with schizophrenia.
TL;DR: Results show that binge eating after weight loss surgery is common and is associated with more psychopathology and lower HRQL, which might increase the vulnerability for future weight regain and complications beyond the follow-up period of the present study.
Abstract: BACKGROUND: Studies that have investigated the relationship between binge eating and the long-term outcome of bariatric surgery have shown mixed results Does binge eating affect long-term BMI, health-related quality of life (HRQL), or psychopathology after surgery? METHODS: We assessed 173 bariatric patients before and three years after weight loss surgery with regard to weight, binge eating, HRQL, and psychopathology RESULTS: Binge eating before and after weight loss surgery was unrelated to long-term BMI outcome Binge eating after weight loss surgery was associated with more psychopathology and lower HRQL CONCLUSIONS: Binge eating before or after weight loss surgery does not predict long-term BMI outcome Therefore, exclusions from surgery for this reason alone are difficult to motivate However, results show that binge eating after weight loss surgery is common and is associated with more psychopathology and lower HRQL, which might increase the vulnerability for future weight regain and complications beyond the follow-up period of the present study The high rate of binge eating after surgery and its negative association with HRQL and psychopathology suggest that we need to be observant of the occurrence and potential effects of binge eating in the context of bariatric surgery
TL;DR: Age and sex-specific changes in rates, methods used and characteristics of suicide attempters receiving medical care, over a 15-year period in two European WHO catchment areas (Stockholm, Sweden; and Würzburg, Germany) are investigated.
Abstract: To investigate age and sex-specific changes in rates, methods used and characteristics of suicide attempters receiving medical care, over a 15-year period in two European WHO catchment areas (Stockholm, Sweden; and Wurzburg, Germany). The data for this study were obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour for the period 1989–2003. Sex-specific, person-based suicide attempt rates were calculated for each year separately for the age groups 15–24 and 25 or above. The Chi-square test for trend was applied to estimate changes in proportions of socio-demographic and socio-economic variables. Significantly, increasing trends in suicide attempt rates occurred in young females, and in males and females aged 25 or above in Wurzburg. On the contrary, men 25 years and above showed a significant decrease in suicide attempt rates in Stockholm. Young females in Wurzburg tended to use less violent methods for their attempts whereas in Stockholm young females were increasingly inclined to attempt suicide using violent methods. In Stockholm, young female suicide attempters tended to be more often economically inactive, particularly due to an increasing proportion of students. Young females in Wurzburg were often less well educated, as were their young male counterparts. This contrasted with trends in the education of men and women of 25 or above in Stockholm. The results of this study suggest temporal changes in trends, methods used and in the social profile of suicide attempters.
TL;DR: Caucasian JP2 carriers exist and older subjects can carry the JP2 clone of A. actinomycetemcomitans, according to the history of periodontal disease and microbiological findings in a Caucasian family.
Abstract: Background: Carriers of the JP2 clone of Aggregatibacter actinomycetemcomitans exhibit an enhanced risk for developing aggressive periodontitis compared with individuals carrying non-JP2 clones. Wh ...
TL;DR: The 'Clubs against Drugs' community-based intervention programme, a systems approach to prevention, appears to increase the frequency and effectiveness of club doormen's interventions regarding obviously drug-intoxicated guests.
Abstract: Aims To evaluate long‐term effects of a multi‐component community‐based club drug prevention programme. Design A pre‐ (2003) and post‐intervention study (2004 and 2008) design. Setting High‐risk licensed premises in central Stockholm, Sweden. Participants The intervention programme, 'Clubs against Drugs', included community mobilization, drug‐training for doormen and other staff, policy work, increased enforcement, environmental changes and media advocacy and public relations work. Measurement The indicator chosen for this study was the frequency of doormen intervention towards obviously drug‐intoxicated guests at licensed premises. Professional male actors (i.e. pseudopatrons) were trained to act impaired by cocaine/amphetamines while trying to enter licensed premises with doormen. An expert panel standardized the scene of drug intoxication. Each attempt was monitored by two male observers. Findings At the follow‐up study in 2008 the doormen intervened in 65.5% of the attempts (n = 55), a significant improvement compared to 27.0% (n = 48) at the first follow‐up in 2004 and to 7.5% (n = 40) at baseline in 2003. Conclusion The 'Clubs against Drugs' community‐based intervention programme, a systems approach to prevention, appears to increase the frequency and effectiveness of club doormen's interventions regarding obviously drug‐intoxicated guests.
TL;DR: The prevalence of life-time and last year drug use among staff atlicensed premises is high compared to the general population in Sweden, and staff at licensed premises represent an important target population in club drug prevention programs.
Abstract: The objective of this study is to examine self-reported drug use among staff at licensed premises, types of drugs used, attitudes towards drugs, and observed drug use among guests. Results are presented from two measurement points (in 2001 and 2007/08). This study was carried out within the framework of the "Clubs against Drugs" program, which is a community-based multi-component intervention targeting licensed premises in Stockholm, Sweden. Two cross-sectional surveys were conducted, the first in 2001 and the second in 2007/08. Staff at licensed premises attending server training were asked to participate in the anonymous survey. A survey was administered in a classroom setting and consisted of four sections: 1) demographics, 2) respondents' own drug use experience, 3) respondents' attitudes towards drug use, and 4) observed drug use among guests at licensed premises. Data were collected from 446 staff in 2001 and 677 staff in 2007/08. The four most commonly used drugs among staff were cannabis, cocaine, amphetamine, and ecstasy. The highest rates of drug use were reported by staff in the two youngest age groups, i.e., those younger than 25 and those between the ages of 25 and 29. In 2007/08 staff reported significantly lower rates of drug use than staff in 2001. Last year drug use for the sample in 2007/08 was 19% compared to 27% for the 2001 sample. While drug-using staff compared to non drug-using staff reported more observations of drug use among guests, they were less inclined to intervene. Overall, staff reported restrictive attitudes towards drugs. The prevalence of life-time and last year drug use among staff at licensed premises is high compared to the general population in Sweden. Lower rates of self-reported drug use among staff were reported in 2007/08. The results of this study highlight that staff at licensed premises represent an important target population in club drug prevention programs.
TL;DR: The results suggest that inclusion of the “soft” non-respondents does not by necessity lead to higher levels of assessed alcohol use and the results indicate no differences in the level of reported alcohol or tobacco use with except for a slightly higher proportion of alcohol abstainers in the sample of initial non-response.
Abstract: AIMSThis study aimed at describing the effects of missing data when surveying alcohol consumption using a Random Digit Dialling procedure.MethodsData was part of the Monitor project including repea...
TL;DR: The Swedish version of the NEO-PI-R shows satisfactory psychometric properties and the instrument will continue to be a valuable tool in psychological research and in clinical practice.
Abstract: Background: Internationally, the NEO Personality Inventory-Revised (NEO-PI-R) is a well established questionnaire for assessment of personality in accordance with the Five Factor Model. The instrument has been translated into many languages including Swedish. Aim: The aim of this study was to make a psychometric evaluation of the Swedish version of NEO-PI-R based on a sample from the general population. Methods: Postal questionnaires were sent to a random sample of 1250 persons (n = 766 responders). Results and conclusions: The test showed satisfactory internal consistency in the broad factors as well as the facets. A factor analysis indicated that the factors were similar but not identical to those obtained in American studies. In sum, The Swedish version of the NEO-PI-R shows satisfactory psychometric properties and the instrument will continue to be a valuable tool in psychological research and in clinical practice.
TL;DR: It is suggested that a questionnaire is used 12–18 months after delivery to establish the short-time outcome in terms of pelvic floor dysfunction.
Abstract: Introduction and hypothesis
The incidence of obstetric anal sphincter injuries is used in Sweden as a measurement of quality of care and this might influence the reporting. However, the correlation between reported diagnosis of pelvic floor injury at delivery and pelvic floor symptoms a year later is unknown. A questionnaire could identify such symptoms and provide beneficial feedback to obstetrical practices.
TL;DR: In this article, an independent evaluation of a psychosocial, adult-to-youth mentoring program run by the Swedish branch of the Mentor Foundation is presented, aiming to prevent substance use in low-risk youth.
Abstract: This report describes an independent evaluation of a psychosocial, adult-to-youth mentoring program run by the Swedish branch of the Mentor Foundation, aiming to prevent substance use in low-risk y...
TL;DR: In this paper, the authors evaluated the ability of MAPLe-AC to predict adverse outcomes in acute care for older people and to assess its usability as a decision-making tool for discharge planning.
Abstract: Although numerous risk factors for adverse outcomes for older persons after an acute hospital stay have been identified, a decision making tool combining all available information in a clinically meaningful way would be helpful for daily hospital practice. The purpose of this study was to evaluate the ability of the Method for Assigning Priority Levels for Acute Care (MAPLe-AC) to predict adverse outcomes in acute care for older people and to assess its usability as a decision making tool for discharge planning. Data from a prospective multicenter study in five Nordic acute care hospitals with information from admission to a one year follow-up of older acute care patients were compared with a prospective study of acute care patients from admission to discharge in eight hospitals in Canada. The interRAI Acute Care assessment instrument (v1.1) was used for data collection. Data were collected during the first 24 hours in hospital, including pre-morbid and admission information, and at day 7 or at discharge, whichever came first. Based on this information a crosswalk was developed from the original MAPLe algorithm for home care settings to acute care (MAPLe-AC). The sample included persons 75 years or older who were admitted to acute internal medical services in one hospital in each of the five Nordic countries (n = 763) or to acute hospital care either internal medical or combined medical-surgical services in eight hospitals in Ontario, Canada (n = 393). The outcome measures considered were discharge to home, discharge to institution or death. Outcomes in a 1-year follow-up in the Nordic hospitals were: living at home, living in an institution or death, and survival. Logistic regression with ROC curves and Cox regression analyses were used in the analyses. Low and mild priority levels of MAPLe-AC predicted discharge home and high and very high priority levels predicted adverse outcome at discharge both in the Nordic and Canadian data sets, and one-year outcomes in the Nordic data set. The predictive accuracy (AUC's) of MAPLe-AC's was higher for discharge outcome than one year outcome, and for discharge home in Canadian hospitals but for adverse outcome in Nordic hospitals. High and very high priority levels in MAPLe-AC were also predictive of days to death adjusted for diagnoses in survival models. MAPLe-AC is a valid algorithm based on risk factors that predict outcomes of acute hospital care. It could be a helpful tool for early discharge planning although further testing for active use in clinical practice is still needed.
TL;DR: The psychotherapy sample was characterized by problems with oneself closely related to other problematic areas, at both pre-treatment and at follow-up 1.5 years after termination, while problematic sense of belonging was a general theme only prior to psychotherapy, but they were less troubled by their problems after psychotherapy.
Abstract: This study aims to explore how young adults in psychotherapy and young adults in general describe their problems and how their problem formulations change over time. Two matched samples from longit ...
TL;DR: Investigation of attitudes towards under‐age drinking and use of program components, i.e. alcohol‐specific parenting behaviors, in parents who did and did not take part in the parental prevention program found strict attitudes and alcohol‐ specific rule‐setting were more frequently reported among parents in the experimental group.
Abstract: Purpose – Within the framework of an ongoing cluster‐randomized effectiveness trial of a parental prevention program, the aim of the present study is to investigate attitudes towards under‐age drinking and use of program components, i.e. alcohol‐specific parenting behaviors, in parents who did and did not take part in the programme.Design/methodology/approach – Non‐parametric tests were used to analyze cross‐sectional data from 1,239 14‐year‐olds and their parents, collected at a 12‐month follow‐up.Findings – Strict attitudes and alcohol‐specific rule‐setting were more frequently reported among parents in the experimental group than among parents in the control group (89.2 v. 81.7 percent, p < 0.001, respectively 92.8 v. 88.5 percent, p < 0.01). Parental reports were supported by that significantly fewer youths in the experimental group reported being served alcohol at home (36.6 v. 44.7 percent, p < 0.01).Research limitations/implications – Most of the measures were not included at the baseline measureme...
01 Jan 2011
TL;DR: MAPLe-AC is a valid algorithm based on risk factors that predict outcomes of acute hospital care and could be a helpful tool for early discharge planning although further testing for active use in clinical practice is still needed.
Abstract: Although numerous risk factors for adverse outcomes for older persons after an acute hospital stay have been identified, a decision making tool combining all available information in a clinically meaningful way would be helpful for daily hospital practice. The purpose of this study was to evaluate the ability of the Method for Assigning Priority Levels for Acute Care (MAPLe-AC) to predict adverse outcomes in acute care for older people and to assess its usability as a decision making tool for discharge planning. Data from a prospective multicenter study in five Nordic acute care hospitals with information from admission to a one year follow-up of older acute care patients were compared with a prospective study of acute care patients from admission to discharge in eight hospitals in Canada. The interRAI Acute Care assessment instrument (v1.1) was used for data collection. Data were collected during the first 24 hours in hospital, including pre-morbid and admission information, and at day 7 or at discharge, whichever came first. Based on this information a crosswalk was developed from the original MAPLe algorithm for home care settings to acute care (MAPLe-AC). The sample included persons 75 years or older who were admitted to acute internal medical services in one hospital in each of the five Nordic countries (n = 763) or to acute hospital care either internal medical or combined medical-surgical services in eight hospitals in Ontario, Canada (n = 393). The outcome measures considered were discharge to home, discharge to institution or death. Outcomes in a 1-year follow-up in the Nordic hospitals were: living at home, living in an institution or death, and survival. Logistic regression with ROC curves and Cox regression analyses were used in the analyses. Low and mild priority levels of MAPLe-AC predicted discharge home and high and very high priority levels predicted adverse outcome at discharge both in the Nordic and Canadian data sets, and one-year outcomes in the Nordic data set. The predictive accuracy (AUC's) of MAPLe-AC's was higher for discharge outcome than one year outcome, and for discharge home in Canadian hospitals but for adverse outcome in Nordic hospitals. High and very high priority levels in MAPLe-AC were also predictive of days to death adjusted for diagnoses in survival models. MAPLe-AC is a valid algorithm based on risk factors that predict outcomes of acute hospital care. It could be a helpful tool for early discharge planning although further testing for active use in clinical practice is still needed.
TL;DR: It appears as if a policy document does not directly predict whether schools identify students having substance abusing parents, however, it does influence whether respondents have participated in further training, which subsequently predicts the identification of students having Substance abusing parents.
TL;DR: Treatment patterns were explored during a 3-year follow-up among 157 Swedish offenders with substance use problems who had undergone forensic psychiatric assessment, finding that outcomes were less successful for those participants displaying a non-stable treatment pattern.
Abstract: Research on treatment utilization among offenders with mental health problems and substance use problems, i.e. the ‘triply troubled’, is scarce. The aim was to contribute to the general knowledge about treatment patterns among the triply troubled. This register-based study explored treatment patterns during a 3-year follow-up among 157 Swedish offenders with substance use problems who had undergone forensic psychiatric assessment. There were three subgroups of treatment users: low treatment, planned substance abuse treatment and substance abuse emergency room visits, and planned psychiatric treatment. About 40% of the participants displayed a stable treatment pattern. Outcomes were less successful for those participants displaying a non-stable treatment pattern. Allocation of treatment resources should take into account the associations between treatment patterns and recidivism into criminality. Also, it should be valuable for clinicians to gather information on treatment history in order to meet various treatment needs.