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  • 1.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro University Hospital, Örebro, Sweden.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Lohse PT, Georg
    Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro University Hospital, Örebro, Sweden.
    Liljegren, Göran
    Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro, Sweden; Department of Surgery, University Hospital, Örebro, Sweden.
    Interventions for lifestyle changes to promote weight reduction, a randomized controlled trial in primary health care2013In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 16, no 1, article id 213Article in journal (Refereed)
    Abstract [en]

    Background: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care.

    Methods: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start.

    Results: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively.

    Conclusions: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.

  • 2.
    Kjellin, Lars
    et al.
    Örebro University Hospital. Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Pelto-Piri, Veikko
    Örebro University Hospital. Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Community treatment orders in a Swedish county: Applied as intended?2014In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 7, no 1, article id 879Article in journal (Refereed)
    Abstract [en]

    Background: Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present study were to examine the use of compulsory psychiatric care before and after the reform and if this intention of the law reform was fulfilled.

    Methods: The study was based on register data from the computerized patient administrative system of Örebro County Council. Two periods of time, two years before (I) and two years after (II) the legal change, were compared. The Swedish civic registration number was used to connect unique individuals to continuous treatment episodes comprising different forms of legal status and to identify individuals treated during both time periods.

    Results: The number of involuntarily admitted patients was 524 in period I and 514 in period II. CTOs were in period II used on relatively more patients in forensic psychiatric care than in general psychiatry. In all, there was a 9% decrease from period I to period II in hospital days of compulsory psychiatric care, while days on leave decreased with 60%. The number of days on leave plus days under CTOs was 26% higher in period II than the number of days on leave in period I. Among patients treated in both periods, this increase was 43%. The total number of days under any form of compulsory care (in hospital, on leave, and under CTOs) increased with five percent. Patients with the longest leaves before the reform had more days on CTOs after the reform than other patients.

    Conclusions: The results indicate that the main intention of the legislator with introducing CTOs was fulfilled in the first two years after the reform in the studied county. At the same time the use of coercive psychiatric care outside hospital, and to some extent the total use of coercive in- and outpatient psychiatric care, increased. Adding an additional legal coercive instrument in psychiatry may increase the total use of coercion.

  • 3.
    Olsson, Lovisa A.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine/Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Hagnelius, Nils-Olof
    Örebro University Hospital. Department of Geriatrics, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Torbjörn K.
    Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
    Renal function is a determinant of subjective well-being in active seniors but not in patients with subjective memory complaints2014In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 7, no 1, article id 647Article in journal (Refereed)
    Abstract [en]

    Results: There were no significant differences in cystatin C and eGFR values between the two cohorts: cystatin C medians 0.88 vs 0.86 mg/L and eGFR 73 vs 80 mL/min/1.73 m2(AS vs DGM). In the AS cohort cystatin C was negatively related to PGWB index in women (P < 0.001, R 2≈ 5%), and the covariates age and BMI did not improve the models. The renal biomarkers were unrelated to the PGWB index in the DGM cohort. Cystatin C in the AS cohort was adversely related to the PGWB subdimensions anxiety, depressed mood, positive well-being, and vitality in women, but in men only to depressed mood (P < 0.006; R 2≈ 6%). In the DGM cohort, depressed mood in men was also significantly related to cystatin C (P = 0.050), but not in women.

    Background: During our whole life span, factors influencing health and functioning are accumulated. In chronic kidney disease, quality of life is adversely affected. We hypothesized that biomarkers of renal function could also be determinants of subjective well-being (SWB) in Swedish elderly subjects. SWB was assessed by the Psychological General Well-Being index (PGWB index) in two study groups: Active seniors (AS) consisted of community-dwelling elderly Swedes leading an active life (n = 389), and the DGM cohort (n = 300) consisted of subjects referred to the Memory Unit at the Department of Geriatrics for memory problems, Serum creatinine, cystatin C, and eGFR (CKD-EPI) were used as biomarkers of renal function.

    Conclusions: Renal function even within the normal range, measured by serum cystatin C concentration, has significant and sex specific associations with subjective well-being and its subdimensions in healthy elderly subjects. Maintenance of good renal function in aging may be of importance in maintaining a high subjective well-being.

  • 4.
    Pelto-Piri, Veikko
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center (UFC).
    Kjellin, Lars
    University Health Care Research Center (UFC), Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Hylén, Ulrika
    University Health Care Research Center (UFC), Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Valenti, Emanuele
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Priebe, Stefan
    Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
    Different forms of informal coercion in psychiatry: a qualitative study2019In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 12, no 1, article id 787Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of the study was to investigate how mental health professionals describe and reflect upon different forms of informal coercion.

    RESULTS: In a deductive qualitative content analysis of focus group interviews, several examples of persuasion, interpersonal leverage, inducements, and threats were found. Persuasion was sometimes described as being more like a negotiation. Some participants worried about that the use of interpersonal leverage and inducements risked to pass into blackmail in some situations. In a following inductive analysis, three more categories of informal coercion was found: cheating, using a disciplinary style and referring to rules and routines. Participants also described situations of coercion from other stakeholders: relatives and other authorities than psychiatry. The results indicate that informal coercion includes forms that are not obviously arranged in a hierarchy, and that its use is complex with a variety of pathways between different forms before treatment is accepted by the patient or compulsion is imposed.

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