Age of first alcohol intoxication and psychiatric disorders in young adulthood: A prospective birth cohort study

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample. Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15?16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI. Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13?14 years and Conclusions: We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.</div

Patient Participation in Kidney Care : Patients’ and professionals’ perspectives

Background: Patient participation is central to modern healthcare, known to enhance both physical health and well-being. However, the way in which a person prefers to engage can vary depending on their condition, knowledge, and healthcare context. Person-centred care considers a person’s needs and preferences, thereby facilitating preference-based patient participation. Managing a long-term disease, such as chronic kidney disease (CKD), often necessitates regular contact with healthcare and engagement in symptom management in day-to-day life. What facilitates person-centred patient participation in kidney care is unknown, but a further understanding of patient participation when living with CKD is needed. The overall aim of this thesis was to investigate patient participation in kidney care and assess variations in levels of preferencebased patient participation over time. Method: This thesis comprises four studies and is part of a research intervention project on participation in kidney clinics in south-eastern Sweden. Data collection commenced in 2018 and was concluded in 2022. Study I was of a qualitative design, with group discussions of patients and professionals (n=42) in dialysis care. Studies II and III employed the 4Ps tool, a validated questionnaire on patient participation completed by patients with CKD stage 4 or 5 (n=358). Study II adopted a cross-sectional design and Study III employed a quasi-experimental design to examine changes in participation over time and the effects of two interventions directed at managers and some healthcare professionals. In Study III, data from before and after the interventions were compared. Study IV employed a mixed-methods design, encompassing qualitative and quantitative data. It entailed repeated individual interviews (n=19 patients, 17 professionals) and data from a systematic review of patient records (n=240). The qualitative data from Studies I and IV were addressed using content analysis, while the quantitative data from Studies II, III, and IV were subjected to statistical tests using IBM Statistical Package for Social Sciences (SPSS) and Stan software. Results: Both individuals living with CKD and healthcare professionals recognised the importance of patient participation in kidney care. Patient participation in CKD stage 4 and 5 involved understanding the disease and its management, as well as mutual exchange of knowledge. However, there was not always a shared understanding between patients and professionals as to what patient participation entails. While patients described comprehending their condition and being involved in mutual communication and treatment planning, professionals primarily emphasised treatment management as the key aspect. Moreover, the patient records predominantly documented the professionals' actions for and with their patients. The findings also showed that although most patients had good matches between their preferences and experiences, suggesting sufficient levels of preference-based participation, some patients had insufficient preference-based participation, indicated they had experienced either more or less conditions for participation than their preferences. The staff-directed interventions in the research project did not appear to improve preference-based participation. Conclusion: Living with CKD stage 4 or 5 requires patient engagement and participation, meaning that patients understand how to manage their illness in their day-to-day lives. The studies suggest that further efforts are required in the management of kidney failure to enable more patients to engage in person-centred participation. One potential key to achieving mutual understanding between patients and professionals is dialogue. The tool utilised in these studies may prove useful in facilitating such conversations: the 4Ps is a tool that can be used to identify preferences for and experiences of patient participation. As such, it can be employed to measure preference-based patient participation in clinical settings and research. However, the findings of this thesis indicate that additional efforts are necessary for its implementation and to promote person-centred participation. Therefore, further research is needed, as are strategies healthcare professionals can employ to better recognise and respond to patients' resources and needs

Nyckeltal i ideella föreningar - En studie av tio årsredovisningar samt en fallstudie av Cancerfonden

Syfte: Syftet är att beskriva och analysera förekomsten samt karaktären av nyckeltal i ideella föreningars årsredovisningar. Vidare är syftet att utveckla nyckeltal för extern användning inom ramen för ett Balanced Scorecard i en ideell förening. Metod: Denna uppsats består av två delstudier. Den första delstudien, årsredovisningsstudien kan sägas vara av explorativ karaktär. Metoden vi använt oss av är en kombination av kvantitativ och kvalitativ metod där de kvalitativa inslagen är övervägande. Denna delstudie utgår från en induktiv ansats. När det gäller delstudie två baseras den på en fallstudie av Cancerfonden. Metoden vi använder oss av är övergripande av kvalitativ karaktär. I denna delstudie utgår vi från en abduktiv ansats. Slutsatser: Mot bakgrund av den ideella sektorns mångfald och betydelse i svensk samhällsliv aktualiserade vi frågan hur den information som ideella föreningar visar upp gentemot sina intressenter är utformad i exempelvis en årsredovisning. Nyckeltal är ett vanligt sätt att utvärdera verksamheten i ett privat företags årsredovisning, vilket väcker tanken på dess relevans även för den ideella sektorn. Vi studerade tio ideella föreningars årsredovisningar och fann att flest nyckeltal fanns representerade inom den kategori vi valde att benämna som verksamhetsspecifik. Vidare fann vi även att traditionella nyckeltal förekom i betydligt högre utsträckning än vi kunnat tro. Gällande delstudie två hade vi för avsikt att studera Cancerfonden med dess intressenter och presentera ett Balanced Scorecard som skulle kunna användas i föreningens årsredovisning. Föreningens vision, strategi samt kritiska framgångsfaktorer mynnade ut i följande perspektiv: finansiellt perspektiv, internt process-, givar- samt mottagarperspektiv. Inom respektive perspektiv föreslogs tre till fyra nyckeltal

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample. Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15?16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI. Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13?14 years andPeer reviewe

Patient participation in end-stage kidney disease care: variation over time and effects of staff-directed interventions - a quasi-experimental study

Abstract Background Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one’s individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation. Methods A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15–19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1–2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression. Results Over time and across all sites, most patients’ experiences of participation fully or almost fully matched their engagement preferences (57%–90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches. Conclusions Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one’s preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed