Влияние климатических факторов на содержание флавоноидов в листьях пойменных видов ив (Salix sp.)

ИВАФЛАВОНОИД

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

Alcohol screening; Brief intervention; Referral to electronic brief adviceDetección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónicoDetecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònicObjectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBIThe research leading to these results or outcomes has receivedfunding from the European Union’s Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN)

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study

Detecció d'alcoholèmia; Intervenció breu; Actitud del personal sanitariDetección de alcoholemia; Intervención breve; Actitud del personal sanitarioAlcoholism detection; Brief intervention; Attitude of Health PersonnelAims: To determine the relation between existing levels of alcohol screening and brief interventionrates infive European jurisdictions and role security and therapeutic commitment by the participat-ing primary healthcare professionals. Methods: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psy-chologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities aspart of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Pro-blems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screeningrate in a multilevel logistic regression analysis adjusted for occupation of the provider, number ofeligible patients and the random effects of jurisdictions and primary health care units (PHCU). Nosignificant relationship was found between role security and brief intervention rate nor betweentherapeutic commitment and screening rate/brief intervention rate. The proportion of patientsscreened varied across jurisdictions between 2 and 10%. Conclusion: Thefindings show that the studied factors (role security and therapeutic commitment)are not of great importance for alcohol screening and BI rates. Given the fact that screening and briefintervention implementation rate has not changed much in the last decade in spite of increased pol-icy emphasis, training initiatives and more research being published, this raises a question aboutwhat else is needed to enhance implementation.Radboud university medical centre received co-funding from The NetherlandsOrganization for Health Research and Development (ZonMW, Prevention Pro-gramme), under Grant Agreement n° 200310017—ODHIN—Optimizing de-livery of healthcare interventions in the Netherlands, according to Art.II.17 ofthe FP7 EC Grant Agreement. Pomeranian Medical University in Szczecin re-ceived co-funding regarding presented research from the Polish sciencefinancialresources in the years 2012–2014 allocated to conduct the international co-funded project ODHIN

Generation Pep – study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden

BackgroundThere is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden’s municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children &lt;18 years. The goal is to spread knowledge and create commitment to children’s and young people’s health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities.MethodsThe project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden’s 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics.DiscussionThe findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings

Digital encounters : Human interactions in mHealth behavior change interventions

Digitalization and high mobile phone ownership globally have radically changed communication in all areas of society, including health care. Previous research has shown the effectiveness of behavior change interventions delivered by mobile phones and has highlighted advantages, such as that they require fewer resources than traditional face-to-face interventions and can be delivered at any time. One of the foremost questions pertaining to unsupported digital interventions is whether they can ever be comparable to in-person interventions. Little is known about the therapeutic alliance and the specific qualities of encounters in digital interactions for behavior change. Human interactions in digital interventions and their relationship with outcomes require further investigation. This paper aims to encourage critical reflection and further consideration of mHealth behavior change interventions in a digital age, when even the professional is excluded from the intervention. Questions are raised on the feelings associated with digital therapeutic relationships and how such interactions might affect users capacity for behavioral change. Some technological features and human-like considerations for enhancing digital encounters in mHealth interventions are given. Finally, suggestions for future research to facilitate the digital encounter in mHealth behavior change interventions is presented.Funding Agencies|Link_oping university, Sweden</p

Encouraging Encounters : Experiences of People on Sick Leave in Their Meetings with Professionals

Background: The recent increase in long-term sickness absence both in Sweden and many other countries has been met with various attempts to intensify the use of rehabilitation measures in order to prevent people from remaining long-term sickness absent. Several actors, among them professionals in healthcare, occupational health services, and social insurance are involved in handling issues related to the sick leave of an individual, and in providing measures to promote return to work (RTW). Identification of the factors that are related to RTW of the individual is a multifaceted task; therefore to meet the individual in this process is an essential challenge for many actors involved. Knowledge is needed about factors that might promote RTW in order to facilitate future research aimed at designing effective rehabilitation programs. Such information is of great importance to improve the work situations of the professionals, to decrease the cost for society, and to improve the situations for people on sick leave by facilitating RTW. Objectives: The overall aim of the work underlying this thesis was to ascertain whether contacts between professionals and sickness absentees might a factor that can promote RTW, and also to identify different aspects of how such positive encounters are experienced by those who are sick listed. Material and methods: Five investigations were conducted using different study designs, data, and methods of data analyses. The first two (papers I and II) concerned interviews with people on sick leave about positive experiences of their encounters with professionals. The third study (paper III) was based on four questions about encounters, which were included in a questionnaire that was administrated to people who were on sick leave. The fourth study (paper IV) used a broad questionnaire to examine experiences of positive encounters, and the final study (paper V) proposed a model of possible effects of the encounters on RTW. Results: In paper I and II different aspects of sick-listed person’s experiences of positive encounters were identified. For example, it seemed that important qualities included being treated with respect, feeling supported, establishing a personal relationship, and participating in decisions regarding RTW measures. Several of the interviewees stated that RTW might be promoted by positive encounters. Paper III showed that perceptions of interactions varied with the type of professionals, as well as with demographics. The respondents perceived their encounters with professionals within healthcare as most positive, followed by social insurance, and lastly occupational health services. In general, females, people born in Sweden, and those who were older, or had a higher education rated their encounters with professionals as more positive. The main finding reported in paper IV was that the majority of the participants had experienced being positive encountered by professionals. Three aspects of such encounters were stressed, namely being treated with ”competence”, ”personal attention”, and ”competence and trust”. The results related in paper V indicated that theories about empowerment and on social emotions could be successfully applied in this area, after they were specifically adapted to some unique features of the contacts between sickness absentees and rehabilitation professionals. Conclusions: This thesis emphasizes that being positively encountered by professionals can have a beneficial impact on RTW after a period of sickness absence. More research is required to elucidate the interaction between sick-listed persons and professionals who are involved in their cases. Further studies should focus on how methods for professionals can be provided to increase sick-listed persons’ own ability to mobilize and develop their resources. Moreover, additional knowledge is needed to extend professional treatment strategies that enhance self-confidence and empowerment of individuals during sickness absence

Entitlement to Sickness Benefits in Sweden: The Social Insurance Officers Experiences

Background: Social insurance offices (SIOs) handle a wide range of complex assessments of the entitlement to sickness benefits for an increasing number of clients on sick leave and consequently, the demands on the SIOs have increased considerably.Aim: To gain deeper knowledge of the problems experienced by the SIOs in their work associated with entitlement to sickness benefits.Method: A descriptive and explorative qualitative approach was used to analyse data from two focus-group interviews, including six participants in each group.Results: The participants discussed different dilemmas in regard to; physicians’ responsibility for issuing sickness certificates, interactions with the insured individuals, disclosure of decisions, communications with medical consultants, documentation of sickness benefit claims, threats in the workplace, as well as their own competence. The SIOs regarded incomplete information on sickness certificates as a main problem, because they frequently had to contact the client and the physicians who issued the certificates in order to obtain further details, leading to delays in the decision-making whether to grant sickness benefits.Conclusions: More knowledge regarding SIOs work is required to improve the methods used in the sickness insurance system and to ensure adequate training of new staff members

Det goda mötet - en viktig del i sjukskrivnings- och rehabiliteringsprocessen

Ansvaret för att stötta individer vid återgång i arbete delas mellan flera offentliga aktörer såsom Försäkringskassan, hälso- och sjukvården, Arbetsförmedlingen, arbetsgivaren och den sjukskrivne själv. Studien visar att bemötandet från dessa aktörer påverkar hur personer som varit sjukskrivna hanterar sin situation relaterat till de förändringar som genomförts i sjukförsäkringen samt deras möjlighet att återgå till arbete. Möten där individens styrkor och förmågor på olika sätt lyfts fram tycks påverka självförtroendet och synen på den egna arbetsförmågan.  Kritik riktas mot sjukförsäkringssystemet, t.ex. regler och bestämmelser, snarare än mot aktörerna som arbetar i det. I intervjuerna framkommer att systemets utformning i sig bidrar till att de professionella har svårt att se och beakta individuella behov vilket bidrar till orättvisa bedömningar och beslut.

Kan jag få ett läkarintyg? - Erfarenheter av telefonrådgivning i primärvården

En stor andel av telefonsamtalen till primärvårdens telefonrådgivning avser andra problem än sjukdom, skada eller medicinska frågor. Sammanlagt deltog 35 sjuksköterskor som arbetar med telefonrådgivning i fokusgruppintervjuer. De hade tidigare deltagit i en två dagars utbildning i försäkringsmedicin. Resultaten visar att sjuksköterskorna ansåg att de efter utbildningen ökat sin kunskap om sjukförsäkringen, att de lättare kunde ställa frågor om alternativ till att besöka läkaren och stödja patienten i att fatta beslut om t.ex. egenvård.Nurses’ knowledge on matters other than medical issues is limited although a growing number of the calls in the telephone services in primary health care deal with the need for a sickness certificate due to other problem than sickness/disease or injury. A two days course in insurance medicine was given to nurses with experiences of telephone advisory services. Data from focus-group interviews including 35 nurses were analysed. Outcomes of the practices of the course highlighted the value of this new knowledge to help nurses to: better understand the sickness insurance system, encounter their patients in a supportive way, getting their patients to be accountable for their own situation, and to improve the collaboration with colleagues