Parkinson's Disease with Device, Diary, or in Disguise. Dyskinesia reduction, motor state evaluation, and workforce participation among persons with Parkinson's disease.

INTRODUCTION: In the wait for disease-modifying treatment for Parkinson’s disease (PD), efforts towards improved symptom control and reduced negative effects of PD can result in meaningful change patients. The general efficacy of levodopa-carbidopa intestinal gel (LCIG) in advanced PD has been established, but its effects on dyskinesia need more investigation. The PD Home Diary has been used in clinical trials to evaluate treatment effects for almost 20 years, but needs to be validated. As treatments improve, it is vital to understand how PD affects workforce participation to further reduce the personal and societal effects of PD.AIMS: The overarching aim of this thesis is to increase the knowledge on how health services can support persons with PD. The thesis has two main themes: motor fluctuations and workforce participation. Firstly, the aim was to contribute to a better understanding and utilization of existing tools in the treatment and evaluation of motor fluctuations in PD: LCIG and the PD Home Diary. Secondly, the aim was to improve our understanding of the impact of PD on workforce participation.METHODS: Two clinical observational studies were used to investigate the effects of LCIG on dyskinesia and to validate the PD Home Diary, while one cross-sectional and one longitudinal registry study was designed to investigate workforce participation among persons with PD.RESULTS: LCIG was found to reduce dyskinesia among persons with advanced PD and troublesome dyskinesia at baseline. Motor state assessments from the patient-reported PD Home Diary and those by an experienced observer were found to be in fair agreement. Workforce unavailability was found to be associated with anxiety among working-age persons with PD. Persons with a first sick-leave due to PD exhibited increased sickness absence in the preceding five-year period compared to controls, particularly due to musculoskeletal diagnoses.CONCLUSIONS AND IMPLICATIONS: LCIG is a feasible treatment also for persons with advanced PD and troublesome dyskinesia. The PD Home Diary should not be regarded as interchangeable with the observer assessment gold standard. The association between workforce unavailability and anxiety needs further investigation, but anxiety should nonetheless be treated when identified. Musculoskeletal sickness absence is significantly increased in prodromal and early PD, which emphasizes that functioning and workforce participation is likely to be affected already at the time of diagnosis and thus demands immediate attention

Muscle strength and physical education: epidemiological studies of factors in adolescence and their association with later morbidity

Although Physical Education (PE) is a part of the school curriculum in many countries, the association between the performance in PE and later morbidity is largely unknown. An important marker of health, cardiorespiratory fitness is inversely associated with future cardiovascular disease (CVD) and mortality. It has been suggested that muscle strength is associated in a similar way. However, whether low muscle strength in youth is a risk factor for CVD independently of cardiorespiratory fitness is not known. In a cohort of men and women, I investigated the association between PE performance in adolescence and morbidity in middle age (paper I and II). In cohorts of adolescent men, I investigated isometric muscle strength as a risk factor for later musculoskeletal pain (paper III), CVD, and mortality (paper IV). In women, low PE performance was associated with having a musculoskeletal diagnosis as well as with increased sick leave and increased number of physician visits. Men with low muscle strength did not have an increased risk for musculoskeletal pain but an increased risk of ischemic CVD as well as middle age CVD mortality. Notably, the associations were independent of cardiorespiratory fitness. In summary, I conclude the following 1) Adolescent girls with low PE performance could be important to target with early interventions to reduce future musculoskeletal illness and health impairment. 2) General isometric muscle strength in youth is not a risk factor for adult musculoskeletal pain in men. 3) The role of muscle strength in the development of CVD warrants further attention

Organisational Policy and Shop-floor Requests in Design: Visualisation of the Argumentation behind an Information System for the Swedish Trade Union Movement

Design Rationale is an approach to the design of information systems which highlights the underlying argumentative reasoning and documentation of design decisions. The Argumentative Design (ArD) method extends Design Rationale to address organisational problem identification and the formulation of needs to be supported by the system. In this study, ArD was further modified and then applied in the early phase of the design of an information system for shop stewards in the Swedish trade union movement. The application of ArD revealed that both similarities and significant discrepancies existed between top-management information technology strategies and shop-floor needs, and that the strategies involve fundamental power-relation issues in terms of centralisation versus decentralisation and individualism versus collectivism. It is suggested that ArD can be of general benefit in early design phases by eliciting fundamental organisational issues and by illustrating what impact chosen information technology solutions may have on organisations. The study is of value for other unions wishing to learn from the Swedish experience and the modified ArD approach can also be used in other contexts where several interest groups are to be satisfied by a system

The hopes of West African refugees during resettlement in northern Sweden: a 6-year prospective qualitative study of pathways and agency thoughts

<p>Abstract</p> <p>Background</p> <p>Little is known about how positive phenomena can support resettlement of refugees in a new country. The aim of this study was to examine the hopeful thinking in a group of West African quota refugees at arrival and after 6 years in Sweden and compare these thoughts to the views of resettlement support professionals.</p> <p>Method</p> <p>The primary study population comprised 56 adult refugees and 13 resettlement professionals. Qualitative data were collected from the refugees by questionnaires on arrival and 6 years later. Data were collected from the resettlement professionals by interview about 3 years after arrival of the refugees. Snyder's cognitive model of hope was used to inform the comparative data analyses.</p> <p>Results</p> <p>Hopes regarding education were in focus for the refugees shortly after arrival, but thoughts on family reunion were central later in the resettlement process. During the later stages of the resettlement process, the unresponsiveness of the support organization to the family reunion problem became as issue for the refugees. The professionals reported a complex mix of "silent agency thoughts" underlying the local resettlement process as a contributing reason for this unresponsiveness.</p> <p>Conclusion</p> <p>Hopes regarding education and family reunion were central in the resettlement of West African refugees in Sweden. These thoughts were not systematically followed up by the support organization; possibly the resources for refugees were not fully released. More studies are needed to further investigate the motivational factors underpinning host community support of refugees' hopes and plans.</p

Editorial: Prevention of Abuse and Harassment in Athletics and Sports

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Family-based behavioural intervention programme for obese children: a feasibility study

OBJECTIVES: To assess a 2-year family-based behavioural intervention programme against child obesity. DESIGN: Single-group pre- and post-intervention feasibility study. SETTING: Swedish paediatric outpatient care. PARTICIPANTS: 26 obese children aged 8.3-12.0 years and their parents who had consented to actively participate in a 2-year intervention. INTERVENTIONS: 25 paediatric outpatient group sessions over a 2-year period with parallel groups for children and parents. The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was change in standardised body mass index between baseline and after 36 months. The secondary outcome measures were change in the waist:height ratio, metabolic parameters and programme adherence. The participants were examined at baseline and after 3, 12 and 24 months of therapy and at follow-up 12 months after completion of the programme. RESULTS: The primary outcome measure, standardised body mass index, declined from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) (p&lt;0.001) at follow-up 12 months after completion of the programme. There was no change in the waist:height ratio. Biomedical markers of blood glucose metabolism and lipid status remained in the normal range. 96% of the families completed the programme. CONCLUSIONS: This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence. These findings must be confirmed in a randomised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale

A High-Precision Protocol for Identification of Preschool Children at Risk for Persisting Obesity

BACKGROUND:Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. METHODOLOGY/PRINCIPAL FINDINGS:We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a Swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls. The sensitivity was higher for girls (41%) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% CI 24.5 to 589.9) for boys. CONCLUSION/SIGNIFICANCE:A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sensitivity was low especially for boys. Implementation and further evaluations of the protocol in child health centre settings are warranted

Повышение качества профессионального фармацевтического образования

ОБРАЗОВАНИЕ ФАРМАЦЕВТИЧЕСКОЕКАЧЕСТВО ОБРАЗОВАНИЯЗДРАВООХРАНЕНИЕ, ПРИОРИТЕТЫПОВЫШЕНИЕ КАЧЕСТВА ОБРАЗОВАНИЯОБРАЗОВАТЕЛЬНЫЙ ПРОЦЕССФАРМАЦИЯ /КАДРЫОБРАЗОВАТЕЛЬНЫЕ ТЕХНОЛОГИ

Organizational approaches to the forming of strategic partnership of enterprises of region

Систематизовано організаційні підходи до формування стратегічного партнерства підприємств, що існують у вітчизняній та зарубіжній науковій літературі. Виділено цільовий, або проблемно-орієнтовний, підхід, первинним етапом якого є встановлення стратегічних цілей; ресурсно-компетенційний підхід, який засновано на визначенні наявних ресурсів та компетенцій підприємств – потенційних партнерів, та проектний підхід, згідно з яким формування стратегічного партнерства підприємств пов’язано з реалізацією сукупності проектів. Обґрунтовано функціональний, або структурний, підхід, що передбачає включення у партнерство підприємств тих галузей, які є ключовими та які визначають спеціалізацію регіону. Використання запропонованого підходу забезпечить комплексний соціально-економічний розвиток господарства регіону.Organizational approaches to forming of strategic partnership of enterprises which exist in domestic and foreign scientific literature are systematized. Target, or problem-orientated, approach the primary stage of which is establishment of strategic aims; resource-competent approach which is based on determination of present resources and jurisdictions of enterprises – potential partners, and project approach, according to which the forming of strategic partnership of enterprises is related with the realization of complex of projects are selected. Functional, or structural, approach, which foresees plugging in partnership of enterprises of those industries which are key and which determine specialization of region is grounded. Offered approach has the followings stages: determination of regional type and basic industries of industrial production, successful development of which will become the key factor of regional economic development; formulation of strategic aims of enterprises of priority industries according to norms and normative correlations, set the most perfect technologies, by organization of production on the whole and separate subsystems of enterprises which are utilized in the proper industries in Ukraine and world; estimation by the enterprises of present and necessary resources and jurisdictions, determination of potential partners after the criterion of presence of necessary resources and jurisdictions and choice of enterprises – potential partners, clarification of strategic and operative aims of strategic partnership that formalize the relations of enterprises-partners. The use of this approach will provide complex socio-economic development of economy of region