Healthcare when the bets are off : symptoms, trajectories and treatment of individuals with gambling disorder

Gambling Disorder is a debilitating condition associated with several adverse outcomes. Despite available treatment, most of those suffering never seek help and those that do often present a complex clinical picture with a long duration of gambling problems and additional psychiatric disorders. Currently, there are several gaps in knowledge about this patient population, the care provided within addiction services, and the long-term consequences for these individuals in terms of functionality and work life. The current thesis, therefore, aims to address some of these gaps, with the goal of increasing knowledge about the patient group and improving treatments. In addition, when disseminating scientifically evaluated treatment to clinical practice, the problem gambling counselor plays an important role. What treatments are actually offered, by whom, and the role of the counselor has not previously been explored. Moreover, factors contributing to the development and maintenance of GD have been proposed and deserve further investigation; gambling cravings and difficulties in emotion regulation. Therefore, the overall aim of this thesis is to map the harms of GD, the treatment available and the characteristics of those delivering it, and track changes in gambling during the Covid-19 pandemic. Furthermore, the thesis aims to explore individual factors contributing to maintaining the disorder, i.e., craving and difficulties in emotion regulation. Study I is a case-cohort study using merged national registries to investigate GD’s association with work disability and trajectory groups in a longitudinal design over a sixyear period. The results showed that GD is associated with an increased risk of work disability over a four-year period, starting the year before diagnosis and peaking at the time of diagnosis (AOR = 1.89, 95% CIs = 1.67-2.13). The risk was unevenly distributed: females, those with psychiatric comorbidities or having medicated for psychiatric symptoms, and older individuals were at higher risk of work disability. The results add knowledge to what social and financial harms are associated with GD. Study II maps available treatment in a cross-sectional study surveying practicing PG counselors. This study found that CBT and MI are the most frequently offered treatments and that treating more clients monthly is associated with higher adequacy (OR = 1.49, 95% CIs = 1.12 -1.95), legitimacy (OR = 1.38, 95% CIs = 1.08 – 1.75), and willingness (OR = 1.95, 95% CIs = 1.49-2.61 in their role as PG counselors. Standard CBT techniques and addressing motivation were rated as the most important to include in treatment. Notable, most PG counselors (>70%) saw fewer than two clients monthly with PG. Study III is a qualitative study applying thematic analysis to interviews of individuals with GD or alcohol use disorder, all with recent experiences of craving, and exploring content and modes of thought when craving. Participants described their cravings as dominated by mental imagery often involving positive content of anticipation, carrying out the addictive behavior or expected outcomes. Craving for alcohol was more related to seeking relief and craving for gambling to gain financial assets. Study IV evaluated the feasibility of a transdiagnostic intervention, emotion regulation-enhanced CBT, among treatment seekers in addiction care using a mixed methods design. Participants improved on gambling outcomes: a decrease in symptoms of GD from a pretreatment mean of 7.0 to 2.1 at 12 months follow-up and a reduction in gambling expenditure and comorbid symptoms of depression and anxiety. In addition, participants rated the treatment high in acceptance and credibility, and interviews indicated that individual tailoring and prolongation as potential improvements. Adding emotion regulation to the treatment of GD is feasible and deserves further investigation. Study V investigated changes in gambling behavior during the Covid-19 pandemic in a cohort recruited from social media and a gambling helpline. We did not find associations between pandemic restrictions and increased problem gambling, worries about mental health due to the pandemic (OR = 2.85, p < 0.001), and initiating high-risk gambling formats (OR = 7.44, p < 0.001), such as online casino, were associated with PG. We did not observe any significant migrations between gambling formats despite the change in availability during the initial phase of the pandemic. In conclusion, the findings demonstrate that GD is associated with an elevated risk of work disability, CBT and MI are treatments available, but PG counselors seem to lack important clinical practice; cravings are often experienced as mental imagery of anticipation, and emotion regulation could be added to the clinical toolbox in the treatment for GD and deserves further investigation. In addition, Swedish pandemic restrictions did not seem to have been linked to increased gambling, but those initiating a high-risk gambling format or being worried about their mental health during the pandemic were more likely to develop PG

Haemophilus influenzae – typing, epidemiology and beta-lactam resistance

Haemophilus influenzae is a common cause of respiratory tract infections such as acute otitis media (AOM), exacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia. The species is subdivided into encapsulated and non-encapsulated strains, designated type a-f and nontypeable H. influenzae (NTHi), respectively. Prior to introduction of polysaccharide-protein conjugate vaccines against H. influenzae type b (Hib) in childhood vaccination programmes this serotype frequently caused severe invasive infections in small children. Nowadays invasive disease by Hib is rare, but cases still occur. At present, NTHi is the dominating type to cause invasive disease and invasive NTHi disease appears to be increasing. Nontypeable H. influenzae disease severity traditionally has been considered largely host dependant. In parallel, non-beta-lactamase mediated beta-lactam resistance among NTHi is also increasing. In the first two studies of this thesis, we investigated capsule typing of H. influenzae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), a technology routinely used for bacterial species identification. Mass spectra of the different types of encapsulated H. influenzae were highly similar within each type and separable from each other. The differences in mass spectra relied on the clonal population structure of encapsulated H. influenzae, with conserved type specific genetic lineages. Mass spectra of NTHi were diverse, due to their genetic heterogeneity. Following construction of a comprehensive reference database, MALDI-TOF MS showed high accuracy for capsule typing of H. influenzae. In the third study of the thesis, a clonal group of NTHi with resistance against beta-lactam antibiotics was investigated. The clonal group accounted for one quarter of clinical respiratory H. influenzae isolates with non-beta-lactamase mediated beta-lactam resistance in the study region. Furthermore, patients infected by isolates of the clonal group had an increased risk of hospitalization compared to patients infected by other NTHi, indicating enhanced virulence traits. The clonal group was also found among invasive isolates. In the final study of the thesis we retrospectively compared benzylpenicillin, whose effect on H. influenzae is debated, to wide spectrum beta-lactams (WSBLs) as empirical treatment of H. influenzae lower respiratory tract infections in patients requiring hospitalization. Empirical treatment with benzylpenicllin was not associated with higher mortality or increased risk of hospital readmission compared to treatment with WSBLs. The early clinical response rate was, however, lower for patients receiving benzylpenicillin, which was attributed mainly to a lower response rate in patients infected with beta-lactamase producing isolates. In conclusion this thesis shows that MALDI-TOF MS can be efficiently used for rapid capsule typing of H. influenzae. The newly developed method can be valuable for typing of invasive H. influenzae isolates and for surveillance of Hib vaccination efficacy. The studied clonal group appears to harbour enhanced virulence traits. This indicates that bacterial factors may affect NTHi disease severity more than previously considered, and possibly contribute to the increased incidence of invasive NTHi disease. Finally, although the effect of benzylpenicillin on H. influenzae is debated, empirical treatment of lower respiratory tract infections of mild to moderate severity caused by H. influenzae with the agent appears saf

viktor månsspn's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Konkurrensen inom banksektorn : - en kvalitativ studie om bankkunders upplevelser av ett bankbyte

Despite that the Swedish banking sector consists of many different actors, which provides more options for consumers in their choice of bank, the four major banks, Nordea, Swedbank, Handelsbanken and SEB, have a superior position in the banking sector. Although previous research shows that consumers lose confidence in the four major banks, there is still low consumer mobility in the banking sector. A change of bank is often described as a complicated process that takes a lot of time, which discourages consumers from implementing the change. This is a qualitative study of how bank customers experienced the change of bank. The purpose of this study is to gain a further understanding of how bank customers experience a bank change and what switching costs they experienced. The study is conducted with a deductive approach where previous research forms the basis for the interview questions used to collect data. A compilation of three well-known and widely used references about switching costs has formed the basis for the interviews questions. Ten semi-structured interviews were conducted with respondents who have changed banks in the past year. After the interviews have been presented, these are analyzed and the results of the study show that the respondents have experienced the change of bank as smoothly. The study concludes with a discussion about how customer mobility in the Swedish banking sector may increase.Trots att den svenska banksektorn består av många olika aktörer vilket ger flera alternativ för konsumenterna i deras val av bank har de fyra storbankerna, Nordea, Swedbank, Handelsbanken och SEB, en överlägsen position inom banksektorn. Fastän undersökningar visar att konsumenterna tappar förtroende för storbankerna är det fortsatt låg bytesintensitet inom banksektorn. Ett byte av bank beskrivs ofta som en krånglig process som tar lång tid vilket avskräcker konsumenterna att genomföra bytet. Detta är en kvalitativ studie om hur bankkunder som genomfört ett bankbyte upplevt det. Syftet med denna studie är att få en mer djupgående förståelse för hur svenska bankkunder upplever ett bankbyte och vilka byteskostnader som upplevts vid bytet av bank. Studien utförs med ett deduktivt tillvägagångssätt där tidigare forskning utgör grunden för intervjufrågorna som används för att samla in data. En sammanställning av tre välkända och allmänt använda referenser om byteskostnader har utgjort grunden för intervjufrågorna. Tio semistrukturerade intervjuer har genomförts med respondenter som har bytt bank under det senaste året. Efter att intervjuerna presenteras analyseras empirin och studiens resultat visar att bankkunderna har upplevt bankbytet som smidigt. Studien avslutas med en diskussion angående hur kundrörligheten inom banksektorn kan tänkas öka

Employer Branding : Nyckeln till att få anställda att stanna i en provisionsbaserad bransch?

Employer Branding, EB, är ett koncept inom marknadsföring som syftar till ett företags marknadsföring gentemot anställda. Konceptet grundar sig i att organisationer genom EB kan skapa ett attraktivt varumärke gentemot anställda för att sedan få dem att identifiera sig med det. EB syftar även till att skapa en trivsam organisationskultur. Detta ska resultera i att de anställda känner lojalitet gentemot företaget och därmed tenderar att stanna längre inom företaget. Tillämpning av detta koncept har i tidigare forskning visat sig gynnsamt då resultaten visar att anställda får en tillhörighet till och fortsätter att arbeta inom företaget. Tidigare forskning har skett inom yrkesbranscher där anställda har haft en trygg ekonomisk situation, exempelvis inom vården.   Problematiken i denna studie vilar på att det inom en helt provisionsbaserad yrkesbransch är det svårt för nyanställda att anpassa sig vilket ofta leder till att de slutar inom sitt första år i yrket. I denna studie utgörs denna bransch utav fastighetsmäklarbranschen och det fallföretag som studeras är SkandiaMäklarna. Studien syftar till att undersöka hur EB kan skapa tillhörighet och lojalitet gentemot företaget hos de nyanställda, och vad som motiverar dem att stanna kvar inom företaget, detta för att motverka tidiga uppsägningarna. Studien är deduktiv då vi avser att utgå från teorier om EB och motivationsfaktorer. För att få en djupare förståelse kring problematiken med att nyanställda slutar har det empiriska materialet samlats in via kvalitativa semistrukturerade intervjuer som genomförts med mäklare på olika kontor inom SkandiaMäklarna. Även personal från huvudkontoret har intervjuats för att få ett djupare perspektiv av problematiken.   Den slutsats som presenteras i denna studie beskriver att de faktorer som får en nyanställd som arbetar inom ett provisionsbaserat yrke att stanna kvar på sitt jobb är om denne känner sig trygg på arbetsplatsen samt känner en gemenskap med de andra inom företaget. Vidare drar vi slutsatsen att företag som tar trygghet och gemenskap i akt när de etablerar sin EB också skapar förutsättning för att öka antalet nyanställda som stannar hos företaget. I vår studie kommer vi också fram till att alla delar i skapandet av ett EB inte är lika viktiga. Utifrån vår slutsats kan vi även se att det för företag är viktigt att fokusera på vad målgruppen (de nyanställda) efterfrågar när det kommer till trygghet och gemenskap, samt att det är viktigt att besvara denna efterfrågan och att resultatet senare genomsyrar hela organisationen.

Modern sponsoring in Swedish sport clubs : A qualitative study in how to organize effective sponsoring

Syfte och frågeställningar Syftet med studien var att undersöka hur man kan arbeta effektivt med sponsring i en idrottsorganisation. Det centrala i vår studie är att hitta nyckelfaktorer för hur idrottsorganisationer kan organisera sitt arbete med sponsring. • Hur organiserar man en idrottsförening för att kunna arbeta effektivt med sponsring? • Vilken arbetsform är bäst lämpad för sponsring i svenska idrottsföreningar? • Vilka kunskaper krävs för att maximera nyttan av sponsring inom svenska idrottsföreningar? • Vilken sponsringsform är bäst lämpad för svenska idrottsföreningar? • Hur går man tillväga för att skapa och upprätthålla en framgångsrik kontakt mellan sponsor och idrottsförening? Metod Vi har i vår studie använt oss av en metoden Grundad Teori, som är lämplig för att finna ny kunskap. Vår studie är av kvalitativ art. Vi har baserat studien på intervjuer med sju personer som arbetar med sponsring på företag och inom idrottsvärlden. Förhållandet var fyra från företagsvärden och tre från idrottsvärlden. De data vi erhållit har vi behandlat och kategoriserat in i olika kluster. Genom att göra detta kan vi urskilja mönster som vi för en diskussion kring och drar slutsatser utifrån. Resultat och slutsatser Vi har funnit att sponsringsarbetet med fördel planeras och leds som en egen enhet inom organisationen. Genom att låta de som arbetar med sponsring arbeta parallellt med hela föreningen kan de nå och arbeta på alla nivåer. Ett alternativ för de föreningar som har en omfattande ekonomisk verksamhet är att bilda ett Idrotts AB som kan skapa resurser för arbetet med sponsring. Det har också visat sig att genom att utvärdera resultatet av sponsorsatsningar kan idrottsföreningen ge, förutom en bättre service, återkoppling mot i förväg uppställda mål. Att koppla sin sponsring till ett projekt har en rad fördelar. Studien visar att det är lättare att marknadsföra ett projekt likt en elitsatsning eller en tävling gentemot en förening eller ett förbund. Sponsring är en komplex verksamhet, och för att kunna arbeta med sponsring på ett framgångsrikt sätt och maximera nyttan för både sponsor och idrottsföreningen krävs kunskaper om modern sponsring. Det krävs även kunskaper inom försäljning, ekonomi, juridik och projektledning. Självklart är det mycket begärt att besitta alla dessa kunskaper men för att bedriva sponsringsarbete och kunna skapa en helhet och utnyttja alla de möjligheter som finns inom sponsring krävs en grundläggande förståelse och kunskap inom dessa ämnen.Aim The aim of this study is to investigate how you can work efficiently with sponsoring in Swedish Sport Clubs. Essential in our study is to find key factors to how Swedish Sport Clubs are supposed to organise their work with sponsoring. • How do you organise a sports club to be able to work efficiently with sponsoring? • What type of work procedure is most adequate for Swedish sport clubs? • What knowledge’s does it take to be able to maximize the use of sponsoring activities? • What type of sponsoring procedure is most adequate for Swedish sport clubs? • How do you proceed to create and maintain a successful contact between the sponsor and the sport club? Method We have been using the method Grounded Theory in our study, which is a suitable method for creating new theory. We have based the study on interviews with seven persons four that works with sponsoring in companies and three that work within the sports community. The data that we collected has been processed and categorized in different categories. By doing this have we been able to discern patterns witch we then held a discussion about and drew conclusions from. Result and conclusions We have found that the work with sponsoring preferably is planned and executed as its own unit within the organisation. By letting those that work with sponsoring work parallel with the entire club they can reach and work with all levels. An alternative for those clubs that have an extensive economic activity is to form an Idrotts AB witch can create resources for work with sponsoring. Through evaluating the results of sponsoring it has been shown that sports clubs can give, both a better service and feedback against preset goals. Attaching the sponsoring to a project has an array of benefits. The study shows that it is easier to promote a project like elite commitment versus a club or association. Sponsoring is a complex activity. To be able to work with sponsoring in a successful way and to maximize the use for both the sponsor and the club there is a demand on knowledge’s about modern sponsoring. There is also a demand for knowledge’s in sales, economics, law and project management. Obviously it is to be asking a lot to possess all these knowledge’s but to be able run sponsoring and to create a entity and make use of all the possibilities that sponsoring offers there has to be a fundamental understanding and knowledge in these subjects

Benzylpenicillin versus wide-spectrum beta-lactam antibiotics as empirical treatment of Haemophilus influenzae-associated lower respiratory tract infections in adults; a retrospective propensity score-matched study

There is consensus that definitive therapy for infections with H. influenzae should include antimicrobial agents with clinical breakpoints against the bacterium. In Scandinavia, benzylpenicillin is the recommended empirical treatment for community-acquired pneumonia (CAP) except in very severe cases. However, the effect of benzylpenicillin on H. influenzae infections has been debated. The aim of this study was to compare the outcomes of patients given benzylpenicillin with patients given wide-spectrum beta-lactams (WSBL) as empirical treatment of lower respiratory tract H. influenzae infections requiring hospital care. We identified 481 adults hospitalized with lower respiratory tract infection by H. influenzae, bacteremic and non-bacteremic. Overall, 30-day mortality was 9% (42/481). Thirty-day mortality, 30-day readmission rates, and early clinical response rates were compared in patients receiving benzylpenicillin (n = 199) and a WSBL (n = 213) as empirical monotherapy. After adjusting for potential confounders, empirical benzylpenicillin treatment was not associated with higher 30-day mortality neither in a multivariate logistic regression (aOR 2.03 for WSBL compared to benzylpenicillin, 95% CI 0.91–4.50, p = 0.082), nor in a propensity score-matched analysis (aOR 2.14, 95% CI 0.93–4.92, p = 0.075). Readmission rates did not significantly differ between the study groups, but early clinical response rates were significantly higher in the WSBL group (aOR 2.28, 95% CI 1.21–4.31, p = 0.011), albeit still high in both groups (84 vs 81%). In conclusion, despite early clinical response rates being slightly lower for benzylpenicillin compared to WSBL, we found no support for increased mortality or readmission rates in patients empirically treated with benzylpenicillin for lower respiratory tract infections by H. influenzae

Treatment for problem gambling and counselors' perception of their clinical competence : A national web survey in Sweden

Background Despite their crucial role in bridging science and practice, not much is known about counselors offering treatment for Problem Gambling (PG). This study maps current treatment, the type of change techniques that are prioritized in treatment and how counselors perceive their clinical competence in their work with PG clients. Methods A sample of PG counselors from the healthcare and social services (N = 188, mean age: 49 years, 67% women) completed an online survey. A principal component analysis was conducted to map prioritized types of change techniques, and a multiple regression analysis was carried out to analyze predictors of counselors’ role adequacy in their clinical work. Results There was a large variation in the type of treatments offered for PG (mean 3.6). Cognitive Behavioral Therapy (CBT) and Motivational Interviewing were the most common treatments offered and motivation was rated as the most important type of change technique prioritized in the treatment of PG. A principal component analysis identified four components reflecting different types of change techniques prioritized by the counselors: (1) standard CBT, e.g., gambling cognitions, craving management, and finding alternative activities, (2) assessment of PG, (3) family orientation, i.e., involvement of concerned significant others in treatment, and (4) focus on exposure strategies. Counseling more clients monthly was associated with higher levels of willingness, adequacy and legitimacy in their clinical work with clients with PG. Additionally, offering CBT was a predictor for higher role adequacy and providing counseling on the origins of and consequences of PG. Conclusion There was a large heterogeneity among the treatments offered and what change techniques that were prioritized among the PG counselors. Clinical experience is of importance for developing competence in treating clients with PG. This finding suggests there could be benefits to establishing specialized, more visible treatment units where PG counselors could gain adequate clinical experience, thus increasing clinical competence for treating PG

The usefulness of appetite and energy intake-based algorithms to assess treatment effect of a bacterial infection : An observational prospective study

Background: The diagnosis of infectious diseases and the duration of antibiotic therapies are generally based on empirical rules. Studies implicate that the use biological markers can be used as a reliable method to shorten antibiotic therapies. The return of appetite is a clinical aspect of recovery from an infection that may be used to guide antibiotic therapies. Objective: To compare changes in appetite and daily energy intake with changes in CRP-levels in patients recovering from an infection. Design: Observational study using a consecutive sample of patients admitted to the unit for infectious diseases at a University Hospital in Sweden, February to April 2014. Energy intake, CRP-levels and appetite were recorded daily. Energy intake was calculated using estimated energy contents. Appetite was measured using a validated visual analogue scale. Changes in daily energy intakes, CRP-levels and appetite were analysed. Results: 49 patients (51% men) were included in the analysis from the overall population of 256 patients. During the length of the stay (median 3 days) CRP-levels fell in 92% of the patients (p<0.001), daily energy intake increased in 73% (median intake +6381 kJ/day, p<0.001) and appetite increased in 55% of the patients (p = 0.181). VAS-estimations of appetite augmented in 55%, decreased in 41% and were equal in 5% of the patients (p = 0.181). There was a non-significant difference in the within-subject variances in daily energy intake between female and male patients but not in other subsets. Conclusions: We found a significantly increase in the daily energy intake but not in self-estimated appetite in patients recovering from an infection. We suggest measuring the daily energy intake as a complement to other biological and clinical markers among inpatients to assess treatment effect

Identification of Haemophilus influenzae type b isolates by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry

Haemophilus influenzae type b (Hib) is, in contrast to non-b H. influenzae, associated with severe invasive disease such as meningitis and epiglottitis in small children. To date accurate H. influenzae capsule typing requires PCR, a time-consuming and cumbersome method. MALDI-TOF MS provides rapid bacterial diagnostics and is increasingly used in clinical microbiology laboratories. Here MALDI-TOF MS was evaluated as a novel approach to separate Hib from other H. influenzae. PCR-verified Hib and non-Hib reference isolates were selected based on genetic and spectral characteristics. Mass spectra of reference isolates were acquired, and used to generate different classification algorithms for Hib/non-Hib separation using both ClinProTools and MALDI Biotyper software. A test series of mass spectra from 33 Hib and 77 non-Hib isolates, all characterized by PCR, was used to evaluate the algorithms. Several algorithms yielded good results but the two best were a ClinProTools model based on 22 separating peaks and a subtyping main spectra (MSP) model using MALDI Biotyper. The ClinProTools model had a sensitivity of 100%, a specificity of 99% and the results were 98% reproducible using a different MALDI-TOF MS instrument. The Biotyper subtyping MSPs had a sensitivity of 97%, a specificity of 100% and 93% reproducibility. Our results suggest that it is possible to use MALDI-TOF MS to differentiate Hib from other H. influenzae. This is a promising method to rapidly identify Hib in unvaccinated populations, and for screening or surveillance of Hib carriage in vaccinated populations