Risk assessments of hand-intensive and repetitive work are commonly done using observational methods, and it is important that the methods are reliable and valid. However, comparisons of the reliability and validity of methods are hampered by differences in studies, e.g., regarding the background and competence of the observers, the complexity of the observed work tasks and the statistical methodology. The purpose of the present study was to evaluate six risk assessment methods, concerning inter- and intra-observer reliability and concurrent validity, using the same methodological design and statistical parameters in the analyses. Twelve experienced ergonomists were recruited to perform risk assessments of ten video-recorded work tasks twice, and consensus assessments for the concurrent validity were carried out by three experts. All methods' total-risk linearly weighted kappa values for inter-observer reliability (when all tasks were set to the same duration) were lower than 0.5 (0.15-0.45). Moreover, the concurrent validity values were in the same range with regards to total-risk linearly weighted kappa (0.31-0.54). Although these levels are often considered as being fair to substantial, they denote agreements lower than 50% when the expected agreement by chance has been compensated for. Hence, the risk of misclassification is substantial. The intra-observer reliability was only somewhat higher (0.16-0.58). Regarding the methods ART (Assessment of repetitive tasks of the upper limbs) and HARM (Hand Arm Risk Assessment Method), it is worth noting that the work task duration has a high impact in the risk level calculation, which needs to be taken into account in studies of reliability. This study indicates that when experienced ergonomists use systematic methods, the reliability is low. As seen in other studies, especially assessments of hand/wrist postures were difficult to rate. In light of these results, complementing observational risk assessments with technical methods should be considered, especially when evaluating the effects of ergonomic interventions.
Hand , Upper Extremity , Reproducibility of Results , Risk Assessment/methods , Ergonomics/methods
Purpose: To explore and describe a trained communication partner's use of responsive strategies in dyadic interaction with adults with Rett syndrome. Introduction: Responsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other's focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the partner's use of responsive strategies. Materials and methods: A therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale (RAACS) was used to assess the partner's responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual's communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when (a) the participants used the gaze-controlled device and (b) the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants. Results: Inter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner's use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner's number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device. Conclusion: The communication partner's use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not.
Restoration skills training (ReST) is a mindfulness-based course in which participants draw support from a natural practice setting while they learn to meditate. Well-established conventional mindfulness training (CMT) can improve psychological functioning but many perceive it as demanding and fail to sustain practice habits. Applying non-inferiority logic, previous research indicated that ReST overcomes compliance problems without compromising the benefits gained over 5 weeks' training. This article applies similar logic in a 6-month follow-up. Of 97 contacted ReST and CMT course completers, 68 responded and 29 were included with multiple imputation data. The online survey included questions about their psychological functioning in three domains (dispositional mindfulness, cognitive lapses, and perceived stress) and the forms and frequencies with which they had continued to practice mindfulness after the course. Former ReST participants continued, on average, to show higher dispositional mindfulness and fewer cognitive lapses compared to pre-course ratings. Improved psychological functioning in one or more domains was demonstrated by 35%, as determined by a reliable change index. Again, analyses detected no indications of any substantive disadvantages compared to the more demanding, established CMT approach. Compared to the CMT group, more ReST participants had also continued to practice at least occasionally (92 vs. 67%). Continued practice was linked to sustained improvements for ReST but not clearly so for CMT. ReST participants thus continued to use the skills and sustained the improvements in psychological functioning that they had gained in the course, further supporting the utility of ReST as a health intervention.
BACKGROUND: Work-life balance (WLB) is the extent to which individual's multiple life roles and demands carry over between each role. WLB can be divided into work interference with personal life (WIPL) and personal life interference with work (PLIW). This study aimed to investigate longitudinal associations between WIPL, PLIW and work ability outcomes. METHODS: In this cohort study, 224 employees in the energy and water sector in Sweden were followed-up over 2 years. Three questions derived from the Work Ability Index were used for measuring work ability outcome: current work ability compared with lifetime best; work ability regarding physical; and mental demands. Logistic regression models were used to analyse longitudinal associations between work ability and WIPL and WIPL respectively, controlling for workplace (company), position at work, experience of leadership quality, demographics, and work ability. RESULTS: Work ability compared to lifetime best were associated with WIPL in the adjusted logistic regression models (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.15-2.73), and PLIW (OR 3.34, 95% CI 1.66-6.74). Work ability regarding physical demands was associated with WIPL (OR 1.60, 95% CI 1.07-2.40). Work ability regarding mental demands was associated with WIPL (OR 1.59, 95% CI 1.03-2.44) and PLIW (OR 2.88, 95% CI 1.31-6.32). CONCLUSION: In this two-year longitudinal study, lower WIPL predicted good/excellent overall work ability compared with lifetime best, higher work ability regarding physical and mental demands, and lower PLIW predicted good/excellent overall work ability compared with lifetime best and higher work ability regarding and mental demands.
Work Capacity Evaluation , Work-Life Balance , Cohort Studies , Humans , Longitudinal Studies , Surveys and Questionnaires , Sweden/epidemiology , Water , Workplace
Restoration skills training (ReST) is a mindfulness-based course that draws on restorative nature experience to facilitate the meditation practice and teach widely applicable adaptation skills. Previous studies comparing ReST to conventional mindfulness training (CMT) showed that ReST has important advantages: it supports beginning meditators in connecting with restorative environmental qualities and in meditating with less effort; it restores their attention regulation capabilities; and it helps them complete the course and establish a regular meditation habit. However, mindfulness theory indicates that effortful training may be necessary to achieve generalized improvements in psychological functioning. Therefore, this study tests whether the less effortful and more acceptable ReST approach is attended by any meaningful disadvantage compared to CMT in terms of its effects on central aspects psychological functioning. We analyze data from four rounds of development of the ReST course, in each of which we compared it to a parallel and formally matched CMT course. Randomly assigned participants (total course starters = 152) provided ratings of dispositional mindfulness, cognitive functioning, and chronic stress before and after the 5-week ReST and CMT courses. Round 4 also included a separately recruited passive control condition. ReST and CMT were attended by similar average improvements in the three outcomes, although the effects on chronic stress were inconsistent. Moderate to large improvements in the three outcomes could also be affirmed in contrasts with the passive controls. Using a reliable change index, we saw that over one third of the ReST and CMT participants enjoyed reliably improved psychological functioning. The risk of experiencing deteriorated functioning was no greater with either ReST or CMT than for passive control group participants. None of the contrasts exceeded our stringent criterion for inferiority of ReST compared with CMT. We conclude that ReST is a promising alternative for otherwise healthy people with stress or concentration problems who would be less likely to complete more effortful CMT. By adapting the meditation practices to draw on restorative setting characteristics, ReST can mitigate the demands otherwise incurred in early stages of mindfulness training without compromising the acquisition of widely applicable mindfulness skills.
This was a two-phase study that aimed to (a) develop a tool for assessing visual attention in individuals with Rett syndrome using AAC with a communication partner during naturalistic interactions in clinical settings; and (b) explore aspects of the tool's reliability, validity, and utility. The Assessment of Visual Attention in Interaction (AVAI) tool was developed to assess visual attention operationalized as focused gazes (1 s or longer) at the communication partner, an object, and a symbol set. For the study, six video-recorded interactions with nine female participants diagnosed with Rett syndrome (range: 15-52-years-old) were used to calculate intra- and inter-rater agreement, and 18 recorded interactions were analyzed to examine sensitivity to change and acceptability. There was a significant difference in the AVAI results between two conditions (with and without aided-language modeling). Inter-rater agreement ranged from moderate and strong. There was a range in scores, indicating that the AVAI could differentiate between participants. The AVAI was found to be reliable, able to detect change, and acceptable to the participants. This tool could potentially be used for evaluating interventions that utilize aided AAC.
Attention , Communication Disorders/physiopathology , Fixation, Ocular , Rett Syndrome/physiopathology , Adolescent , Adult , Communication Aids for Disabled , Communication Disorders/rehabilitation , Female , Humans , Interpersonal Relations , Middle Aged , Photic Stimulation , Pilot Projects , Reproducibility of Results , Rett Syndrome/rehabilitation , Young Adult
Mindfulness courses conventionally use effortful, focused meditation to train attention. In contrast, natural settings can effortlessly support state mindfulness and restore depleted attention resources, which could facilitate meditation. We performed two studies that compared conventional training with restoration skills training (ReST) that taught low-effort open monitoring meditation in a garden over five weeks. Assessments before and after meditation on multiple occasions showed that ReST meditation increasingly enhanced attention performance. Conventional meditation enhanced attention initially but increasingly incurred effort, reflected in performance decrements toward the course end. With both courses, attentional improvements generalized in the first weeks of training. Against established accounts, the generalized improvements thus occurred before any effort was incurred by the conventional exercises. We propose that restoration rather than attention training can account for early attentional improvements with meditation. ReST holds promise as an undemanding introduction to mindfulness and as a method to enhance restoration in nature contacts.
Attention/physiology , Meditation , Mindfulness , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Parks, Recreational , Young Adult
Cuprous oxide (Cu2O) is a promising material for large scale photovoltaic applications. The efficiencies of thin film structures are, however, currently lower than those for structures based on Cu2O sheets, possibly due to their poorer transport properties. This study shows that post-deposition rapid thermal annealing (RTA) of Cu2O films is an effective approach for improving carrier transport in films prepared by reactive magnetron sputtering. The as-deposited Cu2O films were poly-crystalline, p-type, with weak near band edge (NBE) emission in photoluminescence spectra, a grain size of ~100 nm and a hole mobility of 2-18 cm2 V-1 s-1. Subsequent RTA (3 min) at a pressure of 50 Pa and temperatures of 600-1000 °C enhanced the NBE by 2-3 orders of magnitude, evidencing improved crystalline quality and reduction of non-radiative carrier recombination. Both grain size and hole mobility were increased considerably upon RTA, reaching values above 1 µm and up to 58 cm2 V-1 s-1, respectively, for films annealed at 900-1000 °C. These films also exhibited a resistivity of ~50-200 Ω cm, a hole concentration of ~1015 cm-3 at room temperature, and a transmittance above 80%.
OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting. DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants. INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes. RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome ( p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment ( p= 0.02), and at the 10-year follow-up ( p=0.03). DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.
Behavior Therapy/methods , Disability Evaluation , Exercise Therapy/methods , Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/rehabilitation , Adult , Aged , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Physical Therapy Modalities , Risk Assessment , Severity of Illness Index , Statistics, Nonparametric , Time Factors , Treatment Outcome
Folates have been used with cytotoxic agents for decades and today they are used in hundreds of thousands of patients annually. Folate metabolism is complex. In the treatment of cancer with 5-fluorouracil, the administration of folates mechanistically leads to the formation of [6R]-5,10-methylene-tetrahydrofolate, and the increased concentration of this molecule leads to stabilization of the ternary complex comprising thymidylate synthase, 2'-deoxy-uridine-5'-monophosphate, and [6R]-5,10-methylene-tetrahydrofolate. The latter is the only natural folate that can bind directly in the ternary complex, with other folates requiring metabolic activation. Modulation of thymidylate synthase activity became central in the study of folate/cytotoxic combinations and, despite wide use, research into the folate component was neglected, leaving important questions unanswered. This article revisits the mechanisms of action of folates and evaluates commercially available folate derivatives in the light of current research. Better genomic insight and availability of new analytical techniques and stable folate compounds may open new avenues of research and therapy, ultimately bringing increased clinical benefit to patients.
Antineoplastic Combined Chemotherapy Protocols/pharmacology , Fluorouracil/pharmacology , Folic Acid/pharmacology , Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Fluorouracil/administration & dosage , Folic Acid/administration & dosage , Humans
PURPOSE: To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. METHODS: A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. RESULTS: The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. CONCLUSIONS: Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].
Communication Aids for Disabled , Communication , Rett Syndrome/rehabilitation , Speech-Language Pathology/statistics & numerical data , Cross-Sectional Studies , Humans , Surveys and Questionnaires , Sweden
BACKGROUND: There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. METHODS: This study included migrants to Sweden since 1960 who were 28-47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. RESULTS: Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. CONCLUSIONS: Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.
Emigrants and Immigrants/statistics & numerical data , Health Status , Hospitalization/statistics & numerical data , Insurance, Disability/statistics & numerical data , Mortality/trends , Registries/statistics & numerical data , Work/statistics & numerical data , Adult , Emigration and Immigration/statistics & numerical data , Female , Follow-Up Studies , Heart Diseases/therapy , Humans , Lung Diseases/therapy , Male , Mental Disorders/therapy , Middle Aged , Musculoskeletal Diseases/therapy , Occupational Diseases/therapy , Risk Factors , Sweden/epidemiology , Time Factors
AIM: The aim of this cost-effectiveness analysis (CEA), performed from a societal perspective, was to compare costs and consequences of an individually tailored oral health educational programme (ITOHEP) based on cognitive behavioural strategies integrated in non-surgical periodontal treatment compared with a standard treatment programme (ST). MATERIAL AND METHODS: A randomized (n = 113), evaluator-blinded, controlled trial, with two different active treatments, was analysed with respect to their costs and consequences 12 months after non-surgical treatment. Costs referred to both treatment costs and costs contributed by the patient. Consequences (outcome) were expressed as the proportion of individuals classified as having reached the pre-set criteria for treatment success after non-surgical treatment ("successful-NSPT"). RESULTS: More individuals in the ITOHEP group reached the pre-set criteria for treatment success than individuals in the ST group did. The CEA revealed an incremental cost-effectiveness of SEK1724 [191.09; SEK9.02 = 1 (January 2007)] per "successful-NSPT" case, of which treatment costs represented SEK1189 (131.82), using the unit cost for a dental hygienist. CONCLUSION: The incremental costs per "successful-NSPT" case can be considered as low and strengthens the suggestion that an ITOHEP integrated into non-surgical periodontal treatment is preferable to a standardized education programme.
Chronic Periodontitis/therapy , Cognitive Behavioral Therapy/economics , Health Behavior , Health Education, Dental/economics , Oral Hygiene/economics , Adult , Aged , Attitude to Health , Chronic Periodontitis/economics , Cost-Benefit Analysis , Dental Devices, Home Care , Dental Hygienists/economics , Dental Plaque/economics , Dental Plaque/therapy , Dental Scaling/methods , Female , Financing, Personal , Follow-Up Studies , Gingival Hemorrhage/economics , Gingival Hemorrhage/therapy , Goals , Health Care Costs , Humans , Male , Middle Aged , Motivation , Periodontal Debridement/methods , Periodontal Pocket/economics , Periodontal Pocket/therapy , Self Care , Single-Blind Method , Treatment Outcome
The purpose of this study was to systematically review the scientific literature and search for indicators of healthy work environments. A number of major national and international databases for scientific publication were searched for research addressing indicators of healthy work environments. Altogether 19,768 publications were found. After excluding duplicates, non-relevant publications, or publications that did not comply with the inclusion criteria 24 peer-reviewed publications remained to be included in this systematic review. Only one study explicitly addressing indicators of healthy work environments was found. That study suggested that the presence of stress management programs in an organization might serve as indicator of a 'good place to work', as these organizations were more likely to offer programs that encouraged employee well-being, safety and skill development than those without stress management programs. The other 23 studies either investigated employee's views of what constitute a healthy workplace or were guidelines for how to create such a workplace. Summarizing, the nine most pronounced factors considered as important for a healthy workplace that emerged from these studies were, in descending order: collaboration/teamwork: growth and development of the individual; recognition; employee involvement; positive, accessible and fair leader; autonomy and empowerment; appropriate staffing; skilled communication; and safe physical work.
Occupational Health , Stress, Psychological/prevention & control , Cooperative Behavior , Humans , Leadership , Power, Psychological , Professional Autonomy , Reinforcement, Social , Workload , Workplace
The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0-10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.
Back Pain/diagnosis , Disability Evaluation , Education, Continuing , Inservice Training , Models, Educational , Physical Therapists/education , Physical Therapy Modalities/education , Referral and Consultation , Adult , Attitude of Health Personnel , Back Pain/psychology , Back Pain/therapy , Clinical Competence , Education, Continuing/standards , Female , Guideline Adherence , Health Behavior , Health Knowledge, Attitudes, Practice , Humans , Inservice Training/standards , Male , Motivation , Physical Therapists/psychology , Physical Therapists/standards , Physical Therapy Modalities/standards , Practice Guidelines as Topic , Predictive Value of Tests , Primary Health Care , Prognosis , Referral and Consultation/standards , Self Efficacy , Sweden , Time Factors
AIM: The aim was to empirically test the extended Theory of Reasoned Action (TRA) and the prospective direct and indirect role of attitudes, beliefs, subjective norms, self-efficacy, and a cognitive behavioural intervention in adult's oral hygiene behaviour and gingival outcomes at 3- and 12-month follow-up. MATERIALS AND METHODS: Data were derived from an RCT evaluating the effectiveness of oral hygiene educational programs integrated in non-surgical periodontal treatment (n = 113). Before baseline examination, participants completed a self-report questionnaire. Structural equation modelling using maximum likelihood estimation with bootstrapping was used to test the direct and indirect (mediated) pathways within the extended TRA model. RESULTS: The extended TRA model explained a large amount of variance in gingival outcome scores at 12 months (56%). A higher level of self-efficacy at baseline was associated with higher frequencies of oral hygiene behaviour at 3 months. Being female was linked to more normative beliefs that, in turn, related to greater behavioural beliefs and self-efficacy. Gender was also related to behavioural beliefs, attitudes and subjective norms. Both frequency of oral hygiene behaviour at 3 months and the cognitive behavioural intervention predicted gingival outcome at 12 months. CONCLUSIONS: The model demonstrated that self-efficacy, gender and a cognitive behavioural intervention were important predictors of oral hygiene behavioural change.
Chronic Periodontitis/prevention & control , Health Behavior , Health Knowledge, Attitudes, Practice , Oral Hygiene/psychology , Self Efficacy , Adult , Aged , Chronic Periodontitis/pathology , Chronic Periodontitis/psychology , Chronic Periodontitis/therapy , Cognitive Behavioral Therapy , Dental Prophylaxis , Female , Follow-Up Studies , Gingiva/pathology , Humans , Likelihood Functions , Male , Middle Aged , Models, Psychological , Patient Education as Topic , Periodontal Index , Prospective Studies , Psychological Theory , Sex Factors , Single-Blind Method , Treatment Outcome
BACKGROUND: Prospective studies on high-risk populations, such as subgroups of health care staff, are limited, especially prospective studies among staff not on sick-leave. This paper is a report of a longitudinal study conducted to describe and compare the importance and consistency of life domains among registered nurses (RNs) working in a Swedish hospital and evaluate a model based on the consistency of valued life domains for prediction of pain, disability and sick leave. METHOD: Importance and consistency ratings of life values, in 9 domains, were collected during 2003 and 2006 from 196 RNs using the Valued Living Questionnaire (VLQ). Logistic regression analyses were used for prediction of pain, disability and sick leave at the three-year follow-up. The predictors family relations, marriage couples/intimate relations, parenting, friends/social life, work, education, leisure time, psychological well-being, and physical self-care were used at baseline. RESULTS: RNs rated life values regarding parenting as most important and with the highest consistency both at baseline and at follow-up. No significant differences were found between RNs' ratings of importance and consistency over the three-year period, except for friends/social relations that revealed a significant decrease in importance at follow-up. The explanatory models for pain, disability and sick leave significantly predicted pain and disability at follow-up. The odds of having pain were significantly increased by one consistency rating (psychological well-being), while the odds were significantly decreased by physical self-care. In the model predicting disability, consistency in psychological well-being and education significantly increased the odds of being disabled, while consistency in physical self-care significantly decreased the odds. CONCLUSION: The results suggest that there might be a link between intra-individual factors reflecting different aspects of appraised life values and musculoskeletal pain (MSP).
Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8) with clinically assessed seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD) participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale), fatigue (fatigue questionnaire), and health-related quality of life (SF-36) were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD.
AIMS: To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles. BACKGROUND: Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions. DESIGN: Explorative cross-sectional multicentre survey. METHODS: The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One-way analysis of variance (anova) or Pearson's chi-square test was used for comparing subgroups. RESULTS: Three distinct subgroups were found and subsequently labelled: (1) low self-efficacy, (2) distraction and depressive symptoms and (3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice. CONCLUSIONS: Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms. RELEVANCE TO CLINICAL PRACTICE: Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient's fluid control, is introduced.
Drinking , Renal Dialysis/nursing , Renal Dialysis/statistics & numerical data , Self Efficacy , Water-Electrolyte Imbalance/prevention & control , Adult , Aged , Aged, 80 and over , Analysis of Variance , Chi-Square Distribution , Cluster Analysis , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Depression/nursing , Female , Hemodialysis Units, Hospital , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Nurse-Patient Relations , Patient Compliance , Renal Dialysis/methods , Renal Dialysis/psychology , Stress, Psychological , Surveys and Questionnaires , Sweden , Weight Gain
BACKGROUND AND AIMS: There is a gap between guidelines and clinical management of risk factors for prolonged disability in back pain. The aims of this study were to (1) evaluate the interrater reliability of a research protocol designed to analyze screening of physical and psychosocial risk factors for prolonged disability in back pain during telephone consultations; and (2) describe the overall content and the nature and extent of physical and psychosocial risk factors assessed by physiotherapists in telephone consultations for diagnostic screening of patients with back pain. METHODS: The material consisted of 17 initial telephone consultations regarding back pain recorded by five physiotherapists. A research protocol covering eight evidence-based risk factors was developed. Three raters performed separate analyses according to the protocol. RESULTS: Intraclass correlation of how many risk factors that were investigated was 0.82 (p < .001.) Kappa values (pairwise) of which risk factors that were screened were 0.79, 0.73, and 0.66 (p < .001). A median of two risk factors were screened in each consultation; most frequent was signs of spinal pathology/radiating pain, followed by sick leave, disability, coping with pain, and negative beliefs. Rating of pain intensity, depression, and expectations of long-term pain were not screened. CONCLUSIONS: The method of analysis appears reliable. It will be used in an intervention study that evaluates to what extent physiotherapists can learn to screen in concordance with guidelines in initial telephone consultations.
Back Pain/diagnosis , Telemedicine , Adult , Back Pain/therapy , Female , Humans , Middle Aged , Observer Variation , Physical Therapy Specialty , Reproducibility of Results , Young Adult
