Bakgrund: Den globala befolkningen blir allt äldre. Det är även vanligt hos äldre människor att känna ensamhet, vilket kan leda till fysisk ohälsa och lidande. Eftersom sjuksköterskan ska motverka ohälsa och främja hälsa är det av stor vikt att ha kunskap om hur ensamhet i denna ökande befolkningsgrupp kan minskas.  Syfte: Syftet med litteraturstudien var att kartlägga interventioner som kan motverka ensamhet hos äldre över 60 år som bor hemma.  Metod: Litteratursökningar gjordes i Cinahl, Scopus, PubMed, PsycInfo och MEDLINE. Litteraturstudien består av 9 kvantitativa interventionsstudier som har kvalitetsgranskats, analyserats och sammanställts. Resultat: Resultatet visade på att de studerade interventionerna var väldigt olika och involverade olika komponenter: samtalsgrupper, kognitiva övningar, fysisk aktivitet, sociala aktiviteter och information/rådgivning. Samtliga interventioner som innehöll kognitiva övningar var i denna litteraturstudie effektiva. KBT i kombination med Baduanjin qigong sågs vara effektivare än enbart KBT. Resterande komponenter var delvis effektiva. Konklusion: Lösningen på problematik med ensamhet verkar vara högst komplicerad. Samtliga komponenter kan ha potential att kombinerade vara effektiva i att minska ensamhet. Etablerade mätinstrument bör användas på grund av stigmatisering av fenomenet ensamhet. Mer forskning behövs för att kunna dra säkra slutsatser. / Background: The global population is getting increasingly older. Loneliness is common among elderly people and can lead to suffering and decreased physical health. Nurses should promote well-being, which is why knowledge of how loneliness in this rising population can be reduced is important.  Aim: The aim of this literature study was to compile interventions that can counteract loneliness among elderly over the age of 60 who are living at home. Methods: Searches were made in Cinahl, Scopus, PubMed, PsycInfo and MEDLINE. The literature study consists of 9 quantitative intervention studies that have been reviewed for quality, analyzed and compiled. Results: The outcome shows that the studied interventions were very diverse and consisted of different components: therapy groups, cognitive exercises, physical activity, social activities, and information/counseling. All studies that included cognitive exercises were efficient. CBT combined with Baduanjin qigong was more efficient than exclusively CBT. The remaining components were partially efficient. Conclusion: The solution to the problem of loneliness seems to be complicated. All components have the potential of being efficient when combined. More research is needed in order to draw correct conclusions. Established measuring instruments should be used due to the stigma surrounding loneliness.

Postoperative delirium is a common complication that occurs in elderly patients undergoing surgery with anaesthesia. This condition causes feelings of fear, discomfort and suffering for the patient. The aim with this study was to describe what interventions that can be used to prevent or treat postoperative delirium and what effect they have on the condition. This study is a systematic review with a descriptive design which examines existing research on nursing interventions with the aim of preventing and treating postoperative delirium. The study is based on nine scientific original articles, seven were randomized controlled trials and two were quasi experimental studies. The literature search was made through Cinahl, psycINFO and PubMed. When all studies had been examined the results showed multiple interventions and most of them had a preventive or treating effect on postoperative delirium. The interventions focus on different ways to affect the condition. Some of them are geriatric consultation, music therapy and family as caregivers. Postoperative delirium can be both prevented and treated through different kinds of interventions. This study contributes to expanded knowledge on how the condition can be managed, however further research is needed to provide increased evidence and prove which interventions that can provide the most effective affect on postoperative delirium. / Postoperativt delirium är en vanlig komplikation hos äldre som genomgått någon form av kirurgi under anestesi. Tillståndet innebär rädsla, obehag och lidande för patienten. Syftet med studien är att beskriva vilka omvårdnadsinterventioner som finns för att förebygga och behandla postoperativt delirium samt vilken effekt dessa har. Denna studie är en litteraturöversikt med beskrivande design som undersöker befintlig forskning kring omvårdnadsinterventioner med syfte att förebygga och behandla postoperativt delirium. Studien består av nio vetenskapliga originalartiklar, sju var randomiserade kontrollerade studier och två var kvasiexperimentella studier. Datainsamlingen genomfördes i databaserna Cinahl, psycINFO och PubMed. Efter att samtliga studier granskats framkommer ett resultat med flera olika omvårdnadsinterventioner där majoriteten har förebyggande eller behandlande effekt på postoperativt delirium. De interventioner som resultatet baseras på använder sig av olika sätt som tillståndet kan påverkas av. Några av dessa är geriatrisk konsultation, musikterapi och anhörig som vårdgivare. Postoperativt delirium kan förebyggas och behandlas på olika sätt via omvårdnadsinterventioner. Denna studie kan ge läsaren ökad kunskap om hur tillståndet kan hanteras, dock krävs det ytterligare forskning inom området för att ge ökad evidens och fastställa vilka typer av interventioner som har störst inverkan på postoperativt delirium.

Many adults born with congenital heart disease (CHD) face long-term psychosocial issues related the disease. The purpose of this project was to better understand social workers' experiences with interventions for clients who have CHD and experience psychosocial problems. Bronfenbrenner's ecological theory was a basis for the research questions, which focused on clarifying social workers' experiences with interventions and identifying the ecological levels to which the interventions align. A narrative design with nonprobability sampling was used. Six social workers who counsel adults with CHD from 6 of the 109 U.S. CHD clinics participated in individual interviews. Interviews were transcribed, coded, and categorized using thematic analysis, then analyzed for new information, similarities, and differences. The most significant clinical and nonclinical interventions used by participants were financial assistance, health insurance support, and modalities for treating anxiety and depression. Social workers counseling adult CHD patients may benefit by having information from experienced CHD social workers that they can incorporate into their work with clients. Recommendations include (a) bolstering the number of social workers in private practice who specialize in adults with CHD to address the ongoing mental health needs of this population and (b) encouraging social action and awareness to adjust the guidelines set by government agencies so this population can qualify for better financial, health, and disability benefits. Implementation of these recommendations may have a positive social impact for adults living with CHD.

<p>Phenomena investigated from complex systems are characteristically dynamic, multi-dimensional, and nonlinear. Their traits can be captured through data generating mechanisms (<i>DGM</i>) that explain the interactions among the systems’ components. Measurement is fundamental to advance science, and complexity requires deviation from linear thinking to handle. Simplifying the measurement of complex and heterogeneous data in statistical methodology can compromise their accuracy. In particular, conventional statistical methods make assumptions on the DGM that are rarely met in real world, which can make inference inaccurate. We posit that causal inference for complex systems phenomena requires at least the incorporation of subject-matter knowledge and use of dynamic metrics in statistical methods to improve on its accuracy.</p> <p>This thesis consists of two separate topics on handling data and data generating mechanisms complexities, the evaluation of bundled nutrition interventions and modeling atmospheric data.</p> <p>Firstly, when a public health problem requires multiple ways to address its contributing factors, bundling of the approaches can be cost-effective. Scaling up bundled interventions geographically requires a hierarchical structure in implementation, with central coordination and supervision of multiple sites and staff delivering a bundled intervention. The experimental design to evaluate such an intervention becomes complex to accommodate the multiple intervention components and hierarchical implementation structure. The components of a bundled intervention may impact targeted outcomes additively or synergistically. However, noncompliance and protocol deviation can impede this potential impact, and introduce data complexities. We identify several statistical considerations and recommendations for the implementation and evaluation of bundled interventions. </p> <p>The simple aggregate metrics used in clustering randomized controlled trials do not utilize all available information, and findings are prone to the ecological fallacy problem, in which inference at the aggregate level may not hold at the disaggregate level. Further, implementation heterogeneity impedes statistical power and consequently the accuracy of the inference from conventional comparison with a control arm. The intention-to-treat analysis can be inadequate for bundled interventions. We developed novel process-driven, disaggregated participation metrics to examine the mechanisms of impact of the Agriculture to Nutrition (ATONU) bundled intervention (ClinicalTrials.gov Identifier: NCT03152227). Logistic and beta-logistic hierarchical models were used to characterize these metrics, and generalized mixed models were employed to identify determinants of the study outcome, dietary diversity for women of reproductive age. Mediation analysis was applied to explore the underlying determinants by which the intervention affects the outcome through the process metrics. The determinants of greater participation should be the targets to improve implementation of future bundled interventions.</p> <p>Secondly, observed atmospheric records are often prohibitively short with only one record typically available for study. Classical nonlinear time series models applied to explain the nonlinear DGM exhibit some statistical properties of the phenomena being investigated, but have nothing to do with their physical properties. The data’s complex dependent structure invalidates inference from classical time series models involving strong statistical assumptions rarely met in real atmospheric and climate data. The subsampling method may yield valid statistical inference. Atmospheric records, however, are typically too short to satisfy<i> </i>asymptotic conditions for the method’s validity, which necessitates enhancements of subsampling with the use of approximating models (those sharing statistical properties with the series under study). </p> <p>Gyrostat models (<i>G-models</i>) are physically sound low-order models generated from the governing equations for atmospheric dynamics thus retaining some of their fundamental statistical and physical properties. We have demonstrated statistic that using G-models as approximating models in place of traditional time series models results in more precise subsampling confidence intervals with improved coverage probabilities. Future works will explore other types of G-models as approximating models for inference on atmospheric data. We will adopt this technique for inference on phenomena for AstroStatistics and pharmacokinetics. </p>

There have been many studies on teaching behavior analytic skills to parents for addressing problem behavior exhibited by their children. However, very few studies have addressed the issue of teaching parents to conduct a functional assessment and design a treatment for the problem behavior. The present study utilized behavioral skills training to teach parents how to conduct ABC recording, write a summary statement based on the data collected, and determine the proper treatment choices. The 8 participants participated in one 3 hour class in which a trainer used instructions, modeling, rehearsal, and feedback to teach these three skill sets. Prior to class, during class, directly after class training, and 1 to 2 weeks following class, the participants viewed at least four videos with each showing a problem behavior serving a different function in the context of a parent child interaction. The percentage of correct responding for each dependent variable (ABC recording, summary statement, and treatment choices) was calculated and baseline and post-treatment scores were compared via a multiple baseline across participants design. The results showed an increase in the percentage correct for most skills for most participants. These results show that it is possible to teach parents to conduct a functional assessment and chose proper treatment strategies. Future implications in parent training are discussed.

Physical activity among children and adolescents around the world is decreasing and will imply negative effects on their current and future health, which also contributes to higher costs for the society. Interventions promoting physical activity among youths could increase their physical activity and, at the same time, reduce the costs for society. The purpose of this study is to evaluate interventions for increased physical activity targeted towards children and adolescents from a health economic perspective. The results indicate that there exist different types of interventions and that the choice of health economic evaluation method differs widely between studies. In order for policymakers to choose the most effective interventions that allocate the society’s scarce resources in the best way, there is a need for a more streamlined methodological approach for health economic evaluations of the interventions that promote psychical activity among children and adolescents. / Fysisk aktivitet minskar bland barn och ungdomar runt om i världen och kan medföra negativa effekter på deras nuvarande och kommande hälsa, vilket också bidrar till högre kostnader för samhället. En intervention som främjar fysisk aktivitet bland barn och ungdomar, kan öka den fysiska aktiviteten och samtidigt minska samhällets kostnader. Syftet med denna studie är att utvärdera interventioner som främjar fysisk aktivitet riktad mot barn och ungdomar ur ett hälsoekonomiskt perspektiv. Resultaten indikerar att det finns olika typer av interventioner och att valet av hälsoekonomisk utvärdering skiljer sig mellan interventioner. För att beslutsfattare ska kunna välja de mest effektiva interventioner som fördelar samhällets knappa resurser på bästa sätt finns det ett behov av gemensamma tillvägagångssätt i hälsoekonomiska utvärderingar på interventioner som främjar psykisk aktivitet bland barn och ungdomar.

Aim: The purpose of this study is to describe the intervention process at a psychiatric clinic in Vietnam, from evaluation to goal setting, and how the staff choose occupation-based intervention for their patients. Method: This study is a qualitative study with inductive approach where the data collection is based on a semi-structured interview with the health care staff at a psychiatric clinic in Vietnam. The respondents consisted of a total of ten participants and were required by a purposive sample. Content analysis according to Kristensson (2014) was used to examine the data. Result: The findings from the result revealed that the clinic work without a standard procedure where the staff evaluates and assess their patient from their own experience. They also interview and observe the patients without an aim. The result also showed that the clinic offers different occupation-based interventions where the doctor decides occupation-training but not in consultation with the patient. It was revealed that the purpose of the occupation is to make the patients independent. The last finding was that the staff has a lack of individual goal setting and the general goal is for patients to get healthy. To see if the patients achieve improvement, observations are made without aim. Conclusion: The study concludes that the health care staff at the clinic has found their strategies using their own experience, for evaluating and assessing their patients.

Evidence-based practices in the field of special education within the United States has been well defined in the literature yet challenges persist with the widespread implementation of these practices within school settings. There are many factors that can negatively influence the portability of these practices in classroom settings that remain unaddressed in the literature. The results of a qualitative evaluation aimed at determining teacher’s perspectives on barriers to implementing evidence-based procedures in the area of positive behavioral interventions and supports (PBIS) are described. Data analysis revealed several highly pertinent barriers that teachers face in their attempts to implement evidence-based practices in the classroom. Recommendations for minimizing these implementation barriers are discussed.

Social Validity is a concept used in behavioral intervention research. It focuses on whether the goals of treatment, the intervention techniques used, and the outcomes achieved are acceptable, relevant, and useful to the individual in treatment. The Social Validity Manual, 2e, provides background on the development of social validity, an overview of current research in social validity, and guidelines for expanding the practice of social validation. The book offers detailed information on scales and methods for measuring social validity across the goals, procedures, and effects of treatments utilized in various fields. The second edition incorporates advances in research findings and offers two new chapters on the use of social validity in the health sciences and how social validity plays an important role in increasing cultural awareness.

Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.